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Non Pharmacology Treatments For Osteoarthritis


By Sarah Bersey BSc (Hons) Pg Dip



Osteoarthritis (OA) is a non-communicable, chronic, and progressive disease characterized by symptoms that stem from degenerative changes in the joint (see below) (Ferreira et al 2024).


Pharmacological treatments include topical and oral non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, capsaicin cream, and steroid injections. For pain not managed effectively by these treatments, weak opioids like codeine may be used short-term. (Ferreira et al 2024). It is generally agreed by clinicians that treatment of OA should focus on using the lowest effective dose of pharmacological treatment for the shortest possible time. (Ferreira et al 2024, Yusuf 2016). However with a chronic problem like OA, treatment periods are very long - potentially the rest of the patients’ lives. OA sufferers and their healthcare advisors may therefore choose to hold off or to limit the use of pharmacological treatments until absolutely necessary, when pain is too bad to endure without them.

 

In the interim between initial diagnosis and high pain levels that require pharmacological treatment, other therapies are available that could be of benefit:

 

·      Acupuncture

·      Exercise

·      Low‑Level Laser Therapy (LLLT)

·      Tai Chi

·      Yoga

·      Devices (Assistive Orthotics)

·      Electrotherapy

·      Extracorporeal Shockwave Therapy (ESWT)

·      Hydrotherapy (Aquatic Therapy)

·      Dietary Supplements

·      Chinese Herbal Medicine

 

We’re going to explore these one by one. However this seems a good place to mention that weight management (and weight loss if necessary) are very important in managing OA symptoms. The authors of a meta-analysis (a statistical method used to combine and analyze the results from multiple independent studies on the same topic to draw a more precise overall conclusion) concluded that symptomatic relief can be experienced if overweight patients are able to reduce their body weight by at least 5% within six months (Dawson et al 2005). Additionally, an IDEA trial (Intensive Diet and Exercise for Arthritis) found that participants with knee OA who were overweight and who achieved a modest weight loss (10% of body weight) through diet and exercise, achieved a 50% reduction in pain scores. (Messier et al 2013, Osteoarthritis Action Alliance (OAAA) n.d).

 

 

1.   Acupuncture

 

What it is: Insertion of fine needles at specific points on the body, sometimes combined with electrical stimulation.This is thought to trigger the release of enkephalins, endorphins, and possibly cortisol which may be the mechanism by which some patients experience a reduction in OA pain (Osteoarthritis Action Alliance (OAAA) n.d.)

 


How it may help: Acupuncture appears to reduce pain intensity and improve functional mobility in knee OA. However, effectiveness is reported to be modest and tends to wane after treatment ends. (Luo et al 2024, Dawson et al 2005)

 


Evidence: Study reviews show modest short‑term pain reduction and improved function, especially when combined with conventional physiotherapy. Benefits tend to diminish after treatment stops. (Luo et al 2024, Dawson et al 2005)



2.  Exercise (Therapeutic Exercise)

 

What it is: Structured programs that include aerobic conditioning, strength training, flexibility, and balance work.

 


How it may help: Strengthens muscles around joints, improves joint stability, enhances range of motion, and promotes cartilage health through mechanical loading. (Luo et al 2024, Yusuf 2016, Osteoarthritis Action Alliance (OAAA) n.d)

 


Evidence: Strongest evidence among non‑drug options. Regular, supervised exercise consistently reduces pain and improves functional scores across knee, hip, and hand OA. The benefits are strongest in people with higher baseline pain/disability. (Luo et al 2024, Yusuf 2016, Osteoarthritis Action Alliance (OAAA) n.d). A 2024 meta-analysis by Luong et al indicates that exercising in water, allied with use of knee braces is the most effective therapy for knee OA.

 

 

 


 3.   Low‑Level Laser Therapy (LLLT)

Also known as Photobiomodulation Therapy (PBMt)

 

What it is: Application of low‑intensity red or near‑infrared light to affected joints via laser or LED. (Recuperate Health 2025).

 


How it may help: Purported to stimulate cellular metabolism by increasing mitochondrial numbers, reduce oxidative stress, and modulate inflammatory mediators.
 Adding LLLT to exercise yields small‑to‑moderate reductions in pain and modest gains in range of motion and function in knee OA. (Luo 2024, Recuperate Health 2025).

Application is painless (Recuperate Health 2025).

 

Evidence: Mixed results. Some trials report small pain reductions and functional gains, but meta‑analysis reports have highlighted a lack of consensus in dosing protocols, making definitive conclusions difficult. (Luo 2024, Yusuf 2016)


 



4.   Tai Chi

 

What it is: A mind‑body practice combining slow, flowing movements, deep breathing, and meditation. Tai Chi is practised standing or sitting and so may appeal to OA sufferers.

 


How it may help: Improves muscle strength, proprioception, balance, and psychosocial well‑being.
 Mind‑body traditional Chinese movement improves short‑term pain, stiffness and physical function in knee OA, as found in a 2020 meta-analysis by Lee et al.

 

 

Evidence: Randomized studies show comparable pain relief and functional improvement to moderate‑intensity aerobic exercise, with added benefits for balance and fall risk. (Lee et al 2020, Yusuf 2016) Evidence quality is moderate and long‑term data are limited. (Lee et al 2020)




5.   Yoga

 

What it is: A series of postures (asanas) which may include sitting and lying, breath work, and relaxation techniques.
 A longstanding Indian cultural practice with variants such as hot yoga and yoga flow. Gentler forms such as Hatha Yoga and Restorative Yoga are recommended for arthritis. (Moonaz et al 2018)

 

How it may help: Enhances flexibility, muscular endurance, and stress reduction, which can indirectly lower pain perception. Yoga offers people with arthritis a form of exercise that is enjoyable enough to do regularly. (Bernstein (n.d.)) So Yoga is associated with a wide range of physical and psychological benefits that may be especially helpful for people living with a chronic illness such as osteoarthritis (Moonaz et al 2018).

 


Evidence: Small‑to‑moderate effect sizes for pain and stiffness in knee OA; benefits appear greatest when sessions are tailored to joint limitations. (Moonaz et al 2018)




6. Devices (Assistive Orthotics)

 

What Are They: Orthotics and other devices can manage osteoarthritis by providing support, stability, and by offloading pressure from painful joints in the feet, ankles, hips, and knees.

 

Examples: Knee braces, shoe insoles/orthoses, sleeves, walking aids (canes, walkers).

 


How they may help: Off‑load stressed compartments (inner, outer and central areas) of the joint, improve alignment, and reduce mechanical stress during weight‑bearing activities (London Orthotics (n.d.), Liverpool Orthotics (2025)):

 

  • Insoles/Orthotics: Prescription inserts can be custom-made to provide cushioning, redistribute weight, and improve gait, which helps reduce stress on lower extremities.

  • Braces: These can be designed for specific joints like the knee, ankle, or hip to provide stability, limit movement, or offload weight from the damaged area.

·       Knee Braces: Can offer general support or be specialized to transfer weight away from the painful part of the knee, such as in medial knee osteoarthritis.

  • Ankle-foot orthoses (AFOs): These can provide significant support and stability to the ankle, especially during flare-ups.

  • Weight-bearing orthoses: Devices can include features like an ischial weight-bearing brim to reduce the load on a severely arthritic knee joint.

  • Compression socks: Can improve blood flow and reduce swelling in the feet.

(London Orthotics (n.d.), Liverpool Orthotics (2025))

 

 


Evidence: Luo et al in their recent (2024) meta-analysis of studies that involved more than 9600 adults with knee OA, determined that knee braces were the most effective measure in reducing stiffness, lack of mobility and pain. (Wong 2025)

 Custom foot orthoses can improve gait mechanics and reduce knee load. Patient compliance motivation and comfort influence outcomes – just buying the device is not enough! (Wong 2025).


Footwear orthotics:



 

7.   Electrotherapy

 

Types: Transcutaneous Electrical Nerve Stimulation (TENS), neuromuscular electrical stimulation (NMES), interferential currents, a type of electrical stimulation used by physiotherapists to relieve pain, reduce swelling, and stimulate muscle. It works by using two different medium-frequency currents that interfere with each other to create a lower-frequency current within the body's tissues, which is more comfortable and can penetrate deeper than some other electrical stimulation methods like TENS.
 (Arthritis Foundation (b) (n.d.))

 

How it may help: Provides analgesia via gate‑control mechanisms or muscle activation to support joint stability. TENS has been shown to relieve osteoarthritis (OA) pain and reduce the need for pain medications. A 2015 Cochrane Review concluded, “[there is] tentative evidence that TENS reduces pain intensity over and above that seen with placebo. It’s estimated that overall, about half of people who try TENS get a 50 percent reduction in pain. (Arthritis Foundation (b) n.d.)

 


Evidence: TENS yields short‑term pain relief in many patients, though long‑term functional benefits are less clear. NMES can improve quadriceps strength when combined with exercise. (Sheffield Physiotherapy 2025)




8. Extracorporeal Shockwave Therapy (ESWT)


What it is: Focused acoustic waves delivered to the peri‑articular region. stimulate healing, reduce pain, and improve function by increasing blood flow and triggering a pro-inflammatory response.

 

 


How it may help: May stimulate neovascularization, reduce nociceptive input, and promote tissue regeneration. The therapy is often recommended for chronic cases that haven't responded to conservative treatments and typically involves multiple sessions (e.g., 3-5 sessions a week apart), with results taking a few months to become apparent. Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (2021)

 




Evidence: Emerging data suggest modest pain relief and functional gains, particularly for knee and shoulder OA, but optimal dosing remains under investigation. Focused or radial shockwaves reduce knee‑OA pain and improve function without serious adverse effects; higher energy doses appear more effective. Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (2021), Yusuf 2016).



9.   Hydrotherapy (Aquatic Therapy)

 

What it is: Exercise performed in warm water pools, often combined with manual therapy.

 


How it may help: Buoyancy reduces joint loading, allowing greater range of motion with less pain; warmth relaxes muscles.


 

Evidence: Consistently shows pain reduction and improved mobility, especially in individuals unable to tolerate high‑impact land exercises. A 2024 meta-analysis by Luong et al indicates that exercising in water, allied with use of knee braces is the most effective therapy for knee OA.

 

Water‑based exercise programs lower pain intensity and enhance knee‑joint function. The safety profile is excellent and adverse events are rare. (Yusuf 2016)




10.   Dietary Supplements

 

Common supplements for osteoarthritis:

 

  • Glucosamine and chondroitin: These are naturally found in cartilage and may help slow its degeneration and reduce pain and inflammation. Research results have been mixed, but some studies show they can provide a moderate benefit, particularly in those with mild pain. 

  • Omega-3 fatty acids: Found in fish oil, these may help reduce inflammation. 

  • Curcumin: The active compound in turmeric, it is known for its anti-inflammatory properties and may help with pain and stiffness. 

  • Vitamin D: Supplementing with vitamin D can be an inexpensive way to help improve muscle strength and physical function in individuals with osteoarthritis. 

  • Methylsulfonylmethane (MSM): When combined with other supplements like glucosamine, chondroitin, or boswellia, MSM may help reduce joint pain, inflammation, and stiffness. 

  • Boswellia serrata: Also known as Indian frankincense, this supplement may help reduce pain and inflammation. 

  • S-adenosyl-L-methionine (SAMe): This is another supplement that has been studied for its potential to relieve arthritis symptoms. 

(Yusuf 2024, Arthritis Foundation (c) (n.d.))

  • Hyaluronic Acid: Lubricates joints, reducing discomfort and improving mobility.

  • Ginger: Naturally reduces joint pain and stiffness with anti-inflammatory properties.(Dr Arthritis 2025)

 

How they may help: Aim to support cartilage metabolism, reduce inflammation, or provide antioxidant effects. Recent reviews find glucosamine alone offers minimal pain relief, whereas the combination with chondroitin shows a modest but statistically significant benefit for knee OA symptoms. (Luo et al 2016)

  


Evidence: Results are mixed. Glucosamine/chondroitin may provide mild pain relief in a subset of patients, while omega‑3s and curcumin have modest anti‑inflammatory benefits. Supplements should be discussed with a healthcare provider for dosing and potential interactions. (Yusuf 2024, Dr Arthritis 2025)



11.   Therapeutic Ultrasound

 

What it is: High‑frequency sound waves applied to soft tissues around the joint. Ultrasound is used for both the diagnosis and treatment of arthritis. For diagnosis, it provides real-time images to identify joint inflammation, fluid, and structural damage like bone spurs or cartilage issues, helping to differentiate between types of arthritis and guide treatment. For treatment, therapeutic ultrasound may be used to deliver heat or mechanical stimulation to help manage pain, while newer technologies like focused ultrasound offer a non-invasive way to ablate tissue causing pain. (Yusuf 2024, Focused Ultrasound Foundation 2025)

 

How it may help: Generates deep heat, potentially increasing blood flow and reducing muscle spasm.
 Low‑intensity pulsed ultrasound produces small short‑term improvements in pain and self‑reported function in knee OA; the effect is modest and high‑quality trials are still needed. (Yusuf  2024, Yuon 2016) The Focused Ultrasound Foundation report that for some patients, use of this non-invasive therapy may offer an alternative to surgery. A recent clinical trial was completed in Japan and revealed that MRgFUS (Magnetic Resonance-guided Focused Ultrasound) tissue removal was both safe and effective at treating chronic pain caused by medial knee arthritis. (Focused Ultrasound Foundation 2025)

 

 

Evidence: Clinical trials show mixed outcomes; some report short‑term pain relief, but systematic reviews conclude that evidence is insufficient to recommend routine use for OA at present. (Yusuf 2024, Yuon 2016)



  1. Chinese Herbal Medicine


What It Is: Chinese herbal medicine uses plants like:


Tripterygium wilfordii (Thunder God Vine), Boswellia, and ginger for arthritis due to their anti-inflammatory properties. Many traditional formulas are used, such as Guizhi Shaoyao Zhimu Decoction, to help with joint pain, swelling, and stiffness. However, some herbs, particularly Tripterygium wilfordii, can be potent and require caution, and it's crucial to consult a healthcare professional before use. 


Specific herbs and formulas

  • Tripterygium wilfordii (Thunder God Vine): Used for a long time to treat arthritis, it can help reduce inflammation and bone damage. It is sometimes used in creams or as a root extract.

  • Boswellia: This plant contains boswellic acids that are known for their anti-inflammatory and antiarthritic effects.

  • Ginger and turmeric: These can be cooked with fat and black pepper to help with absorption and may help with inflammation, but they are generally not a powerful enough treatment on their own for serious arthritis pain.

  • Guizhi Shaoyao Zhimu Decoction: This formula is designed to reduce joint swelling and stiffness and has fewer side effects than some other options.

  • Zushima Tablet: Another formula used to alleviate joint swelling, tenderness, and morning stiffness. 

(Li et al 2023)






Important considerations


  • Consult a professional: It is essential to speak with a healthcare professional before using any herbal medicine for arthritis.

  • Potency: Some herbs, such as Tripterygium wilfordii, are potent and can have significant effects.

  • Side effects: Always be aware of potential side effects, such as those associated with oral aloe vera, and follow recommended dosages.

  • Combination therapy: Some Chinese herbal medicines are used alongside conventional treatments like DMARDs to improve effectiveness and reduce side effects. 

 (Li et al 2023)



Putting It All Together


Core strategy – Most guidelines place exercise (strength + aerobic) as the cornerstone of OA management, supplemented by patient‑preferred modalities.

 

Adjuncts – Techniques such as tai chi, yoga, or hydrotherapy can increase adherence by providing variety and addressing balance or flexibility.


Pain‑focused options – Acupuncture, TENS, LLLT, and ESWT may be useful for breakthrough pain or when exercise alone is insufficient.

 

Mechanical support – Braces, orthoses, and walking aids help unload stressed joint compartments, especially during flare‑ups.

 

Nutritional adjuncts – Supplements can be trialed on an individual basis, keeping expectations realistic and monitoring for side effects.

 

 

Practical Tips for Arthritis Patients

 

Start slowly: Begin with low‑impact activities (e.g., swimming, cycling) and gradually progress to resistance training under professional supervision.

 

Combine modalities: Pair exercise with a supportive device (brace or cane) if pain limits activity.


Consistency matters: Benefits accrue over weeks to months; aim for at least 150 minutes of moderate aerobic activity weekly plus 2–3 strength sessions.

 

Monitor response: Keep a symptom diary to track which interventions provide the most relief and adjust the regimen accordingly.

 

Consult professionals: Physical therapists, rheumatologists, or certified acupuncture practitioners can tailor programs to individual joint involvement and comorbidities.

 

 

 


Useful Sources

 

Arthritis Foundation (a) (n.d.) Pain Management Resources [online] https://www.arthritis.org/pain



Arthritis Foundation (c) (n.d.) Popular Supplements For Arthritis: What You Need To Know [online]https://www.arthritis.org/health-wellness/treatment/complementary-therapies/supplements-and-vitamins/vitamins-supplements-arthritis#


Bernstein, S. (n.d.) Arthritis Foundation Yoga Benefits For Arthritis [online] https://www.arthritis.org/health-wellness/healthy-living/physical-activity/yoga/yoga-benefits-for-arthritis


Dawson J, Linsell L, Doll H. (2005).  Assessment of the Lequesne index of severity for osteoarthritis of the hip in an elderly population. Osteoarthr Cart. 13:8 54–60.

The Focused Ultrasound Foundation (2025) Arthritis [online] https://www.fusfoundation.org/diseases-and-conditions/arthritis/#


Li, R., Chen, H., Feng, J., Xiao, Y., Zhang, H., Lam, C. W., & Xiao, H. (2020). Effectiveness of Traditional Chinese Exercise for Symptoms of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International journal of environmental research and public health, 17(21), 7873. [online] https://pubmed.ncbi.nlm.nih.gov/33121082/


Lin, Z., Zheng, J., Chen, M., Chen, J., & Lin, J. (2022). The Efficacy and Safety of Chinese Herbal Medicine in the Treatment of Knee Osteoarthritis: An Updated Systematic Review and Meta-Analysis of 56 Randomized Controlled Trials. Oxidative medicine and cellular longevity, 2022, 6887988. [online] https://doi.org/10.1155/2022/6887988




Luo, Y., Rahmati, M., Kazemi, A., Liu, W., Lee, S. W., Gyasi, R. M., López Sánchez, G. F., Koyanagi, A., Smith, L., & Yon, D. K. (2024). Effects of therapeutic ultrasound in patients with knee osteoarthritis: A systematic review and meta-analysis. Heliyon, 10(10), e30874. [online] https://doi.org/10.1016/j.heliyon.2024.e30874

 

Messier SP, Mihalko SL, Legault C, et al. (2013) Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273.[online] https://jamanetwork.com/journals/jama/fullarticle/1741824


Moonaz, S., Bartlett, SJ., Bingham, CO. (2018) Yoga For Arthritis [online] https://www.hopkinsarthritis.org/patient-corner/disease-management/yoga-for-arthritis/


Osteoarthritis Action Alliance (OAAA) n.d.) Nonpharmacologic: Osteoarthritis Prevention & Management in Primary Care [online] https://oaaction.unc.edu/oa-module/oa-treatment/nonpharmacolgic/


Recuperate Health (2025) What Is Photobiomodulation or Laser Therapy (PBMt)? [online] https://recuperatehealth.com.au/photobiomodulationSheffield Physiotherapy (2025)


Understanding Electrotherapy: Uses, Types and Benefits  [online] https://sheffieldphysiotherapy.co.uk/what-is-electrotherapy/


Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust (2021) Shockwave Therapy: Patient Information [online] https://www.wwl.nhs.uk/media/.leaflets/6110de0259d2a0.36360639.pdf



Yusuf, E. (2016) Pharmacologic and Non-Pharmacologic Treatment of Osteoarthritis. Curr Treat Options in Rheum 2, 111–125  [online] https://link.springer.com/article/10.1007/s40674-016-0042-y#citeas

 


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