Nonpharmacologic interventions for Osteoarthritis

Nonpharmacologic interventions for Osteoarthritis that should be tried first and/or added to medications

  • • Patient education and self-management courses/books/web sites.
  • • Weight loss: every 1 lb (0.45 kg) lost results in a four-fold reduction in load per step on the knee. Weight loss of 5% results in 18% to 24% improvement in function in patients with knee OA.
  • • Occupational therapy, assistive aids/devices, joint protection, and modification of activities of daily living.
  • • Exercise for muscle strengthening/flexibility and aerobic conditioning: proven for knee OA more than for hip OA.
  • • Medial taping of patella for patellofemoral disease.
  • • Unloader/off-load knee brace.
  • • Optimal footwear (athletic shoe) with shock-absorbing insoles: medial knee OA may be symptomatically improved and progression potentially slowed by biomechanical interventions to unweight the knee. The use of clogs, dress shoes, and high heels increases medial compartment loading of the knee by 15% compared with flat shoes, flip flops, or bare feet.
  • • Foot orthotics: orthotics for pes planus/foot pronation to help knee and patellofemoral symptoms and heel lifts to alter forces causing pain in hip OA appear useful. However, in many clinical guidelines, lateral wedge insoles to unweight and help medial knee joint OA have not been shown to be beneficial (controversial).
  • • Ambulatory aids (canes, crutches, walkers): cane can unload the hip by 25% to 40% if used in hand opposite the hip.
  • • Splinting (CMC splints, knee sleeves).
  • • Paraffin baths for hands (may be done at home).
  • • Cervical collar.
  • • Cervical traction or distraction.
  • • Topical lidocaine.
  • • Topical capsaicin (works by depleting nerve terminal of substance P, thereby decreasing pain).
  • • Transcutaneous electrical nerve stimulator (controversial but may help individual patients).
  • • Superficial heat and cold.
  • • Hydrotherapy.
  • • Unconventional: acupuncture (controversial); spa.
  • • Not effective: pulsed electromagnetic fields; static magnets.
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