Osteoarthritis: Therapy

General measures

  • Activated osteoarthritis (osteoarthritis with signs of inflammation):
    • Systemic or topical nonsteroidal anti-inflammatory drugs (NSAIDs) (see “Drug therapy” below).
    • Immobilization of the joint
    • Local cold application
    • Intra-articular (“into the joint cavity”) glucocorticoids.
  • Nicotine restriction (refraining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day); ≥ 20 glasses of beer/week lead to a significant increase in coxarthrosis (hip osteoarthritis) and gonarthrosis (knee osteoarthritis); individuals who drank 4 to 6 glasses of wine per week had a lower risk of gonarthrosis
  • Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition using electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for the underweight.
  • Inclusion of physical activity (e.g., walking; tai chi) for all patients with coxarthrosis (hip osteoarthritis) or gonarthrosis (knee osteoarthritis) with mild to moderate symptoms to minimize pain and improve mobility; an additional exercise program may reduce the need for arthroplasty in patients with coxarthrosis by 44% for the previously named group
  • An upright posture – while sitting and standing – relieves pressure on the joints.
  • Avoidance of:
    • Overloading of the joints, for example, by competitive and high-performance sports or long-lasting heavy physical loads, for example, in the profession (construction workers, especially floor layers).
    • Lack of physical activity, since the cartilage gets its micronutrients from the synovial fluid, it is dependent on the joint being moved
    • Incorrect footwear – A resulting foot malposition can lead to wear and tear of the articular cartilage. Frequent wearing of high heels is particularly harmful.

Conventional non-surgical therapy methods

Medical aids

Orthopedic aids are of importance for a mechanical load distribution:

  • Footwear with good cushioning! (Buffer heels, if necessary shoe elevation).
  • Walking stick
  • Orthosis – orthopedic device for relief and immobilization of the affected joints.

Nutritional medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
    • Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – Taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Regular exercise ensures that joint cartilage is well supplied with synovial fluid. In addition, physical activity supports the build-up of bone mass.
  • Endurance training (cardio training) and strength training (muscle training) and flexibility training.
  • Strengthening the muscles surrounding the joint can relieve arthritis symptoms.
  • Cycling, swimming, aqua gymnastics and Nordic walking are joint-friendly sports.
  • Sports with rapid changes of direction and high pressure loads such as volleyball, handball and badminton are not recommended.
  • An additional exercise program can reduce the need for arthroplasty by 44% for patients with coxarthrosis (hip osteoarthritis; with mild and moderate symptoms)
  • For mild gonarthrosis (knee osteoarthritis), an aerobic exercise program with small jumps in postmenopausal women resulted in improved cartilage structure detectable by magnetic resonance imaging (MRI).Significant improvements in knee injury and osteoarthritis outcome score (KOOS) parameters of pain, symptoms and function, and quality of life could not be demonstrated.
  • Training under venous blood flow restriction – Blood Flow Restriction (BFR): training of the thigh and calf muscles on a bicycle ergometer twice a week with the cuff pressure set at 40-80% of the arterial occlusion pressure with the result that the venous vessels are “clamped off”; Result: after 6 weeks, increase in muscle strength and measurable muscle growth, which leads to a stabilization of the joints and equally contributes to the lower load during movement. Furthermore, it comes to a reduction in pain.
  • Caution: Monotonous movement sequences and overload (sports, occupation) can damage the articular cartilage.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Physical therapy (including physiotherapy)

Physical therapy can help alleviate symptoms. It offers a wide range of treatment methods that support the therapy of osteoarthritis:

  • Balneotherapy (bath therapy) with warm mineral salt baths.
  • Exercise therapy – cycling, swimming or walking can help slow down the degenerative process
  • Occupational therapy
  • Thermotherapy, this consists of heat and cold therapy (cryotherapy):
    • Heat therapy in the form of balneotherapy (warm water baths with mineral salts dissolved in it) or electrothermotherapy has analgesic (analgesic), decongestant and improves walking distance and health-related quality of life.
    • Cryotherapy is used only in active, inflammatory osteoarthritis.

Complementary treatment methods

  • Acupuncture for analgesia (pain relief) in gonarthrosis (osteoarthritis of the knee joint)
    • Both acupressure and sham acupressure reduce pain
  • Electrical stimulation for analgesia in gonarthrosis:
  • High-Intensity Ultrasound (HIU) – The procedure is used for localized, noninvasive delivery of therapeutic compounds (pharmaceuticals) by ultrasound to articular cartilage and subchondral bone. [The procedure is still in testing.]
  • Magnetic resonance therapy (MRI) (Synonyms: MBST nuclear magnetic resonance therapy, nuclear magnetic resonance therapy, multibiosignal therapy, multi-biosignal therapy, MBST nuclear spin) – treatment method in which the magnetic resonance imaging (MRI; magnetic resonance imaging; short: nuclear spin) known from diagnostics is used therapeutically. The procedure aims at reactivating metabolic processes in the cells, thus enabling the regeneration of defective cartilage and bone tissue.
  • Magnetic field therapy – physical procedure that usually uses pulsating electric magnetic fields to improve microcirculation and stimulate and regulate cellular and energy balance.