Lifestyle Changes
Many physicians suggest first trying lifestyle changes to reduce stress on affected joints. Physical therapy and supportive devices can be helpful. Intensive education on how to protect and care for an osteoarthritic joint may help patients avoid multiple visits to their doctor and translate into substantial long-term savings.
Occupational Changes
Once osteoarthritis has been diagnosed, patients should reduce shock to the affected joint. Hammering away at deteriorating cartilage is likely to speed up the degeneration. People in occupations requiring repetitive and stressful movement should explore ways to reduce trauma. Adjusting the work area or substituting tasks that produce less stress on joints helps reduce shock.
Exercise
Joints require motion to stay healthy. Long periods of inactivity cause the arthritic joint to stiffen and the adjoining tissue to atrophy. A moderate exercise program that includes low-impact aerobics and power and strength training has benefits for osteoarthritic patients, even if exercise does not slow down the disease progression:
- Exercise helps to reduce stiffness and increases flexibility.
- Exercise is a critical component for any weight loss program--which is important for people with osteoarthritis who are overweight.
- Exercise improves strength, which in turn improves balance and endurance.
- Exercise improves feelings of well being and reduces stress, which helps reduce the emotional burden of pain.
- Exercise helps patients with mild to moderate osteoarthritis in the hip or in the knee. And many patients who embark on an aerobic or resistance exercise program report less disability and pain and are better able to perform daily chores and remain independent than their inactive peers. Older patients and those with medical problems should always check with their physician before embarking on an exercise program.
Exercising Tips for Osteoarthritic Patients. The three types of exercise that are best for people with arthritis are range of motion exercises, strengthening exercises, and aerobic, or endurance, exercises.
- Strengthening exercises include isometric exercises (pushing or pulling against static resistance). Isometric training builds muscle strength while burning fat, helps maintain bone density, and improves digestion.
- Some experts encourage patients to emphasize strengthening leg muscles as a first treatment step, even before using pain relievers. They fear that patients who rely on pain killing drugs may overuse knees, which do not have muscle tissue sufficiently strong enough to protect the joints from further damage. Of some concern is a study suggesting that building up thigh muscles may worsen osteoarthritis in people whose knees are misaligned (for instance those who are "bow-legged" or "knock-kneed"). Such individuals should check with a physical therapist for the best options. Strengthening the thigh muscles is certainly protective for those people who have not developed osteoarthritis.
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| Exercise, such as weightlifting, helps build muscle that is usually lost with age and puts stress on bones which helps keep them strong and healthy. |
- Range-of-motion exercises increase the amount of movement in a joint and muscle. In general, they are stretching exercises. The best examples are yoga and tai chi, which focus on flexibility, balance, and proper breathing. They also lower stress levels, help to reduce blood pressure, and may even have beneficial effects on cholesterol levels. In one 2001 study, older adults who practiced the gentle movement, breathing, and meditation exercises of tai chi for 10 weeks reported less pain than their peers who did not learn the technique.
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Click the icon to see an image of cholesterol. |
- Aerobic or endurance exercises are also important for the heart, help control weight, and improve overall function. They may even reduce inflammation in some joints. Low-impact workouts also help stabilize and support the joint. Cycling and walking are beneficial, and swimming or exercising in water is highly recommended for people with arthritis. (Arthritic patients should avoid high-impact sports, such as jogging, tennis, and racquetball.)
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- Some researchers are now focusing on "power" training, which involves improving the muscle's ability to move more rapidly against resisting forces, such as gravity. (For example, such training helps people to stand up or climb stairs more quickly.) Muscle power declines more rapidly than muscle strength and may be particularly important in older people.
Physical Therapy
In addition to exercise, manipulation of muscles and joints by a trained therapist may be helpful. In one 2000 study, patients who had a combination of physical therapy and an exercise program reported that they felt 30% to 40% better after only two to four visits. Such a program may also reduce the need for operations.
Weight Reduction
Overweight osteoarthritis patients can lessen the shock on their joints by losing weight. Knees, for example, sustain an impact three to five times the body weight when descending stairs. Consequently, a modest loss of five pounds can eliminate at least 15 pounds of stressful impact on the joint. The greater the weight loss, the greater the benefit. [For more information, see the Well-Connected Report #53, Weight Loss and Diet.]
Vitamins and Other Dietary Factors
Plant Chemicals. A multicenter study in France reported significant symptomatic improvement in patients who took extracts from avocados and soybeans called saponins compared with patients who took a placebo. Another French pilot study noted that although these substances did not allay hip pain, they did slow progression of joint deterioration.Soy also has chemicals called isoflavones that may have additional benefits, such as preventing bone loss.It should be noted that such chemicals have effects that are similar to estrogen, so more research is needed to determine long-term risks and benefits these nutrients.
Fish Oil and Omega-3 Fatty Acids. Omega-3 fatty acids, which are found in fish oil, canola oil, black currant or primrose seed oils, and flax seeds, have anti-inflammatory properties and may even help protect against cartilage deterioration. Supplements of omega-3 fatty acids, such as docosahexaenoic (DHA) and eicosapentaneoic (EPA) acids that are found in fish oil, are available.
Vitamin B3 (Niacin). Some research suggests that vitamin B3 may have some benefits for people with osteoarthritis.
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Click the icon to see an image of the sources of vitamin B3. |
Calcium and Vitamin D and C. Calcium and vitamin D are important for strong bones. Although osteoarthritis is primarily a disease of joints, bone strength is also important, particularly in older people.
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Many experts are now recommending 1,000 mg of calcium a day for most adults and 1,200 to 1,500 mg for adolescents. Pregnant women, postmenopausal women not on estrogen therapy, and those on corticosteroids should get 1,500 mg per day; breast feeding women should get 2,000 mg/day. Because calcium supplements increase the risk for kidney stones, an upper limit of 2,500 mg is recommended.
Current guidelines recommend 400 IU of vitamin D per day and 600 IU per day after age 60. Lack of sunlight and unhealthy diets contribute to deficiencies in vitamin D. Good dietary sources include fortified milk, sardines, herring, salmon, tuna, liver, dairy products, and egg yolks. Although supplements are often necessary, vitamin D can be toxic in high doses, and no one should take more than 1,200 IU per day.
Vitamin C. Vitamin C is essential for the formation of collagen. In animal studies, it helped reduce arthritis. In one study, patients who took a combination of calcium and vitamin C reported less pain compared to a placebo pill. More research is warranted.
Heat and Ice
Ice. When a joint is inflamed (particularly in the knee) applying ice for 20 to 30 minutes can be effective. (If an ice pack is not available, a package of frozen vegetables works just as well.)
Heat Treatments. Patients afflicted with osteoarthritis of the hands can relieve pain with hot soaks and warm paraffin application. Osteoarthritis of the hip can be treated with heating pads.
Note: Interestingly, moving to a warm climate does not seem to make much difference. According to one study, people who live in warmer places are actually more sensitive to small shifts in temperature than people who live in cold damp climates, and they experience pain as readily as their northern peers do in response to larger temperature shifts.
Mechanical Aids
A wide variety of devices are available to help support and protect joints:
- According to studies published in 2003, wrapping the knee with special therapeutic tape that provides support to specific parts of the joint may be very effective. In one trial, patients experienced a 40% reduction in pain within a few days. They wore the tape for three weeks, and pain relief continued for three more weeks following treatment. The tape should be applied by physical therapists or other trained health professionals. Longer-term studies are needed to determine any continuous benefits.
- Wearing shock-absorbing soles in shoes or orthopedic shoes can help in daily activities and during gentle exercise. Heel wedges in the shoes can even sometimes help patients avoid knee replacement surgery.
- Splints or braces, worn while the joint is at rest or in use, help align joints and properly distribute weight. They are used most frequently to treat arthritic hands, wrists, knees, ankles, and feet. Many of such devices allow some movement within the affected joint and do not restrict nearby joints. They are usually made from lightweight metal, leather, elastic, foam, and moldable plastic with easy-to-use Velcro straps. Any brace, splint, or other device for joint protection should be custom-fitted by a physical or occupational therapist, or an orthotist. Poorly fitting or improperly used orthoses can cause more harm than good. Some insurance companies cover 80% of the expense.
- Using elastic supports on affected or important joints many benefit some people. For example, in one study, overweight women with osteoarthritis in the knee were helped by insoles plus elastic straps supporting the ankle joint. It is important, however, to consult with a physician on how to use elastic supports.
- A neck brace or corset may relieve back pain.
- A firm mattress also often proves beneficial.
- In extreme cases of back pain, lying in traction might be necessary.
- Canes, crutches, or walkers offer benefits to patients with advanced arthritis.
- Specially designed hip protectors, worn under the clothes, can also protect against hip fractures in elderly patients with impaired mobility who are apt to fall.
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