8 Best Non-Surgical Treatments for Osteoarthritis
What’s the best treatment for osteoarthritis (OA)? Like most things related to your health, the answer depends on a number of factors. “When you’re first diagnosed with OA, your doctor will do a physical exam, ask about your medical history and symptoms, and likely do an X-ray to see what’s going on inside the joint,” says E. Grant Sutter, M.D., orthopedic surgeon at Northwestern Medicine Central DuPage Hospital in Naperville, IL. Everything that process reveals—severity of the disease, pain level, amount of disability, X-ray results—is then used to determine the best treatment option for you.
When Surgery Might Be Necessary
Quick refresher: OA, the most common form of arthritis, develops when cartilage—the flexible connective tissue that cushions the ends of bones in a joint—wears away. Without that cushion, bones start to rub together, causing pain, swelling, and sometimes bony growths. OA is a degenerative disease, meaning it slowly gets worse over time. In the most advanced stages of OA, joint replacement surgery may be the best way to regain normal functioning. But before it gets to that point, there are plenty of non-surgical treatments that can help you manage symptoms and prevent pain and discomfort from interfering with your life.
Nonsteroidal Anti-Inflammatory Medications (NSAIDs)
NSAIDs like aspirin, naproxen, and ibuprofen can help reduce pain and inflammation for people with minor-to-moderate OA, says Savyasachi C. Thakkar, M.D., assistant professor of orthopedic surgery at Johns Hopkins Medicine in Columbia, MD. But there are risks associated with regular use of NSAIDs, like heartburn, stomach ulcers, or kidney damage, so talk to your doctor first—especially if you have a medical condition that predisposes you to those things. Prescription-only NSAIDs, like Celebrex, or topical NSAID gels, like Voltaren, may work well for some people, Dr. Thakkar says. As always, a chat with your doctor is the first step.
Yes, you can (should!) continue physical activity with OA. Exercise, and the strength and flexibility benefits that come along with it, helps promote healthy joint function, says Julius Kunle Oni, M.D., medical director of orthopedics at Johns Hopkins Bayview. There’s just one caveat: “Focus on lower-impact exercises,” Dr. Oni says. High-impact activities like jumping, burpees, or running for long distances may put too much pressure on the joints and aggravate arthritic pain. Instead, try things like cycling and water exercises.
Cold or Hot Therapy
Different symptoms call for different temperatures. If you’re dealing with pain and swelling, icing is best. “Putting ice on a painful joint works by reducing blood flow and temporarily disrupting the inflammatory process,” Dr. Thakkar says. It’s a good strategy for treating an acute injury, redness and swelling, or a flare from overdoing it. Applying heat to a joint, on the other hand, improves circulation and can help reduce stiffness (but isn’t great for inflammation). Switching between cold and hot therapies based on what your body needs can help you manage symptoms day-to-day.
Getting to and maintaining a healthy weight is one of the best ways to slow down OA progression. “A huge percentage of overweight patients with mild-to-moderate OA find their symptoms drastically improve—and sometimes go away completely for a period of time—if they lose excess weight,” Dr. Sutter says. Weight loss is most helpful when we’re talking about OA in weight-bearing joints, like the hips, knees, and ankles, adds Dr. Thakkar. Need help losing weight? Talk to your doctor, who can refer you to a registered dietitian or other specialist who can help.
Targeted physical therapy (PT) is recommended for the exact same reason as exercise. “When degeneration happens in a joint, the muscles around it also get weaker,” Dr. Thakkar says. “And when the muscles get weaker, they can’t support the joint anymore.” This leads to reduced function and pain. When you strengthen the muscles that surround and support an arthritic joint—like you do in PT—the muscles are then able to work harder and take some of the stress off the joint. Visit ChoosePT.com to find a PT who specializes in orthopedics, or ask your doctor for a referral.
When NSAIDs, activity modification, and physical therapy aren’t enough, your doctor may suggest corticosteroid injections to help control OA joint inflammation. These powerful, targeted medications mimic natural hormones in the body to reduce inflammation. They’re injected directly into the inflamed joint, start working within a few days, and can provide up to six months of relief for some people, Dr. Thakker says. There is a small risk that corticosteroids can compromise bone health in the area of injection, so doctors advise against getting these injections more than three times per year, he adds.
Viscosupplementation involves injecting a gel-like substance called hyaluronic acid into the joint. Hyaluronic acid is found naturally in the joints, where it acts as a cushion and shock-absorber. Adding more to an arthritic joint may help relieve pain, Dr. Thakkar says, adding that it’s primarily given in the knee. While some people report viscosupplementation helps relieve OA pain, others may not notice a benefit. But it’s an option if other treatments are not working. “Most insurance companies will want to see that you’ve tried corticosteroid injections and failed those first before approving viscosupplementation,” Dr. Thakkar says.
“Turmeric is the one alternative treatment I talk to my patients about,” Dr. Sutter says. Though research on its therapeutic effects is minimal, what does exist is promising: Some studies have shown that curcumin—the compound that gives turmeric it’s yellow color—may reduce pain and help improve physical function in people with OA. It may work by acting as a natural anti-inflammatory, though exactly how it works isn’t fully understood. If you want to try it, turmeric supplements are available over-the-counter—just be sure to clear it with your doctor first.
- Cartilage Facts: International Cartilage Regeneration and Joint Preservation Society. (n.d.). “What Is Cartilage?” cartilage.org/patient/about-cartilage/what-is-cartilage/
- NSAIDs Facts: National Arthritis Foundation. (n.d.). “NSAIDs.” arthritis.org/drug-guide/nsaids/nsaids
- Exercise for OA: National Arthritis Foundation. (n.d.). “Benefits of Exercise for Osteoarthritis.” arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/benefits-of-exercise-for-osteoarthritis
- Hot and Cold Therapy: National Arthritis Foundation. (n.d.). “Heat Therapy Helps Relax Stiff Joints.” arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/heat-therapy-helps-relax-stiff-joints
- Corticosteroid Injections: Kaiser Permanente. (2016). “Corticosteroids (Intra-Articular) for Osteoarthritis.” wa.kaiserpermanente.org/kbase/topic.jhtml?docId=hw125512#hw125512-Bib
- Viscosupplementation: American Academy of Orthopaedic Surgeons. (2015). “Viscosupplementation Treatment for Knee Arthritis.” orthoinfo.aaos.org/en/treatment/viscosupplementation-treatment-for-knee-arthritis
- Turmeric Facts: National Center for Complementary and Integrative Medicine. (2020). “Turmeric.” nccih.nih.gov/health/turmeric
- Turmeric Effects on OA: ACSM's Health & Fitness Journal. (2018). “Turmeric and Osteoarthritis.” journals.lww.com/acsm-healthfitness/fulltext/2018/05000/turmeric_and_osteoarthritis.10.aspx