14 Do's and Don'ts for Fighting Osteoarthritis

Your knees shriek as you walk upstairs and hands hurt when opening a jar. Is it just age or the most common form of arthritis – osteoarthritis? Learn how to heal your deteriorating joints. Here are 14 do’s and don’ts from top rheumatologists. Plus, how much do you already know about bone health? Take our osteoarthritis quiz to find out…

When did you start sounding like your grandmother? Those grunts you make bending down to pick up a book or getting out of bed in the morning may be triggered by more than just temporary pain.

Stiff joints could mean that osteoarthritis, the most common form of arthritis, is sneaking up on you. The disorder occurs when cartilage in your joints starts to wear out.

Osteoarthritis mostly strikes people, particularly women, after age 40. Their child-bearing physiology, genes and hormones are partly to blame. Injuries from sports, overuse of the joints and obesity can exacerbate it.

Fortunately, some simple steps can prevent osteoarthritis – or at least halt its progression. We talked to top rheumatologists about the best ways to handle joint pain. Here are their top do's and don’ts.

The Do’s
1. Know your DNA.
“Osteoarthritis has a genetic component,” says rheumatologist Nathan Wei, M.D., director of the Arthritis and Osteoarthritis Treatment Center of Maryland. “If your mom and dad have it, odds are good that you’ll have it too.”

Hand arthritis, for example, is commonly an inherited disorder.

Pay attention to the early warning signs of pain, stiffness and joint swelling. See your doctor, who may X-ray joints to confirm osteoarthritis.

A physician may also take fluid from fluid-filled sacks (bursa) between the joints to rule out other conditions, such as infection. Once you confirm osteoarthritis, you can take steps to care for them.

2. Change your diet.
The right diet can keep your joints in top form as you age.

“Add more sulfur-containing food – like asparagus, eggs and garlic – to your plate,” says internist Rashmi Gulati, M.D., medical director of Patient’s Medical in New York City.

“[They] help repair and rebuild bone, cartilage and connective tissue, and aid in calcium absorption.”
Plenty of whole foods, such as vitamin K-rich leafy greens, have natural anti-inflammatory properties.

The vitamin helps prevent inflammation, Gulati says, which is crucial because the breakdown of bone and cartilage — and the friction between the bones at the joint — trigger irritation.

Many spices also tame the flame, so garnish your plate with oregano, turmeric, rosemary, garlic and ginger.

Also, eat a half-cup of fresh pineapple daily. It contains bromelain, an inflammation-fighting enzyme. The canned and frozen varieties don’t have it, she says.

Gulati also recommends dark berries (blueberries) and red vegetables (red peppers), which contain potent antioxidants that decrease inflammation.

“Eat 3-4 vegetables and three fruits a day," she says.

And make sure your diet contains "6- to 8-ounce servings of small [oily] fish — sardines, anchovies or tilapia — five times a week.” These fish contain omega-3 fatty acids, powerful anti-inflammatories.

Can’t eat that much seafood?

Wei recommends daily omega-3 supplements, following dosage recommendations on the bottle. They’re available in tablets or capsules at most drugstores and health-food stores.

But skimp on fruits and vegetables, such as eggplants, white potatoes and tomatoes, which contain solanine, a bitter poisonous compound.

“It interferes with enzymes in the muscles, causing pain and discomfort,” Gulati says.

3. Exercise.
Do low-impact aerobics like swimming, cycling or elliptical training regularly, Wei says. Keeping muscles around the joints strong and flexible prevents pain.

He recommends using stationary exercise machines, which reduce wear and tear on your joints.

Walking outdoors is great too, he says, “as long as you wear well-cushioned shoes and walk on soft surfaces like grass or dirt.”
Start slowly, working up to at least 30 minutes of gentle exercise most days of the week.

If you work in front of a computer from 9 to 5, get up, move around and stretch throughout the day. Sitting still only exacerbates stiffness and pain.

4. Stretch.
Stretching trains tendons and ligaments to support your joints, Wei says.

Stretch muscles associated with the "joints you use the most — and not before you warm up,” he says. Stretching cold muscles makes injury much more likely.

“After exercise, when your muscles and tendons are warm, is the best time to stretch.”

Thirty-minute yoga sessions 2-3 times a week are another way to stretch, stay flexible — and relaxed, Gulati says.

Her advice is backed by science: A 2005 University of Pennsylvania study found that after eight weeks of 90-minute yoga sessions, people with knee osteoarthritis had significantly less pain, better function and happier moods.

5. Strengthen.
Knee osteoarthritis is common, but strengthening quadriceps muscles at the front of the thigh helps stabilize your knee and prevent osteoarthritis — or at least keeps it from getting worse.

“It’s as easy as leg lifts,” says rheumatologist Frank Arnett, Jr., M.D., a professor at the University of Texas Medical School in Houston.

“Sit in a chair and [straighten] one leg, hold it for 10 seconds and repeat 15 times. Do that daily three times in each leg, and I guarantee that you’ll see your quadriceps grow.”

A small 2001 Tufts University study of 46 people with knee osteoarthritis found that people in a four-month strength-training program had a 71% improvement in knee strength and a 36% improvement in pain.

6. Alternate ice and heat.
“Ice can be your friend,” especially after a workout because it reduces swelling and inflammation, Wei says. Put a bag of frozen peas on the painful spot for 15-20 minutes twice a day, he advises.
Or try alternating cold and hot packs, Gulati says. That way you can have continuous pain relief — and the heat relaxes tight muscles.

“Put one on for 5 minutes, then the other, for up to 15 minutes.”

If you use an ice pack, Wei says, place a cloth between the pack and your skin to avoid irritation.

7. Consider glucosamine-chondroitin.
Glucosamine — a derivative of glucose — is one of the building blocks of new cartilage. Chondroitin is a carbohydrate that slows the breakdown of cartilage. Together, they may help your osteoarthritis.

The largest study on the use of glucosamine and chondroitin supplements, the 2006 Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), looked at 1,583 patients with knee pain caused by osteoarthritis.

Researchers found that the drugs together weren’t much more effective than placebos in stopping cartilage deterioration, but they helped relieve moderate to severe knee pain. Despite the results, Wei remains a believer and user.

“A number of European human studies have shown they work,” he says. “I take them and when I go off them, I notice it.”

8. Soak in Epsom salts.
“Epsom salt baths relax the muscles that cramp up with inflammation,” Gulati says.

It's a combination of sulfates and magnesium. The minerals, which are essential for healthy bones and joints, is absorbed into the body through the skin.

“Put 5 ounces of the salts in a warm water bath and soak for 10-15 minutes,” Gulati says.

9. Get outdoors.
Sunshine stimulates vitamin D production in the body, essential for proper bone formation. So consider this a two-fer tip: Get your exercise and vitamin D at the same time on your daily walks.
You can also get your daily dose of vitamin D through foods, including fortified milk, salmon, sardines and eggs. Or, take a supplement.

Current federal recommendations for vitamin D are 200-400 International Units (IU) daily for adults, but many physicians feel that 1,000 IUs a day is ideal. Consult your doctor before taking any supplements.

The Don’ts

1. Don’t gain weight.
Obesity and joint pain are constant companions.

“If you are overweight or obese, it is nearly impossible to avoid inflamed joints in your legs, pelvis or lower spine,” says physical therapist Matthew Goodemote, MPT, founder of Community Physical Therapy & Wellness in Gloversville, N.Y.

The best way to lose weight? Eliminate high-fat, high-sugar foods and eat fruits, vegetables, whole grains, and lean meats and fish instead.

Get out and exercise too, even if you only walk around the block. Every little step helps you lose weight and ward off joint pain.

2. Avoid regular cortisone shots.
You’ll get immediate relief from cortisone injections, a short-acting steroid that reduces inflammation and pain.

But keep in mind: Cortisone inactivates vitamin D, hampers calcium absorption and inhibits growth hormone, which is important to bone repair. The upshot is weaker bones, ligaments and tendons.

“This is a major don’t,” Wei says, because corticosteroids can damage cartilage over time. “The more shots you get, the worse the damage.”

3. Don't smoke.
“Smoking damages joints,” Gulati says. Tobacco’s toxins also stress connective tissue, which leads to more problems.
In a 2007 Mayo Clinic study of men with knee osteoarthritis, smokers were twice as likely to lose significant amounts of cartilage than nonsmokers.

The researchers believe that smoking slows cartilage cell production and raises the levels of blood toxins, which leads to cartilage loss. Smoking also increases carbon monoxide levels in the blood, which could indirectly affect cartilage repair.

4. Don’t overuse painkillers.
Anti-inflammatories, such as ibuprofen (Advil) or naproxen (Aleve), should be used in moderation for pain; overuse leads to other medical trouble, Gulati says.

Among the risks: high blood pressure, stomach upset and injury and heart and breathing problems.

“Many people don’t consider over-the-counter non-steroidal, anti-infammatory drugs (NAISDs) as drugs,” she says. “But using 3-4 times the recommended dose over months and years is very dangerous.”

5. Don’t run — walk.
“People who engage in high-impact exercise over time will get osteoarthritis because of the repetitive shock to the joints,” Wei says.

That’s backed by recent research. A 2009 University of California, San Francisco study of 236 people with no arthritic symptoms found that those who were very active – doing several hours a week of walking and other sports — were more likely to have cartilage damage and ligament lesions. Those who did high-impact activities (running and jumping, for example) were likely to have even more cartilage damage.

So keep it gentle and regular – and mix up your exercise routine, Wei advises. Varied workouts – for example, swimming one day and doing yoga the next – avoid repetitive movements that may damage your joints, Wei advises.