Non-Pharmacological Treatment of Osteoarthritis
Although there isn’t a great deal of definitive scientific evidence to support complementary and alternative medicine (CAM) and integrative therapies for arthritis, many people feel that using them in addition to medication could have some benefits. Before actively engaging patients should consult with their doctor. Here is a summary of the common CAM therapies used by people with OA:
· Tai Chi and Yoga
· Acupuncture, possibly cupping
· Massage therapy
· Magnetic therapy, copper bracelets
· Relaxation therapy or meditation
· Hydrotherapy, sauna treatment
· Nutrition, dietary herbs and supplements
· Physical therapy
· Aquatic exercise
· Weight management
· Osteopathic manipulation
· Chiropractic adjustments
Exercise is the most recommended therapy for arthritis. Be sure to ask your doctor about the safety of any CAM, even exercise, before starting it to make sure it is right for you.
Exercise Tips for OA
While some people are concerned that exercise can hurt their joints or increase pain levels, the truth is that exercise is good for OA; in fact, it is considered the most effective non-drug treatment for reducing pain and improving movement.
Listen to your body. Don’t do anything that adds more pain and discomfort or could cause an injury. If you can do some kind of movement even during your pain flares, you may find that it can help. Break up your exercise routine into shorter segments. Or do something light that just gets you moving. Water exercise may be a good option when you’re in pain, because you can move your joints without putting pressure on them.
How do you get started? What kinds of exercise work best? It really depends on your symptoms, your overall fitness and health, and what kind of exercise you might like to do the most — because if you like doing an exercise, you’re more likely to keep doing it. Range of motion exercises can help improve flexibility in your joints, while aerobic/endurance exercises can help control your weight, boost fatigue and improve your mood. Strengthening exercises are also important, as these build strong muscles, which in turn protect and support your joints.
In the past, doctors told people with arthritis not to exercise. They thought exercise would damage fragile joints. But now, we know that exercise is safe and healthy for people with OA. It’s not likely to cause more joint pain, especially if you do it in moderation. So start slowly with any new exercise you try, and then work up to longer or more challenging routines.
One reason why exercise is so important for OA is weight management. Being overweight increases the likelihood of both the development of OA and worsening of OA symptoms. Losing weight can reduce stress on your joints that can further break down the cushioning cartilage between the joints. Studies show that being even 10 pounds overweight will increase the stress across the knee joint by 30 to 60 pounds.
Excessive exercise, just like too little exercise, may worsen your OA pain. It’s important to talk to your doctor before starting any new exercise routine so you know that it’s safe and healthy for you. You might start with something as simple as walking or try working out in a heated pool at your local community center or gym. You can take local exercise classes that are designed for people with arthritis so you don’t damage or injure your joints. If you should accidentally overdo, hot and cold compresses may also help to temporarily reduce pain and relax muscles after exercising.
Here are a Few Suggested Exercise Options:
Daily stretching can help you manage your arthritis pain and improve your range of motion. After a three to five minute warm up (marching in place or arm circles), perform a variety of stretches and hold each for about 15 seconds. Reaching for the sky and touching your toes are good places to start. Don’t be afraid to stretch any joints that tend to be problem areas. Listen to your body — don’t push any stretch so far that it causes pain.
This simple exercise can fit easily into your daily routine no matter how old you are or where you live. It’s free — just find a safe place to walk in your area and get moving. Find some friends, neighbors, or family members to join you for a walk to make it even more fun. Walking can be good for your heart health, joint health, and mood.
If the weather is bad, you can walk inside your local mall. If it’s a pretty day, explore your neighborhood or local park. Walk on flat, paved surfaces to be safe. Make sure you have well-fitting, comfortable walking shoes and socks. Wear comfortable clothing that you can work up a sweat in. Drink some water beforehand or bring a small bottle so you don’t get dehydrated.
Start slowly and walk at an easy pace. As you feel more confident, challenge yourself to walk a little faster or farther, or both. Some people like to use personal fitness tracking devices (i.e. a FitBit or a pedometer) to track their daily activity and encourage consistent exercise.
Tai Chi and Yoga
Tai chi and yoga are two ancient forms of movement. Tai chi is a series of flowing movements designed to help you improve function and balance. Yoga, which comes in many different styles, usually involves poses and stretches that are meant to improve arthritis symptoms and mood.
Research suggests that tai chi and yoga may reduce OA pain and improve movement. Both tai chi and yoga are used by many people with OA to feel better and improve some of their OA-related symptoms. Done properly, both tai chi and yoga can be safe for people with arthritis to do on a regular basis. There are a number of arthritis tai chi and yoga programs in local communities, as well as videos and online instruction tools.
You can also take a class from an instructor who can show you how to adapt your moves to be safe for your joints. Talk to your doctor or physical therapist to find out if tai chi or yoga are right for you, and if they recommend any classes in your area.
Exercising in water is great if you have OA, because water’s buoyancy supports your weight, so you can move around without putting lots of pressure on your joints. But water also offers some resistance as you move, so it can help you work your joints and muscles and get stronger. Check out water exercise classes in your area, especially ones designed for people with OA. Your doctor or physical therapist can refer you to the right water exercise classes in your community.
Riding a bike, either stationary or regular, can help you ease stiffness, improve range of motion or flexibility, and build endurance and muscle tone, particularly if you have OA of the knee. Placing the seat at a comfortable height can decrease the strain on the knee and make the exercise less painful.
You can relieve the stress on joints affected by OA if you build up the muscles around them. Strength training is the best way to do that. You can do specific exercises that target those muscles on your own, on a weight machine, or with small free weights. It’s important to do any strength exercises the right way, so talk to a physical therapist (PT). Your PT can recommend strengthening moves for you and show you how to do them properly.
This ancient healing practice uses thin needles that are inserted into specific points on the body. Acupuncture is meant to help balance your body’s natural energy flow (also known as ‘qi’). Its effects can ease your pain, increase a sense of calm, and improve digestion, to name a few possible benefits. Risks are typically mild, including transient lightheadedness, pain at needling site, initial exacerbation of symptoms, and bleeding. Acupuncture should ideally be performed by a licensed acupuncturist (LAc) who has completed a master’s degree or higher level of training. Acupuncture sessions are typically performed once or twice a week. At least six to 10 sessions should occur before you decide on its effectiveness and whether to continue therapies. Insurance coverage varies for this therapy, so check with your carrier to learn if you have coverage for acupuncture. Recent research shows that acupuncture may have some benefits for people with chronic pain:
Performed by massage therapists as well as other health professionals, massage involves pressing or kneading muscles and tissues in a relaxed, quiet environment. The most common type is Swedish massage. Recent studies have shown pain-relief benefits for Swedish massage. Massage therapy can relieve anxiety, which helps ramp down the pain response as well.
Magnet Therapy and Copper Bracelets
Magnets produce a field of energy that attracts metal, just like the ones you use to stick notes on your refrigerator. Magnets are used as an alternative therapy for pain relief in arthritis, and may be sold as products like socks, bracelets, mattress pads, or bands that you strap around your painful joints. However, there’s no evidence that magnet therapy works better than placebo to ease arthritis pain or other symptoms. These products are a waste of money.
Relaxation Therapies or Meditation
Techniques to help you relax or ease stress can help you manage chronic pain or anxiety that’s common with having a disease like OA. Relaxation therapies include biofeedback, self-hypnosis, deep breathing techniques, meditation, or guided imagery. There are therapists trained to help you learn to do any of these relaxation techniques properly, but you can also teach yourself to do them by using online videos or tapes. Tai chi and Yoga may also be done in combination with techniques like meditation to help you relax.
Usually, relaxation is considered safe and healthy, but if you’ve had anxiety or depression, check with your doctor or psychologist to make sure it’s OK for you.
Water therapies use warm water in baths, showers, hot tubs, heated pools, or spas to help you relax tight, sore muscles or ease joint pain. “Hydro” means water. Hydrotherapy can also mean exercising in warm water. Studies show that warm-water exercise is a good way to build strength and fitness, and some research shows it can help with the stiffness and pain common with OA. You can use a warm shower to loosen stiff joints in the morning, or you may find a soak in a spa tub soothes sore, aching muscles. Talk to your doctor or physical therapist about the best ways for you to use hydrotherapy safely and effectively.
By David Borenstein MD, past president American College Rheumatology & CH Weaver MD Medical Editor