What Is OA?

Osteoarthritis (OA) literally means "bone joint inflammation" and is also referred to as degenerative joint disease (DJD). It is caused by the breakdown of bone and cartilage within joints. This breakdown can occur in any joint in the body but is most common in the hand, shoulder, hip, knee, spine, and ankle. Osteoarthritis is more commonly found in older individuals and classic symptoms include joint pain, swelling, and decreased range of motion. Signs of osteoarthritis and joint degeneration are commonly diagnosed using X-Ray imaging. 

Causes of OA

Although osteoarthritis is recognized as a chronic disease of aging, it may also develop in younger individuals. The degeneration that occurs with OA may be due to something as simple as aging but also can be exacerbated by a postural/biomechanical imbalance, chronic injury, or overuse of a joint that continuously gets worse over time. These imbalances may cause persistent rubbing between bones leading to wearing away of the cushion between them (cartilage). Once this cartilage is worn down and there is a no longer a cushion in the joint, this opens up the possibility for even more problems as the bone and ligaments may begin to degrade also. Individuals who are overweight or have a chronic repetitive injury with altered biomechanics are especially at risk for osteoarthritis due to the excess stress that is placed on joints. 

Treatments & Management Strategies for OA

The treatment and management of osteoarthritis largely depends on the stage and severy of the disease. In late stages, many orthopedists recommend surgery on the affected joint usually in the form of joint replacements (most common in knee and hip). This surgery is extremely invasive and can cause decreased function as well as other side effects. Avoiding or delaying a joint replacement surgery is extremely important and can be done through many natural therapeutic options. 

Lifestyle Changes

• Footwear changes/orthotics: Patients with osteoarthritis should receive proper advice regarding correct footwear according to the Osteoarthritis Research Society International. This proper footwear recommendation may be a change of shoe style or could be in the form of orthotics. The goal of this modification is to balance the body weight and decrease the stress and pressure placed on the arthritic joint(s).

• Weight loss: Weight loss is one of the first recommendations for management of osteoarthritis according to the American College of Rheumatology. The American Academy of Orthopedic Surgeons also recommends weight loss in any individual with osteoarthritis and a BMI >25. Some more information about weight loss and more specifically improving body composition follow this link.

Therapies

• Exercise: Getting out and moving is a very important when dealing with osteoarthritis and joint degeneration. Exercise has been proven to be much more effective than rest and a combination of strength training, stretching, and aerobic exercise is the best option for managing the condition (3).

• Physiotherapy: Physiotherapy in the form of exercises and other modalities are commonly performed by a chiropractor or physical therapist. Therapeutic exercises directed by a professional have been shown to allow certain osteoarthritic joints to last longer, possibly delaying or preventing surgery (4).

• Chiropractic Manipulative Therapy: Manipulative therapy of certain joints has been reported to help reduce pain in patients with osteoarthritis (5). This is normally a painless procedure that can provide a quick relief of symptoms.

• Manual Therapy: Manual therapy can consist of many different modes of treatment done by chiropractors or physical therapists. These techniques include soft tissue massage, stretches, chiropractic manipulative therapy, and many others. A randomized controlled trial showed that manual therapy may be more effective than exercise in patients with osteoarthritis (6).

• Acupuncture: Acupuncture has been shown to work for most things related to pain and osteoarthritis is no different. A systematic review shows that acupuncture is proven to be effective for reducing pain, improving mobility, and improving quality of life in those with osteoarthritis (7).

Supplementation

• SAMe: S-Adenosyl-Methionine (SAMe) is a product made naturally in the body as a result of normal biochemical processes. Some studies may indicate that supplementation of 1200 mg/day of this natural substance may provide the same amount of relief as ibuprofen (8).

• Avocado-Soybean Unsaponifiables (ASUs): ASUs are made from the extract of avocado and soybean oils. This natural supplement has been shown to be effective at 300 mg/day for decreasing pain, improving symptoms, and improving function in patients with osteoarthritis (9).

• Boswellia Serrata: 100-250 mg/day of the herb known as Boswellia Serrata may be a safe and effective option in managing osteoarthritis (9)

• Ginger: Ginger supplementation of 500-1000 mg/day has been shown to reduce severity of pain in those with osteoarthritis (10).

• Glucosamine: A Cochrane Review concluded that glucosamine sulfate supplementation may improve pain and function in people with osteoarthritis, likely without the risk of side effects. The standard dose for glucosamine is 1500 mg/day (500 mg/3x daily) (11).

• Chondroitin: Chondroitin sulfate is a supplement that goes along great with glucosamine. It has been shown to be effective in patients with osteoarthritis by decreasing pain, improving function, and slowing the progression and degeneration of cartilage in the joints (12). A standard protocol for chondroitin sulfate supplementation is usually around 1200 mg/day.

Topical Gels

• Arnica: Arnica gel applied topically to the damaged area has been shown to be as effective as ibuprofen and other NSAIDS in people with osteoarthritis. It reduces the pain and improves function to a similar or better level without the side effects (13).

• Capsaicin: Topical application of a capsaicin gel product has been shown to be effective at treating symptoms of osteoarthritis (8).

Overall, if you are suffering from mild to moderate osteoarthritis and are looking for ways to improve symptoms and manage/slow the progression there are plenty of options. Many lifestyle changes, supplements, and even topical gels have been shown to naturally improve this condition. Joint replacement surgeries are extremely invasive and often come with many side effects which makes avoiding surgical intervention critical.