8 Doctor-Recommended Osteoarthritis Treatments Best Ways to Reduce Knee Osteoarthritis Pain

Reducing the pain of knee osteoarthritis may be as simple as losing weight, exercising and staying in touch with your doctor. These 8 guidelines from the American Academy of Orthopaedic Surgeons will help you help yourself... If you have osteoarthritis pain, it’s important to take an active role in your osteoarthritis treatment, experts say. That why the American Academy of Orthopaedic Surgeons (AAOS) drafted guidelines about best treatments for knee osteoarthritis, which are widely used by physicians today. “The [2009] guidelines were written based on the current best evidence to improve treatments for knee osteoarthritis,” says Elizabeth G. Matzkin, M.D., chief of Women’s Sports Medicine in the Department of Orthopedics at Brigham and Women’s Hospital in Boston and a member of the guidelines committee. “They’re intended to enable patients to help themselves rather than just resorting to analgesics [painkillers] and surgery,” she says. Here’s what the committee recommends for people with knee osteoarthritis. Osteoarthritis treatment guideline #1: Lose weight. People with knee osteoarthritis who are overweight – defined as having a body mass index (BMI) of more than 25 – should lose at least 5% of their body weight, the AAOS advises. (Find out your BMI.) Losing weight decreases the risk of osteoarthritis. “And weight loss decreases pain and increases function, meaning range of motion, the ability to walk longer distances and to be on your feet longer,” Matzkin explains. For every pound you lose, your knee will feel as if you’ve lost five, she says. “Besides improving the symptoms of knee osteoarthritis” – such as pain and stiffness – “losing weight will improve your overall health, including your cardiovascular health and [risk of] diabetes,” Matzkin says. Your hips and ankles will get a break too. Next steps: Lose the high-fat and sugary snack foods and eat more fruits and vegetables, Matzkin says. “Keep a log of what you’ve been eating,” she suggests. “You may be surprised how often you eat fried foods or snacks.” Osteoarthritis treatment guideline #2: Get educated. Self-management programs, which help you learn to make lifestyle changes, may help you cope better with knee osteoarthritis. One year after completing educational programs, participants reported more confidence in dealing with their arthritis, less fatigue, better mood and less worry about their health, according to the Centers for Disease Control and Prevention. “Patients often say, ‘I can’t exercise because it makes my knee hurt more,’” Matzkin says. “So I may get them into a formal program with a physical therapist, who can help them jump-start [before undertaking] a home program.” For example, “educational programs can encourage patients to exercise, modify movements from running to walking, or, if they’re doing nothing, start moving,” Matzkin explains. “Programs will also talk about nutrition and offer healthy eating plans and recipes,” she says. “When I check in with patients after a few months, they don’t feel like the knee osteoarthritis is controlling them, but that they are controlling it,” she adds. Next steps: Call your local Arthritis Foundation or hospital to see if and when programs are offered. The Arthritis Self-Management Program sponsored by the Arthritis Foundation is a six-week course with weekly two-hour sessions guided by two trained instructors. Osteoarthritis treatment guideline #3: Pump up the cardio. Aerobic exercise reduces pain and disability, according to a review of studies by the Osteoarthritis Research Society International (OARSI) involving people with hip and knee osteoarthritis. Exercise boosts health, and specifically strengthens joints muscles, keeping joint pain at bay. Next steps: Get some exercise – 30 minutes – most days, Matzkin advises. “I tell patients, ‘If you do nothing, you’ll be sore. If you do too much, you’ll also be sore.' So you have to find a healthy medium,” she says. Try low-impact activities like swimming, walking, biking or yoga, Matzkin advises. Osteoarthritis treatment guideline #4: Strengthen leg muscles. Aerobics offers a huge fitness benefit, but it isn’t enough to vanquish knee pain. You also need to do strengthening exercises for the muscles around the knee, Matzkin says. “The stronger the thigh muscles are, the less work the knee joint has to do,” she adds. “If the muscles are strong, the kneecap rides and glides as it should. If they’re weak, the kneecap rubs in its groove, and that’s when it’s painful.” Next steps: Ask your doctor for a referral to a physical therapist who can help you develop an at-home strengthening program. Self-management programs often teach exercises too. Or do this simple exercise that Matzkin recommends: 1. Lie flat or sit on the floor with your legs in front of you. 2. Tighten the muscle in the front of your thigh as much as you can, pushing the back of the knee flat against the floor. Hold for five seconds. 3. Then lift your heel 4 or 5 inches off the ground, keeping the muscle tight. Lower it back to the floor. 4. Do a set of 20 on each leg, 2-3 times per day. Osteoarthritis treatment guideline #5: Have your knee taped. Taping your knee helps push the kneecap toward the inside part of the leg instead of rubbing in its groove on the outside of the knee. “It decreases the pain that people get in the front of the knee, so that they can do strengthening exercises,” Matzkin says. “It’s a short-term measure that a physical therapist might use on a patient until the muscles are strong enough to pull the kneecap toward the inside of the leg.” Next steps: See a physical therapist to get your knee taped for the first few weeks that you do strengthening exercises. “This is something patients shouldn’t try themselves unless they’re shown how to do it,” Matzkin says. The therapist can show a patient how to wrap it, and how tightly, to ensure that the kneecap will be pulled toward the inside of the leg. Osteoarthritis treatment guideline #6: If possible, avoid heel wedges. If you have arthritis on the inside of the knee and your leg is bowed, there’s more pressure on the knee. In the past, doctors advised patients to use a heel wedge – a heel-shaped cushion placed against the inside heel of a shoe – to help realign the knee and reduce pressure. Trouble is, studies haven’t proven a benefit, says John C. Richmond, M.D., chairman of Orthopedic Surgery at New England Baptist Hospital in Boston and chairman of the AAOS guidelines committee. Next steps: Wedges shouldn’t be the first line of osteoarthritis treatment against knee pain. Instead, try other treatments, such as weight loss and exercise, and use heel wedges only in consultation with a doctor, Richmond advises. Use them “when more successful treatments have failed or to avoid surgery if at all possible,” he says. Osteoarthritis treatment guideline #7: Be cautious when taking pain relievers. Pain medications, when taken appropriately, can reduce knee arthritis pain, says Robert G. Marx, M.D., professor of orthopedic surgery at the Hospital for Special Surgery in New York City and a member of the AAOS guidelines committee. But they can also cause serious side effects such as gastrointestinal bleeding. Next steps: Most patients can take 650 to 1,000 mg of acetaminophen (Tylenol) every four hours, 500 mg of naproxen (Aleve) twice a day, or 600 to 800 mg of ibuprofen (Advil) every six hours for pain from knee osteoarthritis. People with liver disease or who drink three or more alcoholic beverages a day should avoid acetaminophen. And non-steroidal anti-inflammatories (NSAIDS) such as naproxen and ibuprofen carry a risk of stomach upset or ulcers. “Avoid NSAIDS if you’re over 65 since you have a higher risk of gastrointestinal bleeding,” Marx says. People 60 or older can take painkillers, but they may need to take them with drugs that prevent bleeding in their gastrointestinal tract. Another option for those with GI risk is a cyclooxygenase-2 (COX-2) inhibitor such as Celebrex, an NSAID that has minimal effects on the gastrointestinal system. Osteoarthritis treatment guideline #8: Consider injected corticosteroids for short-term relief. One more option in the pain-relief arsenal: Anti-inflammatory corticosteroids can be injected into the joint. These steroid drugs relieve pain by reducing inflammation. Their benefit lasts a couple of weeks or months. Next steps: Injections can provide pain relief within several days, but the treatment should be used sparingly, Marx says. He counsels patients to get by without it because “the medication tends to become less effective with each injection, and there’s a tiny risk of infection.” “I use it on a patient if she has a severe flare-up and has an important family event coming up that she wants to feel good for,” he says.