Top 5 Tips for Managing OA

I influence outcomes in my osteoarthritis (OA) patients by trying therapies that decrease stiffness, decrease joint pain aggravated by movement, restore and improve mobility, help delay the effects of cartilage damage or avoid it altogether, and age with better joint health. Here are five tips I give my OA patients and how they translate into clinical practice.

#1: Move Your Joints

One treatment option over all others is joint movement. Movement allows for hydration of the glycosaminoglycans, allowing for cushioning of the articular cartilage. I visually look at joint motion and palpate each joint, beginning at the foot / ankle and work my way up the kinetic chain. I’m looking for restricted motion or hypermobile joints.

Restricted joints get hands-on mobility. Loose or lax joints get proprioception training and a gentle stability exercise, along with therapy for stimulating collagen production.

One of my treatment goals is to reduce activity limitations, especially related to walking. I strive for 100-112 steps per minute because this pace has been associated with good cardiovascular and mental health as we age.^1-2

#2: Pretend You Are Taller

I tell patients, “Always pretend you are at least ¼ - ½ inch taller than you are in as many joints as you can.” This concept alone for patients with osteoarthritis gives them a cue for the rest of their life.

Cartilage covers the synovial joints. Cartilage is made from collagen fibers and proteoglycans (which are highly concentrated with chondroitin sulfate) to cushion impacting pressure. Each proteoglycan is attached to a hyaluronic acid framework to form the articular cartilage. Proteoglycan molecules absorb synovial fluid when uncompressed and then expel the fluid as it is compressed.

That fact alone dictates my “message in a bottle” encouragement to patients to do this multiple times throughout the day with your specific guidance. The goal: isolate not only the arthritic joint, but also the spot within the joint to provide decompression of the cells. (Gravity will always provide the compression.)

#3: Try Combination Therapies

I am open to chiropractic care along with any combination of fascial / scar release therapy, traditional heat, IASTM, laser, sauna, cold plunge, massage, foam rolling, vibration, percussion, shockwave, dry needling, EMS – and now, after vetting it, a modality called TECaR (transfer of energy capacitive and resistive). TECaR stands out for acute inflammation and osteoarthritis.

The goal of TECaR treatment is to influence body heat – temperatures can be raised to produce heat superficially (capacitive), or deep beneath the skin’s surface, even across entire bone structures (resistive).

With various applicators and controlling the intensity, TECaR can easily direct and focus heat temperature to a specific local tissue area to influence oxygenation, vascularization, tissue and vessel drainage, tissue regeneration, fibroblast stimulation and cellular growth, as well as induce elastin collagen and extracellular matrix production.

I find TECaR technology interesting and useful for my arthritis patients, especially those who have tried other modalities such as laser, shockwave, etc., but the sheen of that treatment has worn off. TECaR includes an old method of therapy called diathermy, but the newer machines today have high frequencies of 300-1,000 kilocycles per second, applied to the body with various modern applicators. (Diathermy has been around since 1891.)

The biochemical mechanism behind TECaR’s relief for osteoarthritis is a form of endogenous thermotherapy based on radiowave electrical current. TECaR stimulates cellular metabolism and this appears to trigger a decrease in the autoinflammatory loop.

The generation of superficial and deep heat saturates synapses and interferes with nociceptor levels. Similar to laser therapy, TECaR can lower the amount of substance P, a neurotransmitter associated with pain.

TECaR also has a diathermy effect and these devices can be set so the patient feels a warm and soothing to deep heat sensation. TECaR’s “heat comfort”effect lasts long enough to give the patient enough time (>24H) to start gentle movement, which allows the brain to know it is safe to move. TECaR + manual therapy improves metabolism, increases blood flow and releases tension around the OA joint.

A unique feature of TECaR is that it can be used with bracelets around the practitioner’s forearms. The energy current can be transferred through your hands and applied to the patient while you are performing soft-tissue / manual therapy. Manual therapy + TECaR has the same effects of massage in that it lowers the body’s stress hormone, cortisol, and increases serotonin production.

TECaR coupled with manual therapy helps create space between the fascial layers, or a specific joint, and the discs. During the hands-on treatment with the TECaR bracelets applied to my forearms, patients feel in real time the improvement in tissue gliding, and I can explore three-dimensional range(s) of motion that may have been lost.

I can repattern proper movement sequences and let the brain know, “This movement is safe, and I can go to these new ranges of motion.” I am reawakening neuroplasticity in this regard, so patients feel less pain and stiffness.

If a patient is in acute inflammatory pain and unable to actively move a joint, I am able to use TECaR therapy as a stand-alone treatment for osteoarthritis.

Your homework for tip #3 is to teach yourself and your patients how to spend 5-10 minutes every day releasing fascial restrictions.

#4 Don’t Forget About Nutrition

Always consider the health of a person’s microbiome as a fundamental strategy for OA.³ Correcting dysbiosis / leaky gut will enhance patient outcomes. In addition, always recommend maintaining hydration.

In one study, 1,500 mg of glucosamine per day after eight weeks was rated better than ibuprofen.⁴ Research also suggests glucosamine increases joint space narrowing.⁵ Chondroitin sulfate (CS) is designed to draw water into cartilage glycosaminoglycans molecule. A reasonable dose of CS is 1,200-1,600 mg per day in a divided dose of 400 mg.⁶ Oral hyaluronic acid (HA) also attracts water molecules; dose ranges are from 50 mg to 240 mg per day.⁷

In addition to the above recommendations, I personally put a scoop of collagen powder in my coffee every morning and recommend omega-3 fatty acids to my patients. Some patients find SAMe [S-Adenosyl methionine] at 1,200 mg/day is effective for decreasing pain and morning stiffness.

Based on science and experience, I still recommend a ketogenic diet if patients are overweight and need fat loss to decrease inflammation. Otherwise, I recognize adherence to the Mediterranean diet improves inflammation reduction, increases antioxidant reserves, and has been shown to slow down the progression of OA.⁸

I also am still a proponent of using topicals. The most popular are menthol, CBD or capsaicin based.

#5: Come in Consistently

My chronic OA patients have placed themselves on a “one session per week” dose of TECaR + manual therapy because this seems to give them optimal therapy for encouraging muscle balance and joint alignment, and relieving pain from arthritis.

More and more patients need relief from osteoarthritis, and your aging patients and your practice can both benefit if you specialize in osteoarthritis therapy.

References

1. Thoma LM, Dunlop D, Song J, et al. Are older adults with symptomatic knee osteoarthritis less active than the general population? Analysis From the Osteoarthritis Initiative and the National Health and Nutrition Examination Survey. Arthritis Care Res, 2018 Oct;70(10):1448-1454.
2. Paluch AE, Bjpai S, Bassett DR, et al. Daily steps and all-cause mortality: a meta-analysis of 15 international cohorts. Lancet, 2022 March;7(3):219-228.
3. Knowles TA, Hosfield BD, Pecorano AR, et al. It’s all in the milk: chondroitin sulfate as potential preventative therapy for necrotizing enterocolitis Pediatric Res, 2021;89:1373-1379.
4. Rindone JP, Hiller D, Collacott E, et al. Randomized, controlled trial of glucosamine for treating osteoarthritis of the knee. West J Med, 2000 Feb;172(2):91-94.
5. Richy F, Bruyere O, Ethgen O, et al. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med, 2003;163(13):1514-1522.
6. Simental-Mendia M, et al. Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials. Rheumatol Int, 2018;38:1413-1428.
7. Oe M, Tashiro T, Yoshida H, et al. Oral hyaluronan relieves knee pain: a review. Nutr J, 2016;15:11.
8. Morales-Invorra I, et al. Osteoarthritis and the Mediterranean diet: a systematic review. Nutrients, 2018 Aug;10(8):1030.