Osteoarthritis

Warning
Warning:

This site gives you information NOT medical advice. You should consult your medical practitioner if you have any unexplained symptoms of illness or concerns about treatment. Do not stop a prescribed conventional treatment without consulting a doctor. Tell all the practitioners you're working with, conventional or complementary, about any medicines, remedies, herbs or supplements you are taking or considering using.

What do we mean by Osteoarthritis?

Osteoarthritis affects the joints - mainly the knees, hips and small joints of the hands and base of the big toe. But it can involve almost any joint. About 1 million people see their GP about it, and in England and Wales the NHS carries out over 140,000 hip and knee replacements every year.

Osteoarthritis causes mild inflammation around the joints, and changes in the smooth cartilage that covers the parts of the bones that meet in the joints. These strong surfaces allow the joint surfaces to slide easily. Osteoarthritis also causes bony bumps to grow around the edge of joints, making them look knobbly. All this may make a joint stiff and painful to move and sometimes swollen.

Who gets osteoarthritis?

It usually starts in people over 50 and in women more often than men. But younger people can also get osteoarthritis. It's usually set off by an old injury to a joint or by some other type of joint problem. The older you get, the more likely you are to have osteoarthritis, but it isn't inevitable by any means. Even though X-rays of most people over 60 show some of these changes, they may not complain of pain or stiffness. Sometimes a joint can look badly damaged without causing any pain, and sometimes what looks like mild osteoarthritis can be very painful. So the symptoms of osteoarthritis vary from person to person, and from one joint to another.

What causes it?

Ageing is the main cause. Obesity and other causes of extra wear and tear (such as years of poor diet, lack of exercise, and fractures near a joint) are also important factors. The fact that some families seem more prone to it than others suggests there are genetic factors too. Since many women get osteoarthritis after the menopause, hormone deficiencies must play some part as well. But we still don't know why some people with osteoarthritic joints don't get the expected pains or stiffness.

How is it treated?

If osteoarthritis is painful, various treatments can help. Painkillers, physiotherapy and weight loss are the mainstays. In more severe cases, hip joint replacement can be very successful, and knee replacements are becoming more widely available. A lot can be done (apart from prescribing medication) to restore strength and suppleness, function and well-being. Self-care is also very important, and some complementary therapies may be effective.

Here are some useful tips on self-care:

For more information on Osteoarthritis see NHS Choices page on Osteoarthritis and for more on self care see Arthritis Care.org.

What other information might be helpful?

When to see the doctor instead of using this information

If you have recently started taking new medication, it would be worth speaking to your pharmacist about whether this might be the cause of your problems.

simplechangesMake Some Simple Changes


pencil Eating a healthy diet

OverviewIt is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. Improving your diet could help with your mood. The Food Standards Agency has eight tips for eating well:

1 Base your meals on starchy foods.
2 Eat lots of fruit and vegetables.
3 Eat more fish.
4 Cut down on saturated fat and sugar.
5 Try to eat less salt - no more than 6 g a day.
6 Get active and try to keep to a healthy weight.
7 Drink plenty of water.
8 Don't skip breakfast. It sets you up for the day and it helps get your body and mind going first thing.

There is no firm evidence to support the idea that special diets have any effect on joint pain. But losing weight definitely helps overweight people with osteoarthritis. And most of us are overweight even if only slightly. Load-bearing joints in your hips, knees and feet are under particular strain if you are overweight. When joints are very worn, their ability to repair themselves is already reduced, and being overweight also puts extra pressure on them.

If you are overweight, you can slim down by doing more physical activity and cutting down on fats, sugar and carbs. This won't lead to very quick weight loss but it will eventually pay off in the health of your joints and a huge improvement in your overall well-being. If your joint pains are bad and you are very overweight, ask your GP or physiotherapist to plan a suitable exercise programme with you. Your GP and practice nurse can also give you a diet plan to help you lose weight slowly and safely.

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simplechanges Cutting down on alcohol and stopping smoking

OverviewCutting down on alcohol and stopping smoking are likely to improve your health generally.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.
EvidenceResearch suggests that alcohol and smoking are not linked to joint pain.
SafetyThere are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are cutting down from heavy drinking you may experience side-effects, including loss of appetite and difficulty sleeping. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you're cutting down.
CostThere are no costs. In fact you will save money.
Find out moreFor more information, see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.
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simplechanges Exercise

OverviewJoint pain can make you avoid being active because you feel stiff and sore. You might worry that exercising could be harmful or painful. But don't be put off. Keeping active builds up muscle, and this will gradually protect your joints and reduce pain.

Exercise will also relieve stress, make you more mobile, burn off fat and tone up your posture. A physiotherapist will give you an exercise plan to follow at home and/or in a group. Once you start to exercise, you will gradually get stronger and fitter. You will then begin to feel better and cope better with daily activities. So, whatever your age or fitness level, getting active is the most important thing you can do. Your plan should include exercises to make your muscles stronger as well as exercises that improve your general fitness.

You don't have to use the gym to exercise. Even 30 minutes brisk walking every day is enough to make a noticeable difference to your mood and fitness level. There are walking groups in many areas now. Read on for more details.

Being active does more than keep you fit. It makes your heart and lungs work better, tones your muscles, and strengthens your bones and joints. It also stimulates circulation to your brain and internal organs, and boosts the immune system. It helps protect against osteoporosis, triggers brain chemicals that lift your mood and can generate a glowing sense of well-being. It has been shown to improve all sorts of health problems. In mild to moderate depression it can be as effective as anti-depressant medication.

Note: Exercise training can include aerobics such as stepping and walking, strengthening exercises such as lifting weights or using resistance machines, and stretching for flexibility. Other types of exercise are Tai Chi, Qigong and yoga, which will help improve balance and suppleness.

EvidenceResearch suggests that exercise is likely to help with joint pain and movement. But the effect may only be small and it is not clear which type of exercise is best.
SafetySupervised exercise programme are safe for most people. But at first you might feel more tired. If you are not used to being active, start off slowly and build up gradually, doing a bit more every other day. If you feel worse, cut back, and increase your activity more slowly. If you think it isn't helping or that you are getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should first get advice about exercise from a doctor or physiotherapist.
CostYou can exercise at home for nothing; walking and gardening is all exercise, although it is best get advice on the best exercises to do from a trainer first. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme.
Find out moreNatural England is one of several organisations that organise walking schemes designed to help people improve their health. The Walking for Health Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.
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simplechanges Hot and cold packs and heat treatments

OverviewApplying heat to a sore joint increases blood flow and so reduces stiffness and pain. DO NOT apply heat if the joint is already warm, swollen tender and inflamed. Cold helps decrease inflammation and pain by reducing the blood flow. Damp cold (use a wet towel between the skin and the ice pack) gets in deeper and faster than dry cold.

You might need to try both hot and cold to work out which is better for you. You can use a bag of frozen peas, or a warm hot-water bottle. Always wrap the pack (whether hot or cold) in a thin towel or cloth so it doesn't burn or freeze your skin.

Usually, applying heat or cold for about 20 minutes will allow your muscles to relax so that you feel less stiff. Then you might be able to try some slow stretches and get the blood flow back into tense muscles. You may find it more effective to alternate between hot and cold packs every five minutes.
EvidenceIn research studies, cold packs seemed to help with swelling but hot packs did not seem to be so useful. Larger studies are needed to be certain of this.
SafetyThere are no safety problems as long as you take care to wrap the hot or cold pack to avoid burning or freezing your skin.
CostYou can buy special heat packs or use something you already have, like a hot water bottle. Other possible heat sources include: soft heated packs filled with grain, poultices, hot towels, hot baths, saunas, steam, heat wraps, heat pads, electric heat pads and infra-red heat lamps.
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simplechanges Relaxation techniques

OverviewStress raises your blood pressure, speeds up your heart, makes your muscles tense and increases your sensitivity to pain. It also affects the way your stomach and intestines work. Relaxation training can make you more aware of how your body reacts to situations that make you feel stressed. It can help you control your stress response and improve your mood. Useful relaxation methods include slow breathing and muscle relaxation, self-hypnosis and imagery techniques. Each of these methods can be used on its own, or in combination with one or more of the others.

EvidenceMuscular relaxation, imagery and meditation can help people cope with pain. More research is needed to be certain of how much these techniques can help with osteoarthritis.
SafetyRelaxation techniques are generally safe unless you have a severe or long-standing mental health problem.
CostRelaxation techniques can be learned from a book, CD, DVD or during exercise classes such as yoga classes. No costs are involved, although you may need to buy a CD, DVD or book.
Find out moreVisit The British Holistic Medical Association for podcasts and leaflets. See also our leaflet on Stress and Anxiety.
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buysomethingBuy Something


pencil Before You Buy

OverviewFor safe use of over-the-counter medicines, herbal remedies and supplements:

Consult a qualified person (such as a pharmacist) before buying or taking any medicine, remedy or supplement:
- if you have a serious medical condition
- if you are breast-feeding, pregnant or planning to become pregnant
- if you are already taking other medicines, herbal remedies or supplements
- if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.
Do not combine any over-the-counter medicines, remedies or supplements with other medicines, remedies or supplements unless you have first checked with a qualified person (such as the pharmacist in your local chemist).

Seek advice from your doctor or pharmacist:
- If your symptoms do not get better
- if your symptoms get worse
- if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

pencil Herbal remedies and food supplements

OverviewThere is ever more research on herbal remedies and food supplements for joint problems. For the latest information on their effectiveness, visit Arthritis Research UK

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buysomething Anti-inflammatory creams and gels

OverviewRubbing anti-inflammatories into the joints, rather than swallowing them, has the advantage of getting the medication directly into the affected tissues. The drug is not absorbed through the skin as well as it is when you take it by mouth. However, they can still cause internal side-effects such as stomach ulcers and bleeding, but they are less likely to. Though the risk of absorbing enough into your bloodstream is low, any NSAID can cause heart or circulation problems especially if you use it long term.
EvidenceAnti-inflammatory creams and gels definitely soak through the skin into muscles and joint fluid. They may help, but their effectiveness varies a great deal. One recent trial of anti-inflammatory creams and gels found that patients experiencing hand osteoarthritis get their pain decreased by 46% in 6 weeks after treatment started. And patients with knee osteoarthritis experienced relief of the pain by 51% in 12 weeks after the start of the treatment.
SafetyDo not apply anti-inflammatory creams and gels if you are taking other NSAIDs drugs or aspirin as this may increase the possibility of side effects.

Do not use anti-inflammatory creams and gels if aspirin or any non-steroidal anti-inflammatory drug (NSAID eg ibuprofen, diclofenac) have ever given you asthma or a severe allergic reaction.

Serious digestive side-effects occur too but much less often with creams and gels than with tablets. Rarely, stomach bleeding or perforation (making of a hole) can happen without warning while you are using anti-inflammatory creams and gels, especially in older adults. So if you have symptoms of stomach bleeding (black, bloody, or tarry stools, or vomit that looks like coffee grounds) go to A&E immediately.

In about 10 - 15% of people, anti-inflammatory creams and gels cause a skin irritation.
CostApproximate costs will be no more than £10 per month.
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buysomething Avocado-soybean unsaponifiables (ASU)

OverviewASU is a nutritional supplement made up of one-third avocado oil and two-thirds soybean oil. The most common brand names are Piascledine, Regividerm and Avosoy.
EvidenceSeveral studies have found that ASU reduces inflammation in joints. This reduction in inflammation protects joint cartilage and helps it repair itself. Research suggests that taking 300 mg ASU per day for three months is safe, and reduces pain and walking problems in some patients with osteoarthritis.
SafetyOnly minor side-effects of ASU have been reported in most trials. Stomach upsets are the most common problem. But you are at more risk of developing an allergic reaction to ASU if you are allergic to bananas and chestnuts. There is also a possible increased risk of bleeding if you take ASU with blood-thinning medications such as aspirin, heparin and warfarin. Note that ASU can raise blood pressure significantly if taken alongside anti-depressant drugs called monoamine oxidase inhibitors (MAOIs).
CostApproximate costs may be from £10 - £50 per month depending on regularity of use.
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buysomething Capsaicin (topical) cream

OverviewCapsaicin cream is made from chilli peppers, and it offsets joint pain by irritating the skin. So if you have osteoarthritis in your hands or knees and anti-inflammatory creams and gels haven't eased your pain, your GP might suggest you try capsaicin. You can only get it on prescription but if it works for you it will be an excellent form of self-care pain relief.
EvidenceThere is some good evidence from research that, alongside the usual treatments, applying capsaicin can help with pain and tenderness in osteoarthritis, particularly in the knees or hands.
SafetyCapsaicin is an irritant, and some people find its irritating effect worse than the pain it is meant to offset. About one-third of patients get local adverse effects from capsaicin.
Always read the package instructions before use, and avoid using capsaicin if you think you may be allergic to it.
Use plastic gloves when you apply it. Keep it away from your eyes and wash your hands immediately after applying it. Keep it away from children. Wash it off any skin areas that do not need treating, using warm cooking oil, rather than soap or detergent.
CostSpeak to your GP about prescription of this product.
Find out moreTo find out more, see Ten things you should know about capsaicin
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buysomething Chondroitin

OverviewChondroitin is generally combined with glucosamine (see above). The usual dose is 1500 mg of glucosamine and 1200 of chondroitin daily for 1- 2 months. It may take weeks or months before improvements are noticed. If it helps, the dose can then be reduced to 1000 mg of glucosamine and 800 of chondroitin or less.
EvidenceIt is not clear from research whether chondroitin used alone helps with osteoarthritis. But it may help with pain in the short term.
SafetyThe long-term safety and effectiveness of chondroitin are unclear. Its reported side-effects include stomach upsets, headaches and rashes, but these are uncommon. Patients taking aspirin, heparin or warfarin should let their doctor know if they are taking chondroitin. Chondroitin might worsen breathing problems in people with asthma.
CostApproximate costs will be from £20 - £50 per month.
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buysomething Devil's claw (Harpagophytum procumbens)

OverviewThis unusual plant from the desert regions of southern Africa has a thorny root, which the local people traditionally used as a remedy for arthritic problems. It is becoming rare nowadays in its natural state so it is important to buy only from reliable manufacturers who supply only farm-grown devil's claw.
EvidenceThere is moderate evidence showing that devil's claw may be as effective as conventional medicines for osteoarthritis of the hip and knee. But the side-effects are a concern.
SafetyMost of the side-effects seem to be mild and uncommon: mainly headaches, ringing in the ears, loss of appetite and loss of taste. Minor side-effects also include skin rashes, stomach upsets and diarrhoea. Devil's claw increases stomach acidity, and therefore shouldn't be combined with blood-thinning medication (e.g. aspirin), painkillers (e.g. ibuprofen), heart drugs (e.g. digoxin) or stomach acid drugs (e.g. famotidine). Serious side-effects of devil's claw (abnormal heart rhythm and bleeding) are uncommon.
CostDevil's claw is available over-the-counter as capsules and liquid tinctures. Researchers suggest a dose of 60 mg a day of the active ingredient (harpagoside). The content of tablets varies a lot. This is equivalent to 500-1500 mg of dried root or the equivalent amount of the extract in a capsule or liquid.
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buysomething Ginger

OverviewGinger is a tropical plant. The herbal preparation is made from the underground stem (called ginger root). Laboratory studies have shown that ginger extracts can lessen the effect of several chemical substances that trigger joint inflammation. Ginger also contains aspirin-like chemicals, called salicylates, which reduce pain.
EvidenceSeveral trials have shown that ginger may ease pain and help with movement.
SafetyBeing a food, ginger is a safe herbal remedy. But the safe and effective dose is not certain. The most commonly reported side-effects are stomach upsets and a sore mouth. Taking ginger might also increase the risk of bleeding if you are taking blood-thinning medications like aspirin, heparin and warfarin.
CostGinger capsules and ginger oil are available from pharmacies and health food shops.
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buysomething Glucosamine

OverviewGlucosamine and chondroitin sulfate are sold as dietary supplements in most pharmacies and healthfood shops. A lot of people now taking glucosamine and/or chondroitin for osteoarthritis say it helps reduce pain. It isn't clear yet whether these supplements actually slow down the wear and tear in joint cartilage. The body produces glucosamine in cartilage and connective tissue. Chondroitin sulfate helps cartilage retain water.

If you take glucosamine in capsule form, you will need at least 1500 mg per day. The usual dose is 1500 mg of glucosamine and 1200 of chondroitin daily for 1- 2 months. It may take weeks or months before improvements are noticed. If it helps, the dose can then be reduced to 1000 mg of glucosamine and 800 of chondroitin or less.
EvidenceA recent big study in the USA found that glucosamine sulphate combined with chondroitin sulfate did not help mild pain. But for people with moderate-to-severe pain, it did give significant relief. There have been many clinical trials of glucosamine for osteoarthritis, but results have been both for and against glucosamine's usefulness. Consequently doctors are not sure whether to recommend it, and it has yet not been approved for NHS prescribing.
SafetySide-effects are rare and mild such as upset stomach. Glucosamine supplements are made from shellfish shells. Chondroitin supplements are generally made from cow cartilage. We have found no reports of allergic reactions to these supplements.
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buysomething Green-lipped mussel extract

OverviewGreen-lipped mussel extract is a nutritional supplement made from a type of New Zealand mussel (Perna canaliculus).
EvidenceSome research studies have suggested that this supplement may help in mild to moderate osteoarthritis, when taken alongside paracetamol or anti-inflammatories.
SafetyOnly minor side-effects, such as stomach upsets, have been noted. But problems may arise if this supplement is combined with blood-thinning medications such as aspirin or warfarin. Recommended safe doses are uncertain.
CostAvailable from pharmacists and healthfood shops as capsules and gel.
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buysomething Indian frankincense

OverviewIndian frankincense is extracted from a tropical plant, Boswellia serrata, traditionally used in India for many diseases. Research has shown that it can stop the body producing some substances that trigger joint inflammation.
EvidenceTrials suggest that frankincense may have some helpful effects in osteoarthritis of the knee.
SafetyA daily dose of 1g has been used in research trials for osteoarthritis. This seems to be safe in the short-term. Its safety is uncertain if you are using it for more than 12 weeks. Possible side effects include digestive upsets.
CostCapsules are available from pharmacies and healthfood shops.
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buysomething Painkillers

OverviewAnti-inflammatory tablets (such as ibuprofen) are slightly more effective than paracetamol for easing knee and hip pain in people with osteoarthritis.
EvidenceThere is good evidence to show that painkillers such as ibuprofen help with pain. Paracetamol also has some effect but not as much as ibuprofen.
SafetyIf used in the correct dose, painkillers are generally safe, but taking painkillers (whether prescription or over-the-counter) every day can cause side effects.

Side effects can include headaches, indigestion and even stomach ulcers or bleeding. Stop taking them if you start getting indigestion or stomach pain, and tell your GP or pharmacist. Always follow the stated dose.
CostPainkillers can be bought from pharmacies for low cost.
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buysomething Phytodolor

OverviewPhytodolor is a German herbal preparation made from aspen, common ash bark and golden rod herb. It is also known as STW1. This product is regulated by the Medicines Act, but does not yet have a UK licence so it cannot be sold over the counter in the UK.
EvidenceSeveral trials have found phytodolor to be effective in reducing pain and improving joint mobility in osteoarthritis. It seems to be as effective as anti-inflammatories (such as ibuprofen and diclofenac) but with far fewer side-effects.
SafetyResearchers have found no reported problems when combining phytodolor with other medicines. Minor side-effects include stomach upsets and skin rashes.
CostPhyodolor does not yet have UK Marketing Authorisation and is not currently available in the UK.
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buysomething Rosehip (Rosa canina)

OverviewThis traditional herbal medication, available over the counter in capsule form, contains substances that might reduce joint inflammation and help prevent joint damage.
EvidenceResearch suggests that rosehip may be helpful in relieving some of the symptoms of osteoarthritis.
SafetySide-effects, though uncommon and mild, include allergies and stomach upsets. A dosage of 5g per day has been used in various clinical trials.
CostApproximate costs will be no more than £10 per month.
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buysomething SAMe (S-adenosylmethionine)

OverviewSAMe (sometimes known as 'Sammy') is a dietary supplement, not a herbal remedy. It occurs naturally in the body. It is an anti-oxidant and an anti-inflammatory and helps produce important brain chemicals that improve mood. SAMe has been used for two decades in Europe to treat arthritis and depression. Laboratory studies have suggested that SAMe stimulates the repair of joint cartilage.

A full dose of SAMe for an adult is 400 mg three to four times a day but some people get digestion problems if they start on this amount straight away. If you decide to try it, you should gradually build up to this amount if you can, starting with 200 mg twice daily, and aiming to reduce to a lower dose once you start to feel better on the full dosage.
EvidenceThe evidence from eleven studies suggests that SAMe is about as effective as anti-inflammatory medicines (ibuprofen etc) for reducing the stiffness caused by osteoarthritis; but less effective against pain.
SafetySAMe does not generally cause problems. The most common side effects are nausea and skin rashes. Patients with allergies should not use it. Do not take it with other medicines, remedies or supplements unless you have checked with a qualified person (such as a pharmacist). The best and safest doses are not yet certain.
CostSAMe is regulated by the Medicines Act, and does not yet have a UK licence, so it cannot be sold over the counter in the UK. It can be purchased from Internet retailers, but there are no guarantees of quality and as this is an expensive supplement, whose long term effects are uncertain.
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buysomething Using transcutaneous electrical nerve stimulation (TENS)

OverviewTENS is a way of delivering a small, pulsating current to your muscles and nerve endings. It is relatively easy and safe to use. Small electrical currents are sent through pads on the skin near the site of the pain. Several small studies have suggested that using TENS machines helps some people with long-term pain in general.
EvidenceThere have been a few small studies of TENS for osteoarthritis of the knee, but they haven't firmly established whether or not TENS gives effective pain relief.
SafetySee the information sheet on TENS machines from Arthritis Care for information on how to use TENS machines safely.
CostTENS machines are available from many pharmacies and some Internet retailers. They usually cost between £20 and £40 but this is a one-off cost.
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attendvisitAttend Classes / Visit Practitioner


pencil Dealing with psychological and emotional problems

OverviewFor someone with severe osteoarthritis, the experience of long-term pain and limited activity may have a psychological impact, perhaps even leading to depression and anxiety. Loneliness and feelings of helplessness make pain worse. Self-care approaches and psychological treatments can help people cope better with pain and disability, and may improve quality of life.
What you can doThere is life after you've been told you have osteoarthritis! A lot can be done to help you manage your pain and preserve your social networks, to control your weight and overcome some of your physical limitations. When you see your GP or practice nurse, don't just talk about your pain. Let them know if osteoarthritis is making relationships and activities difficult. And let them know if you think your overall wellbeing is suffering, or that you might be getting depressed or anxious. A comprehensive treatment plan can include treatment and self-care to help you get on with your life despite osteoarthritis. See also [url=http://www.bps.org.uk]The British Psychological Society[/url]

pencil Manual therapies

OverviewNot all physical therapists use their hands; some are more exercise-based. Manual therapies can involve sessions of light or deep massage, with or without stretches. Osteopaths and chiropractors generally use stretching and manipulation of joints, as well as massage.

NICE guidance on osteoarthritis suggest that manipulation and stretching should be used as 'add-ons' to core treatment, particularly for osteoarthritis of the hip. See below for some treatment options that it may be useful to try.

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attendvisit Acupuncture

OverviewAcupuncture is a traditional treatment that was first used in China thousands of years ago. Thin needles are inserted into the skin at certain points on the body, which practitioners believe will help restore health. The treatment sometimes also involves heat, pressure, electrical currents or soft-laser light. In the UK, acupuncture is most commonly used for pain relief.
EvidenceAcupuncture may help reduce pain and stiffness. The effects are small but they may make a useful difference for some people. It is not clear how acupuncture works, but there is good evidence that it can help with some sorts of long-term pain.
SafetyAcupuncture is generally safe if practised by a trained acupuncturist. The most common side-effects are slight discomfort (common) and bruising (occasionally).
CostA session may cost £35-£50. Frequency of treatment will depend on you and your practitioner.
Find out moreThe following professional organisations can help you find a qualified practitioner:

Acupuncture Association of Chartered Physiotherapists
British Academy of Western Medical Acupuncture
British Acupuncture Council
British Medical Acupuncture Society
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attendvisit CBT for depression

OverviewEven if osteoarthritis only affects one joint, it can reduce your mobility and your independence. The emotional effects of this can lead to depression. And the research suggests that people with osteoarthritis are more likely to get depressed.

You are more likely to get depressed:

- the worse your pain feels
- the fewer social contacts you have
- the harder you find it to get around
- the harder you find it to do enough with your upper body
- the older you are
- the more overweight you are.

In a big US study, patients with osteoarthritis and depression were treated with anti-depressants and psychotherapy. Both their depression and their arthritis symptoms improved. The results showed that, after treatment, the participants had less pain and their arthritis caused less interference with their daily activities. Their general health status and quality of life improved as well.

SIGNS OF DEPRESSION
You might think that feelings of depression don't have anything to do with having osteoarthritis. But please don't ignore them. And if you think you could be depressed, getting help will make a huge difference. For more on this, see our leaflet on Depression.

The following checklist of symptoms is only meant to help you discuss your concerns with your doctor and find out about different treatment options. Don't be scared if you recognise the thoughts and feelings listed. If several of them do apply to you, this could mean that you are suffering from depression. But remember, there are good treatments available to help you get through it and back to feeling well again.
Symptoms of depression include:

- sadness throughout the day, nearly every day
- loss of interest in or enjoyment of your favourite activities
- feelings of worthlessness
- excessive or inappropriate feelings of guilt
- thoughts of death or suicide
- trouble making decisions
- fatigue or lack of energy
- sleeping too much or too little
- change in appetite or weight
- trouble concentrating
- feelings of restlessness or being slowed down.

If you have been experiencing some of these symptoms for more than two weeks, you ought to get some professional advice. If you are feeling as if you can't cope, or that life is just too difficult or not even worth living, get help immediately. These are urgent signs that you need to talk to someone.
EvidenceThere is good evidence that treating depression helps osteoarthritic pain and disability and improves all-round quality of life. CBT can help in depression, though not everyone benefits from this type of treatment.
SafetyCBT can be expensive if you pay for it privately. It is widely available on the NHS, but there can be a long waiting list. Ask your GP if it would be an appropriate treatment for you.
Find out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit CBT for pain

OverviewThe Royal College of Psychiatrists says cognitive behavioural therapy (CBT) can help you change how you think ('cognitive') and what you do ('behaviour'). Instead of looking for causes of distress in the past (as some forms of psychotherapy do), CBT looks for ways to improve your state of mind right now. It aims to help you find ways of reducing insomnia, anxiety, tension and depression.

There is good evidence that CBT can help reduce pain, as well as sleeplessness and depression in people with osteoarthritis.

Pain is stressful; and stress makes pain worse. Relaxation techniques are the most basic form of CBT. A CBT practitioner can also help you make sense of what may seem like overwhelming problems by breaking them down into smaller parts. This makes it easier to see how they are connected and how they affect you.

There are usually three phases in CBT for pain management:
1 learning about how pain is affected by thoughts, feelings and relationships
2 training in relaxation techniques, activity pacing, scheduling, imagery techniques, positive breaks, using distraction, changing negative thought patterns, problem-solving and goal-setting
3 trying out the new skills and applying them in real-life situations.

The ultimate aim of effective CBT is 'active coping'. Active copers know how to go about solving problems and finding information. They get help from friends, family or professionals when they need it. When they feel stressed 'physically or emotionally' they have ways of dealing with it. Active coping is the opposite of 'avoidant coping'. Avoidant copers try to avoid dealing with stressful situations or events by getting into damaging activities (such as over-use of alcohol) or negative mental states (such as withdrawal and isolation).

A recent review of the best clinical studies of psychological treatments for people with osteoarthritic pain looked at CBT (mainly skills for coping with pain) as well as biofeedback, stress management, emotional disclosure, hypnosis and psychodynamic therapy. The researcher concluded that these methods can reduce and prevent pain and suffering by helping people learn to cope better with anxiety, pain, depression, joint swelling and physical limitations. These coping skills improved their quality of life.
EvidenceOverall, psychological treatments had a small, but significant, effect on arthritis pain. These treatments were particularly effective in helping people learn active coping techniques, deal with anxiety and cope with joint changes.
SafetyThese techniques are safe in most people if carried out by or under the guidance of a qualified counsellor or psychologist.
CostCBT can be expensive if you pay for it privately. It is widely available on the NHS, but there can be a long waiting list. Ask your GP if it would be an appropriate treatment for you.
Find out moreIt is important to find a qualified counsellor or psychologist. Contact The British Psychological Society
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attendvisit CBT for sleep problems

OverviewAbout 60% of people with osteoarthritis experience pain in the night. Pain disturbs sleep, and disturbed sleep makes pain worse in the long run. It's a vicious circle.

Cognitive-behavioral therapy for insomnia (CBT-I) uses various methods to help develop positive attitudes and habits that promote a healthy sleep pattern. One common technique is relaxation training.

In one study, 23 older adults with osteoarthritis and insomnia (aged 69 on average) had eight CBT-I sessions, each lasting two hours once a week in classes ranging from four to eight people. After treatment they fell asleep faster, and spent less time awake during the night.
EvidenceA year after the research described above, the participants were still sleeping better and for 30 minutes longer each night. They reported less pain during the month after the CBT sessions ended; and a mild reduction in pain was reported one year later.
SafetyThese techniques are safe in most people if carried out by or under the guidance of a qualified counsellor or psychologist.
CostCBT is available via GP referral to an NHS psychologist. Ask your GP if it would be an appropriate treatment for you.
Find out moreContact The British Psychological Society
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attendvisit Exercise programmes

OverviewBecause you feel stiff and sore, you are likely to become less active. But then you lose fitness and strength. So don't let having osteoarthritis put you off taking exercise. Keeping active will rebuild your muscles, and this will gradually protect your joints and reduce your pain. Getting active will also improve your mood and morale.

Structured exercise programmes generally take place in a group, supervised by a physiotherapist or qualified exercise instructor. Exercises should include aerobic activity as well as strengthening, posture-improving and stretching movements. A programme or course usually means eight or so sessions over 12 weeks, with exercises to practise at home between sessions.

Supervised exercise programmes are safe for most people. But at first you might feel more tired. If you are not used to doing much exercise, you should gradually increase your activity until you can manage a moderate level. If you feel worse, cut back and build up more slowly. If you think it isn't helping or that you are getting worse in any way, check with your doctor. Anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise.

Exercise training can include aerobic forms such as stepping and walking; strengthening exercises such as lifting weights or using resistance machines; and stretches for flexibility. Other types of exercise are Tai Chi, Qigong and yoga.
EvidenceResearch suggests that exercise eases knee pain and stiffness as much as anti-inflammatory medication. But it is not clear which type of exercise is best. Exercise, whether on land or in the water, definitely seems to help osteoarthritis of the knee and hip. The evidence is less certain about its effectiveness for osteoarthritis in other joints.
SafetySupervised exercise programmes are safe for almost everyone. If you haven't been active for some time, start slowly and build up. If you have heart or chest problems, get medical advice first.
CostThere will probably be a small cost (£8 a class) if you join an organised programme. Your GP can also refer you to the local physiotherapy department.
Find out moreClasses are run in most areas by both local authority leisure services and private gyms.
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attendvisit Massage

OverviewThere are many different types of massage, some more of them vigorous and going deeper into the muscles than others. Massage has traditionally been used for relaxation. It may be just on one part of the body (for example, the back and shoulders), or it can be done on the whole body. Aromatherapy massage uses pleasant-smelling essential oils.
EvidenceMassage can ease back and neck pain but it is unclear whether or not it is helpful in osteoarthritis.
SafetyMassage is safe if carried out by qualified massage therapists, and it rarely causes problems. Vigorous massage should be avoided if you have blood disorders, some forms of cancer, skin problems or are on blood-thinning medications (such as warfarin). Allergies or skin irritation can occur with some essential oils used in massage.
CostMonthly cost will depend on how regularly you receive treatments.
Find out moreIt is important to find a qualified practitioner such as one registered with
The General Council for Massage Therapies
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attendvisit Physiotherapy

OverviewPhysiotherapists use exercises and stretches to improve strength, flexibility and stiffness. Often these exercises need to be done at home at least once daily for many weeks or months. Some physiotherapists can provide massage, hydrotherapy in a special pool, many use soft lasers, electrotherapy or ultrasound to speed up healing. A lot of physiotherapists use acupuncture techniques as well. Ask your physiotherapist what sort of methods they have available.
EvidencePhysiotherapy is important in the management of OA. For instance learning the right exercises for strengthening the thigh muscles will reduce pain and stiffness of the knees. Regular aerobic and resisted exercises can improve all round levels of pain.
SafetyPhysical treatments are generally safe if practised by a trained therapist.
CostThe exercises are simple, but they need to be done every day. They cost nothing once you have learned to do them. However you need advice for the right exercises and your GP may refer you to an NHS physiotherapist. Private physiotherapy is available in all areas. A half hour appointment will vary in cost between £30 and £60. Monthly cost will depend on duration of the treatment.
Find out moreIt is important to find a qualified practitioner such as one registered with
The Chartered Society of Physiotherapy
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attendvisit Tai Chi

OverviewTai Chi is also known as 'moving meditation' It is a series of slow, graceful, controlled movements, which develop strength, balance, posture and inner peace. It is a discipline that has to be learned in a class from a teacher and can then be practised at home.
EvidenceThere is some research suggesting that Tai Chi can help people cope with painful knee joints.
SafetyTai Chi is safe for most people. Though Tai Chi is slow and gentle, anyone with severe osteoporosis, joint problems, acute back pain or recent injuries should avoid strenuous exercise and build up gently.
CostOnce you have learned the movements, you can do the exercises at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services or you can contact the The Tai Chi Union.
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attendvisit Yoga

OverviewYoga, as taught in the UK, generally includes physical postures or stretches, breathing techniques, meditation and relaxation. There are several different types of yoga. Some of them are mainly based on the physical exercises (some types are much more strenuous than others). Others focus more on meditation.
EvidenceYoga exercises may help if you have been told that your low back pain is due to osteoarthritis. But there isn't much research to support it as a self-care treatment for osteoarthritis in general, apart from one study which showed that it helped with osteoarthritis in the hands.
SafetyYoga is generally safe when practiced appropriately and at the right level. Classes are run for different ability levels so look for one that is right for you. Yoga stretches should be increased slowly. If in doubt, check with your doctor, osteopath or physiotherapist. Avoid with severe osteoporosis or acute joint or back pain, or recent injuries.
CostOnce you have learned the techniques you can do your yoga at home, at no cost.
Find out moreClasses are run in most areas by both private tutors and by adult education services. To find a qualified teacher near you see also the The Yoga Alliance
and the The British Wheel of Yoga.
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