Natural remedies for osteoarthritis

New ways to beat osteoarthritis pain

Published: May, 2013

Just over the horizon, therapies are being developed to relieve osteoarthritis. But there’s a lot you can do to feel better today.

There’s a 50-50 chance that, at some point in your life, you’ll develop osteoarthritis (OA). Not great odds, considering how much this joint condition can hamper your activity.

The pain and limited mobility in OA occur as the cartilage that cushions the space between bones wears away with age and overuse. Left bare of their padding, bones rub painfully against each other—particularly in the hands, spine, knees, and hips.

For years, treatments have focused on relieving OA symptoms—nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen to control pain, steroid injections to bring down inflammation, and viscosupplements to replace the joint’s natural lubricant. Today, the treatment outlook is changing.

“We’re beginning to understand that osteoarthritis is a disease of the entire joint,” explains Dr. Antonios Aliprantis, director of the Osteoarthritis Center at Harvard-affiliated Brigham and Women’s Hospital. “Much of the research over the last 20 or 30 years has focused on cartilage as the target. But we’re beginning to realize that there are important changes happening in the bone underneath the cartilage, and in the joint lining itself—the synovium. As we begin to understand osteoarthritis as a disease of the entire joint, new treatment targets will emerge.”

Disease-modifying therapies

One of the treatments in development isn’t new at all. It’s an osteoporosis drug called strontium ranelate, which has been used to treat bone loss in Europe; it’s now finding a new purpose for knee OA. “Strontium is thought to inhibit the activity of cells called osteoclasts, which break down bone. How this drug works in OA is not clear, but it might protect bone under the cartilage,” Dr. Aliprantis says.

At the American College of Rheumatology annual meeting in November 2012, researchers presented the results of a three-year study testing strontium ranelate. People with mild-to-moderate OA who took this drug had less narrowing of the joint, indicating a slowing of disease progression. Although the difference in joint narrowing wasn’t huge, it was “encouraging,” Dr. Aliprantis says. Other medications that target changes to the bone under the cartilage may also prove useful.

Stem cells, which are able to transform into many different types of cells, also show potential for treating OA. The hope is that injecting stem cells into damaged joints might help regenerate healthy tissue.

Dr. Aliprantis says that because OA is a localized disease, its ideal treatment would be injected directly into the joint, to avoid the bodywide side effects of current OA drugs.

Established treatments

While it may take time for these new therapies to come to fruition, there are several options women can try to relieve OA pain.

“When I see patients with OA, I try to take a multidisciplinary approach to their care. I might inject their knees with cortisone; I might use viscosupplements; if they’re overweight, I’ll encourage them to lose weight,” Dr. Aliprantis says. “A lot of these little things together can make a big difference.”

Your doctor might recommend one or more of these OA treatments:

  • oral pain medications such as acetaminophen and NSAIDs (ibuprofen, naproxen)

  • topical pain-relieving creams and rubs applied to the skin over the painful joints

  • corticosteroid injections into the affected joints to temporarily relieve pain

  • hyaluronic acid injections (viscosupplements) to replace the fluid that naturally lubricates the joints.

Other ways to relieve joint pain

There are also many simple measures that can help relieve arthritis pain and stiffness:

Heat and cold. Take a warm bath, apply cold compresses, or wrap some frozen vegetables in a towel and hold them to your painful joints. Heat, cold, or alternating the two can be very effective at relieving pain.

Massage. Gently rubbing the joints can increase blood flow to the affected area and ease sore spots. Because arthritic joints can be sensitive, see a massage therapist who specializes in treating people with arthritis.

Glucosamine and chondroitin. Although these nutritional supplements have been “fairly debunked as a potential disease-modifying therapy,” Dr. Aliprantis says, they may improve arthritis pain in some people. However, he points out, “if these supplements are not helping your pain, you should not continue to spend your money on them.”

And don’t forget about exercise—it’s one of the most effective ways to treat OA. Exercise can reduce pain, improve flexibility, strengthen the muscles that support the joints, and help you lose some of the weight that’s straining your joints. “I think it’s pretty clear that exercise is important for maintaining joint health and decreasing pain in patients who have OA,” Dr. Aliprantis says. Swimming and riding a stationary exercise bicycle are good exercises for people with OA, because they don’t put undue stress on already painful joints.

“I think the important thing if you’re embarking on an exercise program is to start slowly and increase slowly, under the watchful eye of a physician or physical therapist, to make sure your muscles are properly balanced,” advises Dr. Aliprantis.

Foods that fight inflammation

No one food can relieve arthritis, but eating—or avoiding—certain foods can help combat inflammation throughout the body.

What to eat

  • Omega-3 fatty acids from cold-water fish, such as salmon and tuna

  • Beans

  • Flaxseeds

  • Walnuts

  • Green leafy vegetables

  • Canola and olive oil

  • Green tea

  • Margarine and butter

What to limit

  • Omega-6 fatty acids from egg yolks and red meat

  • French fries and other fried foods

  • Packaged cookies, crackers,
    baked goods, and other processed, sugary foods

  • Fruit juice

Surgical options

If these treatments don’t work, your doctor might suggest a joint resurfacing or replacement procedure. However, the thought of surgery immediately sends some OA patients into a panic. “Most patients come in thinking, ‘If I need a joint replacement down the road, it’s going to be the end of the world. It’s going to take me months to recover and I won’t be able to care for myself,'” Dr. Aliprantis says.

Women in particular are reluctant to get a damaged joint replaced, “to their detriment,” Dr. Aliprantis says. Instead of fixing the problem, women may just accommodate to their increasingly limited mobility. He says that if your pain is interfering with your daily life, you should discuss a joint replacement with your doctor. “The reality is that when joint replacements are done by an experienced surgeon, most patients do quite well,” he says.

The future of OA treatment

Unlike rheumatoid arthritis, OA hasn’t had any major breakthroughs that have dramatically improved its medical treatment. Drug development for this type of arthritis has been slow because the disease itself follows a slow process. It takes time to track whether a treatment can halt joint damage when that damage occurs so gradually. “Joint replacement surgery has been successful, but medical treatments for OA have been limited,” Dr. Aliprantis says.

Hopefully, strontium or another disease-modifying therapy will prove its merit in future studies. But it could be several more years before any approach revolutionizes the treatment of this condition. “I think we’re just starting to understand OA,” Dr. Aliprantis says.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Treatment and support


Osteoarthritis

Pain relief medicines

Your doctor will talk to you about medicines to relieve pain from osteoarthritis.

Sometimes a combination of therapies, such as painkillers, exercise and assistive devices or surgery, may be needed to help control your pain.

The type of painkiller a GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have. The main medications used are below.

Paracetamol

If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol to begin with. You can buy this at supermarkets or pharmacies. It’s best to take it regularly rather than waiting until your pain becomes unbearable.

When taking paracetamol, always use the dose a GP recommends and do not exceed the maximum dose stated on the pack.

Find out more about paracetamol.

Non-steroidal anti-inflammatory drugs (NSAIDs)

If paracetamol does not effectively control the pain of osteoarthritis, a GP may prescribe a non-steroidal anti-inflammatory drug (NSAID).

NSAIDs are painkillers that work by reducing inflammation.

Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.

Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it.

NSAID tablets may be needed if paracetamol and topical NSAIDs are not easing the pain. They may not be suitable for people with certain conditions, such as asthma, a stomach ulcer or angina, or if you have had a heart attack or stroke. If you’re taking low-dose aspirin, ask your GP whether you should use a NSAID.

If your GP recommends or prescribes an NSAID to be taken by mouth, they’ll usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining.

Opioids

Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.

Codeine is combined with paracetamol in common medicines such as co-codamol.

If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation.

Capsaicin cream

A GP may prescribe capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain.

Capsaicin cream works by blocking the nerves that send pain messages in the treated area. You may have to use it for a while before it has an effect. You should experience some pain relief within the first 2 weeks of using the cream, but it may take up to a month for the treatment to be fully effective.

Apply a pea-size amount of capsaicin cream to your affected joints up to 4 times a day, but not more often than every 4 hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.

Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it’s likely to be very painful for a few hours. However, it will not cause any damage.

You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. But avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.

Steroid injections

Steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems.

Some people with osteoarthritis may be offered steroid injections when other treatments haven’t worked.

The injection will be made directly into the affected area. You may be given a local anaesthetic first to numb the area and reduce the pain.

Steroid injections work quickly and can ease pain for several weeks or months.

Osteoarthritis: Diagnosis and Treatment

Treatment

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Treatment choices fall into four main categories: nonpharmacologic, pharmacologic, complementary and alternative, and surgical. In general, treatment should begin with the safest and least invasive therapies before proceeding to more invasive, expensive therapies. All patients with osteoarthritis should receive at least some treatment from the first two categories. Surgical management should be reserved for those who do not improve with behavioral and pharmacologic therapy, and who have intractable pain and loss of function.

Clinical practice guidelines have been recommended by American and British specialty societies.7,8 Figure 5 presents a stepped-care approach to treating osteoarthritis.

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Stepped-Care Approach for the Treatment of Osteoarthritis

Figure 5.

Recommended stepped-care approach for the treatment of osteoarthritis. (NSAID = nonsteroidal anti-inflammatory drug.)

Figure 5.

Recommended stepped-care approach for the treatment of osteoarthritis. (NSAID = nonsteroidal anti-inflammatory drug.)

NONPHARMACOLOGIC

Nonpharmacologic therapy often starts with exercise. A randomized clinical trial compared supervised home-based exercise with no exercise in 786 patients with osteoarthritis of the knee. The exercise program consisted of muscle strengthening and range-of-motion exercises. The researchers found statistically significant improvements in a validated arthritis symptom score at six, 12, 18, and 24 months.9

A Cochrane review of exercise for osteoarthritis of the knee concluded that land-based exercise can result in short-term reduction of pain and improvement in physical function.10 A similar Cochrane review of water-based exercise for knee and hip osteoarthritis showed improvement, but the results were not as robust.11 A randomized controlled trial of 200 persons compared education by a primary care physician to exercise supervised by a physical therapist. The supervised exercise program had better short-term outcomes, but the differences were no longer noted at 36 weeks.12

Therapeutic ultrasound is a physical therapy modality often used in osteoarthritis treatment. A Cochrane review of this modality concluded that although statistically significant improvements were noted in visual analog pain scales following therapeutic ultrasound for knee osteoarthritis, the clinical significance of these changes is questionable.13 The authors found that the studies were underpowered to properly determine the effectiveness of therapeutic ultrasound for knee or hip osteoarthritis. A Cochrane review on transcutaneous electrical nerve stimulation found no clinically significant improvement in knee osteoarthritis pain.14

Because obesity is considered a major risk factor for osteoarthritis, studies have investigated whether weight loss improves patient outcomes. A meta-analysis of weight reduction and knee osteoarthritis concluded that weight loss of 5 percent from baseline was sufficient to reduce disability.15 Additionally, pain and disability were reduced if patients lost more than 6 kg (13.2 lb).15 Aerobic exercise is important for weight loss, but can be challenging in persons with osteoarthritis of weight-bearing joints. Swimming, elliptical training, cycling, and upper body exercise may help in such cases.

Other nonpharmacologic treatments include bracing and splinting to help support painful or unstable joints. A cane can help reduce the weight load in persons with hip or knee osteoarthritis, but it needs to be properly fitted and used on the side contralateral to the affected joint.3

PHARMACOLOGIC

The mainstay of treatment for mild osteoarthritis is acetaminophen.16 It is inexpensive, safe, and effective. A 2006 Cochrane review concluded that acetaminophen is better than placebo for treating mild osteoarthritis, and equal to nonsteroidal anti-inflammatory drugs (NSAIDs), but with fewer gastrointestinal adverse effects.16 Patients should be instructed to take 650 to 1,000 mg of acetaminophen up to four times per day to relieve osteoarthritis symptoms. The U.S. Food and Drug Administration recommends no more than 4,000 mg of acetaminophen per day to avoid liver toxicity. It further cautions patients to be aware of coincident use of other over-the-counter or prescription medications that may contain acetaminophen.17

When acetaminophen fails to control symptoms, or if symptoms are moderate to severe, NSAID therapy is recommended. NSAIDs as a class are superior to acetaminophen for treating osteoarthritis.16 Patients taking NSAIDs should be cautioned about adverse effects, which may include gastrointestinal bleeding, renal dysfunction, and blood pressure elevation (number needed to harm = 12).16 There have not been many head-to-head studies comparing nonsteroidal agents, so less expensive, generic products are appropriate (e.g., ibuprofen, naproxen, diclofenac). Cyclooxygenase-2 inhibitors, such as celecoxib (Celebrex), have an improved safety profile for gastrointestinal adverse effects,18 but are costly and confer an increased cardiovascular risk.19 Table 2 lists medications commonly used to treat osteoarthritis, typical dosing, and relative costs.

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Table 2.

Medications Commonly Used for Osteoarthritis

NA = not available.

*—Estimated retail price of one month’s treatment based on lowest typical dosage. Information obtained at http://www.drugstore.com (accessed August 4, 2011).

†—May be available at discounted prices ($10 or less for one month’s treatment) at one or more national retail chains.

‡—Estimated cost to the pharmacist based on average wholesale prices in Red Book. Montvale, N.J.: Medical Economics Data; 2010. Cost to the patient will be higher, depending on prescription filling fee.

Table 2.

NA = not available.

*—Estimated retail price of one month’s treatment based on lowest typical dosage. Information obtained at http://www.drugstore.com (accessed August 4, 2011).

†—May be available at discounted prices ($10 or less for one month’s treatment) at one or more national retail chains.

‡—Estimated cost to the pharmacist based on average wholesale prices in Red Book. Montvale, N.J.: Medical Economics Data; 2010. Cost to the patient will be higher, depending on prescription filling fee.

Opioids are often used to treat pain and are an option for osteoarthritis pain. Because of the potential for abuse, opioids should be an option only if the patient has not responded to acetaminophen or NSAID therapy, or cannot tolerate them because of adverse effects. Opioids should be prescribed first at low dosages and carefully monitored to evaluate for potential dependence. Opioids also may cause chronic constipation and can place older patients at risk of falls.3,20

Intra-articular injections of corticosteroids or hyaluronic acid are another option for treating osteoarthritis. The use of intra-articular corticosteroids primarily provides short-term relief lasting four to eight weeks. It has proven effectiveness in osteoarthritis of the knee,21,22 but may not be as effective for osteoarthritis of the shoulder 23 or hand.24 Many physicians inject a corticosteroid and a local anesthetic, such as lidocaine (Xylocaine). The lidocaine can provide some immediate relief, which confirms that the medication was injected into the correct area. Patients should be warned of a potential flare-up of symptoms within the first 24 hours, followed by an improvement from baseline at 48 hours. Repeat injections are possible in the same joint, but usual practice is limited to four injections annually.25

Intra-articular hyaluronic acid injections, also known as viscosupplementation, are widely used by orthopedic surgeons to treat osteoarthritis of the knee. There has been some debate about the effectiveness of viscosupplementation in earlier studies, most of which were manufacturer-sponsored studies. However, a Cochrane review of 76 clinical trials concluded that viscosupplementation was effective for treating knee osteoarthritis.26 The treatment effect often lasted for up to four months and led to improvements in pain and function.26 The biggest drawback of hyaluronic acid injections is the cost. Table 3 provides a cost comparison of intra-articular injections.

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Table 3.

Cost Comparison of Intra-articular Corticosteroids and Hyaluronic Acid Injections for the Knee

note: Self-pay fees and reimbursement information were obtained from a local family medicine office and a local orthopedic office in the author’s community.

Table 3.

note: Self-pay fees and reimbursement information were obtained from a local family medicine office and a local orthopedic office in the author’s community.

There have been head-to-head trials of corticosteroid injections versus hyaluronic acid. A meta-analysis of knee injections found that corticosteroids had a better short-term response rate and were equal to hyaluronic acid in the intermediate four- to eight-week range, but were inferior to hyaluronic acid after eight weeks from the time of injection.27 Therefore, in stable patients with an acute flare-up of osteoarthritis symptoms, corticosteroids may be preferred. For patients experiencing chronic osteoarthritis pain, hyaluronic acid should be considered. The technique of injection is the same for either medication.

COMPLEMENTARY AND ALTERNATIVE MEDICINE

A meta-analysis on the effectiveness of acupuncture for osteoarthritis of the knee found only short-term benefit, which the authors described as clinically irrelevant.28 Acupuncture can be of benefit in chronic low back pain, but studies do not differentiate the etiology of the back pain.29

The most widely used supplements for osteoarthritis are glucosamine and chondroitin. The literature consisted of small clinical trials until the release of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), which included more than 1,500 patients. The trial had five arms comparing glucosamine alone, chondroitin alone, a combination of glucosamine and chondroitin, celecoxib, and placebo. The results were favorable only for the combination of glucosamine and chondroitin, which appeared to be effective for moderate to severe osteoarthritis of the knee.30 Chondroitin alone did not show benefit for osteoarthritis of the knee or hip in a meta-analysis.31

Balneotherapy is a heterogeneous group of treatments also known as spa therapy or mineral baths. A Cochrane review concluded that mineral baths were of some benefit to patients with osteoarthritis, but the authors addressed methodologic flaws in the studies and urged caution in interpreting the findings.32 Capsaicin cream is a topical analgesic derived from chili peppers. It has been found to be superior to placebo in treating osteoarthritis pain. It is widely available, is relatively inexpensive, and can be used as an adjunct to standard osteoarthritis treatments.33 There also is evidence supporting the use of the supplement S-adenosylmethionine (SAM-e) to reduce functional limitation, but not compared with placebo in patients with osteoarthritis pain. The effectiveness of SAM-e is comparable to that of NSAIDs in some studies but with fewer adverse effects.34

SURGICAL

Surgery should be reserved for patients whose symptoms have not responded to other treatments. The well-accepted indication for surgery is continued pain and disability despite conservative treatment. The most effective surgical intervention is total joint replacement, with excellent patient outcomes following total joint replacement of the hip, knee, and shoulder.1,35 Many different prosthetic devices are available; however, controlled trials comparing the various devices are lacking. Patients can expect that most current joint prostheses will function well for 15 to 20 years.35

There are other surgical approaches to osteoarthritis treatment, but they have not equaled the success of total joint replacement. Randomized trials of arthroscopic debridement for osteoarthritis of the knee have consistently failed to show an advantage over maximal medical therapy combined with physical therapy.36

Data Sources: The database Essential Evidence Plus was searched on February 24, 2010. A PubMed search using the key word osteoarthritis was performed in March 2010. The Cochrane Database of Systematic Reviews was searched for various osteoarthritis treatments. Additional articles were found using the search engine in MD Consult, as well as articles found in the reference section of several of the articles previously read.

Rheumatoid Arthritis: Home Remedies for Hip Pain Relief

Do your hips hurt? In the early stages of rheumatoid arthritis (RA), most of the pain and joint destruction happen in the hands and feet. Over time, however, and especially if you also have osteoarthritis, pain can strike your hips as well.

While there’s no magic bullet to stop all hip pain, experts say there are some home remedies you can add to your medication regimen to lessen the agony. Of course, if the pain is severe or comes out of the blue, call your physician. And always get a doctor’s clearance for workouts if you haven’t been exercising regularly.

1. Warm or Ice Hip Joints

People living with rheumatoid arthritis frequently use temperature, or hot and cold therapy, to soothe achy joints. Indeed, this is one of the most widespread coping methods, according to a study published online in the Scandinavian Journal of Occupational Therapy in January 2017. Whether people use heat (via baths, saunas, heating pads) or cold (ice, going outside in winter) is largely a personal preference, the study found, although in general, heat was selected for everyday aches while cold was favored for acute flares. One study participant marveled at how he “never walked so many stairs” as he did while visiting a warm, southern location.

2. Stretch and Loosen Hips With Pliés

Stretching and strengthening the quadriceps and gluteus muscles in the legs and buttocks frees up the surrounding joints that may otherwise be constrained, says Miranda Esmonde-White, the author of the book Forever Painless and the longstanding host of the PBS exercise show Classical Stretch.

To do her “Tai Chi plié with hip swing,” (shown above) follow these steps:

  1. Stand beside the back of a chair. Spread your legs in a comfortably wide stance, and hold the chair with one hand. (If this challenges your balance too much, stand facing the back of the chair and grasp it with both hands.)
  2. Turn out your toes like a ballet dancer. Keeping your spine straight, slowly bend your knees and plié either a small amount or all the way to the level of your knees. Be sure your knees are in line with your feet; if not, adjust the width of your stance.
  3. While you are in this position, slowly swing your hips from left to right and back again, as far as you comfortably can. (See photos above.) Swing a total of 8 times before you center your hips and slowly straighten your knees.
  4. Repeat this sequence 2 to 4 times.

3. Lie on Your Stomach to Relax Tight Hip Flexors

People with hip pain typically try not to stand much, since it can be an uncomfortable position. But sitting shortens the hip flexor muscles, which can actually increase pain, says Genie Lieberman, the director of the physical rehabilitation institute at the Boca Raton Regional Hospital in Boca Raton, Florida.

To promote the full extension of the hips, Lieberman recommends lying facedown for up to 30 minutes, with small pillows placed under your shoulders for comfort. You can do this on your bed; turn your head to either side and rest it on your forearms for comfort. (You should not do this if you have lower-back problems.) In the beginning, it may be too painful to stay this way for more than a few seconds, but as you stretch the muscles it will get easier.

Hip Nonsurgical Options

Massage

Therapy Massage not only feels good, it is an effective way of relieving pain. A masseuse will increase the circulation of the body through rhythmic hand motion. In sports, massage therapy can be used to prevent strain by warming up athletes prior to a workout. The muscles can also be massaged after a workout to bring blood and oxygen into the muscles to flush out metabolic waste and increase circulation to the muscles to bring them the nutrients they need to heal after strenuous activity.

For those suffering from arthritis, massage can also be very helpful. Massage will help blood circulate in the painful area which brings essential nutrients to the muscles and joints which will help reduce inflammation and can also help break up scar tissue and adhesion which is causing pain.

Reflexology

Reflexology has been used as a method to relieve pain for thousands of years starting in ancient Egyptian culture. The premise is that by massaging the feet or hands, you can help ease pain in another part of your body. By massaging a certain part of your foot, for instance, you may be able to sooth hip pain.

Zen

Over the past few years a scientific affirmation has verified the idea of ‘mind over matter’. Zen is a method employed by some to shape the mental state and in some ways actually control pain. In our frenetically paced world, all of us need focus and discipline.

Yoga and Tai Chi

Ancient Eastern exercises are have become increasingly popular in the United States over the past few decades. These exercises stress the importance not only of physical agility, but joining the mind and body to have mental control over the physical state. These exercises are not only trendy, they are useful in increasing flexibility and gaining strength, which can help prevent and alleviate pain.

5 Alternative Treatments for Osteoarthritis

If you have osteoarthritis, you’re probably familiar with the traditional treatment options—such as medication and physical therapy—that can offer relief from pain and stiffness.

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Yoga can help you manage the stress and pain of osteoarthritis. Read Osteoarthritis Treatment

But those aren’t your only options. In addition, there are several complementary and alternative (CAM) treatments you can consider to help decrease pain and increase mobility and quality of life.

5 more potential ways to relieve pain

The National Center for Complementary and Alternative Medicine suggests the following supplemental treatment options for osteoarthritis:1

  1. Glucosamine and chondroitin sulfate supplements

    These supplements can be taken together or separately and have been found to relieve pain for osteoarthritis, particularly in the knee. However, some experts disagree on their benefit, and the American College of Rheumatology has recommended that people with hip or knee osteoarthritis not use glucosamine or chondroitin.

    See Glucosamine and Chondroitin Sulfate Supplements for Osteoarthritis

    Also, glucosamine can react with certain other medications like blood thinners, so talk with your doctor before taking one or both of these supplements.

    Read a summary of studies of glucosamine and chondroitin

  2. Acupuncture

    Numerous studies have been done to determine whether this ancient Chinese practice is helpful to those with osteoarthritis. The results have been mixed, but there’s some good evidence to support its use. For example, one meta-analysis of 12 different studies found that acupuncture was connected with:2

    • Significant reduction of pain intensity
    • Better functional mobility
    • Better health-related quality of life

    You can find a certified acupuncturist by visiting the National Certification Commission for Acupuncture and Oriental Medicine.

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  1. Massage therapy

    A few studies have shown massage therapy to be helpful to those with osteoarthritis, particularly of the knee. According to American Massage Therapy Association, massage can reduce blood pressure, relax muscles, and release endorphins.

    Read about massage therapy for low back pain on Spine-health.com

    Be sure to find a massage therapist who’s licensed to practice in your state. You can also look for therapists who are board certified, which means they have passed a test of their skills and experience. Visit the National Certification Board for Therapeutic Massage & Bodywork for more information.

  2. Tai chi

    Tai chi is a practice of meditative movement. It’s been shown to improve balance for those with knee osteoarthritis, who are at increased risk for falls because of knee weakness and instability. Tai chi is considered a safe practice for nearly everyone.

    See How Mind-Body Techniques Help With Fibromyalgia

  3. Yoga

    Not many studies have been done specifically about yoga and osteoarthritis. However, many studies have confirmed the benefits of yoga in managing stress and anxiety, which are often challenges for those with osteoarthritis.

    Yoga is generally considered safe, but be cautious about poses that may hyperextend your arthritis-affected joint(s). Find an experienced instructor, possibly someone who also has experience instructing those with arthritis or other chronic conditions.

Talk with your doctor first

As with any health treatment, it’s important to talk with your doctor before you begin any new program. Your doctor knows your unique health story best—he or she can help you decide what would be the most helpful and effective options for you.

Learn more:

Knee Osteoarthritis Treatment

Supplements for Hip Osteoarthritis Video

How Yoga Helps the Back on Spine-health.com

  • 1.”Osteoarthritis and Complementary Health Approaches.” National Center for Complementary and Alternative Medicine. May 2014.
  • 2.”Pain management with acupuncture in osteoarthritis: a systematic review and meta-analysis.” BMC Complementary & Alternative Medicine. 2014 Aug 23;14:312

Osteoarthritis Treatments

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Arthritis refers to an inflammation of a joint or joints in the body. One of the most common types of arthritis is osteoarthritis or “degenerative arthritis.” Often described as “wear and tear” arthritis, it affects more than 15 million Americans.

Osteoarthritis follows the breakdown of cartilage in a joint, eventually leading to abnormal bone changes. The role of joints is to provide flexibility, stability, support and protection to the skeleton, allowing movement of limbs and the entire body. Cartilage assists in these functions by coating the ends of the bones. In the early stages of osteoarthritis, the surface of the cartilage becomes swollen, forming tiny crevasses which hinder normal joint functioning. Inflammation may also occur in the synovium, a fluid-filled sac that surrounds the joint and provides nutrients and oxygen to the joint components. As the cartilage loses elasticity, it becomes vulnerable to further damage from repetitive use, which can cause a great deal of pain and swelling. In advanced cases, there is a complete loss of cartilage cushion between the joint and bone, which ultimately limits joint mobility.

Osteoarthritis is not a systemic condition – it does not spread throughout the body, but instead affects only the joint or joints where the deterioration has occurred. The joints most commonly affected are the knees, hips, spine, hands and toes.

Causes & Symptoms Of Osteoarthritis

Osteoarthritis can result from trauma or from repetitive use, although there is often no single identified cause. It is typically divided into two broad categories:

  • Primary osteoarthritis commonly occurs with aging, as the water content in the cartilage increases and the protein portion degenerates.
  • Secondary osteoarthritis is usually due to another disease or condition, such as repeated trauma, infectious disease, gout or surgery on a joint. Obesity is a frequent contributor, as excess weight puts additional stress on the cartilage, particularly on the joints in the knees and hips.

Symptoms of osteoarthritis include:

  • Pain in the affected joint(s) after repeated use, especially later in the day.
  • Swelling, pain and stiffness after long periods of inactivity, such as waking in the morning, that subsides with movement and activity.
  • Continuous pain, even at rest, is a symptom of advanced osteoarthritis, when there is total loss of cartilage.

In osteoarthritis of the spine, pain can occur in the neck or lower back. If bony spurs develop, the nerves exiting from the spine can be irritated, causing numbness, tingling and severe pain in the back or limbs. Osteoarthritis in the fingers can result in hard bony enlargements, and bunions can form at the base of the big toe if the feet are affected.

The degree of symptoms varies among individuals. Some people become completely debilitated, while others may experience few symptoms despite the severity of their condition. Symptoms may also be intermittent, and some individuals go for long periods of time relatively symptom-free.

Suggested Lifestyle Changes For Osteoarthritis Treatment

  • Lose weight if you are overweight; it can alleviate excess mechanical stress on the affected joint(s).
  • Avoid intense activities that injure or strain the joint cartilage.
  • Exercise. This can actually be beneficial as long as it is performed at a level that does not stress the affected joint(s). Strengthening surrounding muscles will support and protect the joint, and physical activity helps improve and maintain joint mobility and aids weight-reduction efforts. The safest activities are swimming, stationary cycling and light weight training – which put little stress on the joints.

Nutrition & Supplements For Osteoarthritis

Dietary changes may help alleviate or reduce the pain associated with osteoarthritis. Research has shown that foods rich in omega-3 fatty acids and the spices ginger and turmeric may help reduce inflammation. Foods rich in antioxidants – plentifully found in most vegetables and fruit – may help reduce tissue damage from inflammation.

  • Eat oily fish such as salmon, or try another source of omega-3 fatty acids such as walnuts or freshly ground flax seed daily.
  • Regularly use ginger and turmeric. Ginger tea is a good example.
  • Eat generous amounts of organically grown vegetables and fruit every day.

The following are nutrients, botanicals and other compounds that Dr. Weil often recommends for joint health:

  • Glucosamine sulfate. Glucosamine sulfate provides the joints with the building blocks they need to help repair the natural wear on cartilage caused by everyday activities. Specifically, glucosamine sulfate provides the raw material needed by the body to manufacture a mucopolysaccharide (called glycosaminoglycan) found in cartilage. Supplemental sources are derived from shellfish. Taken in supplement form, glucosamine may help improve the maintenance of healthy cartilage with an enhanced deposition of glycosaminoglycan.
  • Chondroitin. Chondroitin protects the cartilage and attracts fluids that give the tissue its shock absorbing quality.
  • Evening primrose oil. A source of gamma-linolenic acid (GLA) which may help maintain healthy joints by modifying inflammation.
  • Herbs and spices. Ginger, holy basil, turmeric, green tea, rosemary, scutlellaria and huzhang all have naturally occurring anti-inflammatory compounds known as COX-2 inhibitors.
  • Omega-3 fatty acids. Containing primarily EPA and DHA, which have been shown in studies to help maintain bone health and flexibility.
  1. Pool therapy
  2. Swimming
  3. Elliptical/cross trainer
  4. Power Yoga
  5. Cycling, stationary bike
  1. Nordic track
  2. Treadmill
  3. Brisk walking outdoors (power walking)
  4. Zoomba
  5. Hiking
  6. Nordic skiing
  1. Jogging
  2. Stair stepper
  3. Dancing
  4. Rowing machine
  5. Downhill skiing (experienced skier)

Full Joint Mobilization

A fundamental principle of joint health is full joint mobilization. By articulating throughout a complete range of motion, cartilage is loaded properly and nourished fully. Inflammation and pain are less likely to occur. Perform gentle flexibility/stretching exercises in a yoga-like manner everyday or twice a day. Tai Chi is also worthwhile. Don’t forget hip mobility, mobilization of your small hand joints and spinal rotation.

Gradual Improvement of your BMI

Reduction by two or more levels on the BMI chart is typically associated with reduced pain, less disability and greater longevity.

Specifics

If possible, reduce your dependency on prescription drugs that may have side effects such as memory loss, energy loss, fluid retention, heartburn, etc. Until your osteoarthritis improves, it’s okay to use NSAID’s occasionally. Ibuprofen, Aleve and Diclofenac are options.

Be Patient

Real improvement takes time. Remember to play all of your cards right. There are no magic bullets.

Bone Health

Healthy bone is your next line of defense. Arthritic patients with good bone quality experience less pain; some report no pain at all.

Calcium

High Calcium Foods (3-5 times daily):

  • Skim milk
  • Non-fat cottage cheese
  • Yogurt
  • Kefir

Vitamin K

Vitamin K vegetables daily (3-4 times daily):

  • Broccoli
  • Kale
  • Spinach

Supplements

Balanced multi-nutrients with bone supplements like:

    • Nutriex Sport or Health
  • or equivalent.

*Maitaining an alkaline diet is essential to bone health. While an acid diet undermines bone health, alkaline nutrition sustains bone.

Osteoarthritis of knee in 60 year-old female patient with healthy bone response (good long-term nutritional choices). Patient reports no pain.

Proper Posture and Flexiblity


A typical squatting position

Restricted motion can lead to joint dysfunction and osteoarthritis. Reduced range of motion in one joint will often affect joints above and below. In the lower extremities, the opposite limb can be adversely affected. The 25 spinal vertebrae depend on healthy postural relationships to neighboring vertebrae above and below.

Postural exercises like Pilates, power walking, and swimming reduce arthritis risk and pain and should be performed daily.

  • Walk frequently in a full, upright posture
  • Avoid sitting too much
  • Continue to squat regularly (if you can)

Stress Reduction

Increased stress contributes to weight gain, less energy, compromised sleep patterns and lower pain tolerance, which aggravate all osteoarthritis.

Tips to reduce stress include:

  • Deep breathing
  • Yoga
  • Tai Chi
  • Aroma Therapy
  • Warm Baths
  • Prayer
  • Relaxation Tapes
  • Meditation
  • Soothing Music

When I determine that a patient has a classic node formation from osteoarthritis (Heberden’s node), I may make the diagnosis solely based upon the examination, without the need for any additional tests, such as blood or X-ray testing. Sometimes, testing can be helpful to better understand the degree and character of the osteoarthritis affecting a certain joint. It can also be helpful for monitoring and to exclude other conditions.

Treatment may not be necessary for osteoarthritis of the hands with minimal or no symptoms. When symptoms are troubling and persist, however, treatment might include pain and anti-inflammatory medications, with or without food supplements, such as glucosamine and/or chondroitin. Furthermore, heat/cold applications and topical pain creams can be helpful.

As a first step, I recommend that patients go ahead and try the over-the-counter food supplements glucosamine and chondroitin. Each of these supplements has been independently shown to relieve the pain and stiffness of some (but not all) patients with osteoarthritis. These supplements are available in pharmacies and health-food stores without a prescription. If patients do not benefit after a two-month trial, I tell them that they may discontinue these supplements. The manufacturers sometimes make claims that these supplements “rebuild” cartilage. This claim has not been adequately verified by scientific studies to date.

Interestingly, past research found glucosamine (in a radioactive form that could be identified in tissues) fed to beagles was noted to be incorporated into their cartilage. I spoke with the author of this study who interpreted the results to imply that glucosamine supplements taken by mouth actually can reach the cartilage of the joints.

For another type of dietary supplementation, it should be noted that fish oils have been shown to have some anti-inflammation properties. Moreover, increasing the dietary fish intake and/or fish oil capsules (omega-3 capsules) can sometimes reduce the inflammation of arthritis.

Obesity has long been known to be a risk factor for osteoarthritis of the knee. I recommend weight reduction for patients with early signs of osteoarthritis of the hands who are overweight, because they are at a risk for also developing osteoarthritis of their knees.

Pain medications that are available over the counter for the treatment of osteoarthritis pain, such as acetaminophen (Tylenol), can be very helpful in relieving the pain symptoms of mild osteoarthritis and I recommend these as the first medication treatment. Studies have shown that acetaminophen, given in adequate doses, can often be equally as effective as prescription anti-inflammatory medications in relieving pain in osteoarthritis of the knees. Since acetaminophen has fewer gastrointestinal side effects than nonsteroidal anti-inflammatory drugs (NSAIDS), especially in elderly patients, acetaminophen is generally the preferred initial drug given to patients with osteoarthritis. If symptoms persist, then I recommend trials of over-the-counter anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, Nuprin), ketoprofen (Orudis), and naproxen (Aleve). Many patients do best when they take these medications along with their glucosamine and chondroitin.

Some patients get significant relief of pain symptoms by dipping their hands in hot wax dips in the morning. The wax can often be obtained at local pharmacies or medical supplies stores. It can be prepared (melted) and kept in a crock pot (electric cooker). The hot wax hardens on the hands and thereby provides a warm covering over the hands. The hardened wax then can be reused by peeling it off the hands and placing it back into the melted wax. Warm water soaks and nighttime cotton gloves (to keep the hands warm during sleep) can also help ease hand symptoms. Gentle range of motion exercising regularly can help to preserve function of the joints. These exercises are easiest to perform after early morning hand warming.

Pain-relieving creams that are applied to the skin over the affected joints can provide relief of daytime minor arthritis pain. Examples include capsaicin (Arthricare, Zostrix), salycin (Aspercreme), methyl salicylate (Bengay, Icy Hot), and menthol (Flexall). For additional relief of mild symptoms, local ice application can sometimes be helpful, especially toward the end of the day. Occupational therapists can assess daily activities and determine which additional techniques may help patients at work or home.

QUESTION

What joints are most often affected by osteoarthritis? See Answer

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