How you can beat knee arthritis.

The topic of “what can I do about my arthritis?” is one that comes up frequently.

I’ve written about evidence-based treatment for knee osteoarthritis in the past, as well supplements that I tend to recommend for pain and nerve health, and there was a ton of interest in these articles.

So, I thought I’d continue the conversation as a quasi “Part 3” today, discussing some of the things I recommend for arthritis based on evidence and my experience.

Arthritis is an extremely diagnosis and one that is nearly always clouded with a pessimistic prediction of a bleak future.

“Sorry, there’s not much we can do for arthritis.”

“You’re going to need a joint replacement within the next year or so.”

“It’s bone on bone in there. Avoid what hurts I guess.”

Stop me if you’ve heard this before.

The reality is, there’s a TON of options for battling arthritis and it’s not a death sentence.

Let’s get into what those options are.

Load it!

Nothing new here. We should always start with exercise.

The New England Journal of Medicine published the findings of a randomized controlled trial facing off glucocortocoid injections vs physical therapy in patients with knee osteoarthritis. Findings?

"Patients with osteoarthritis of the knee who underwent physical therapy had less pain and functional disability at 1year than patients who received an intraarticular glucocoricoid injection.”

This isn’t necessarily surprising. We know that exercise is basically the universal medicine that helps everything.

However, there are still people who believe that if you have arthritis, exercise will make it worse. The “wear and tear” will accelerate the degeneration of the joint and you should just take meds or get injections instead.

But what’s the research say?

NSAIDS vs Opioids vs Exercise

Here is how it shakes in this systematic review and meta-analysis of 1398 patients with symptomatic knee osteoarthritis: NSAIDS are as good as Opioids. Exercise beats NSAIDs. Victory exercise.

What shocks me is that no one ever talks about the fact that even if they were all equivalent for pain reduction, exercise has a myriad of other positive systemic side effects while the others have deleterious ones. Thus exercise doesn't even have to win to win. THEN WHY ARE WE STILL PUSHING PILLS?

This graphic from the British Medical Journal does a great job summarizing some of the latest research regarding the management of osteoarthritis.

One of my favorite pieces is the authors discussing pharmacological treatment:

"It adds a new emphasis on non-pharmacological management, reserving pharmacologic management for short term management and increasing the ability of patients to engage in therapeutic exercise.”

FINALLY, pharmaceuticals taking their rightful place: As a short term option to make the ACTUAL solution of movement and loading more accessible!

And this is exactly how I’ve always recommended pharmaceuticals, or as we’ll discuss later, supplements. If they allow you to move more freely and with less pain, then they can be helpful. Essentially acting as a “primer” to exercise. But very rarely should they be used long-term because of the unwanted side effects that come with them.

So, we know that exercise is good.

But what exactly should we target?

Stronger quads = Lower odds

Taking a peek at 46,819 participants this open access systematic review and meta-analysis concluded the following:

"There is low quality evidence that knee extensor muscle weakness is associated with incident symptomatic and radiographic knee osteoarthritis in women and men. Optimizing knee extensor muscle strength may help to prevent knee osteoarthritis.”

When designing a program for a client, I like to use the framework of “it’s the quads until it’s not.” Meaning, I REALLY want to make sure the quad strength is dialed in before I focus on anything else.

Quadriceps weakness is often associated with knee osteoarthritis, and some research suggests that quadriceps strength training can help reduce pain and improve function. Strong quadriceps can act as a natural knee brace, supporting the knee and reducing stress on the joint.

Exercises I love include:

• Seated knee extensions (machine or banded)

• Sissy squats

• Spanish squats

• Banded TKEs (Terminal Knee Extensions)

Speaking of quads, there’s been some interesting research looking at cyclists and knee OA.

What does a lifetime of pedaling do?

Apparently only good things!

​This retrospective, cross-sectional study is a part of the Osteoarthritis Initiative. 2607 participants and their cycling volume across four different time periods of life were analyzed for a relationship between volume and knee pain plus OA. This quote sums things up nicely:

“People who participated in bicycling had a lower prevalence of frequent knee pain, radiographic OA, and symptomatic OA. The benefit appeared cumulative. This study indicates that bicycling may be favorable to knee health and should be encouraged.”

It makes sense.

“Motion is lotion” and every time our knees bend and extend they pump synovial fluid in and out of the joint, lubricating the tissue within and around it.

Also, cycling is a great quad strengthening activity and, as we learned, strong quads can help with OA.

But what about “wear and tear”?

Well, a Systematic Review and Meta Analysis published in Arthritis Care & Research concludes:

"Exercise therapy is not harmful, because it does not increase the concentration of molecular biomarkers related to cartilage turnover and inflammation, implicated in osteoarthritis progression"

Not only is exercise therapy not harmful, it’s essential.

But what if there was a way to make the exercise MORE beneficial and allow it to help the body to what it does best?

Well, like we discussed with the short-term use of NSAIDs, that’s where supplements come in.

Curcumin + Boswelia

This is one of the most potent pain relief combos you can take.

According to this systematic review, “the extensive history of curcuminoid and boswellia use for pain relief coupled with the recent findings showing that these phytochemicals may directly act upon several inflammatory processes offers compelling evidence that these products could reduce pain and may even slow cartilage degradation in patients with knee OA.”

The combination of these two anti-inflammatory natural ingredients suggests potential synergistic activity, which supports their use to further improve OA symptoms and pain. This combination could also improve patients’ quality of life and reduce the dosage and frequency of consumption of acetaminophen and NSAIDs.

Boron Glycinate

Boron plays an important role in reducing the enzymes that cause an inflammatory response, reducing joint pain and stiffness associated with arthritis.

Boron has anti-inflammatory properties that can help alleviate the symptoms of arthritis.

And there’s been some pretty substantial research looking at the effects of boron.

A 2015 review of the benefits of boron found that greater boron intake (3–10 mg a day) was associated with fewer cases of osteoarthritis, reducing cases by as much as 60%. The review also found that people with osteoarthritis had lower concentrations of boron than people without osteoarthritis.

A 2018 review found that people with rheumatoid arthritis also had lower levels of boron.

People with low bone health may wish to speak with a doctor about using boron supplements to replenish calcium and magnesium stores. Supplements may help by reducing how much boron the body loses through urine.

The 2018 review also highlighted how boron can support bone health in general, particularly in women with postmenopausal osteoporosis. It may do this by reducing the loss of essential minerals and increasing calcium and vitamin D levels.

BPC-157 and TB-500

You may also want to consider trying peptides if you’re battling arthritis.

BPC-157 is a favorite of mine and amongst thousands of athletes and bodybuilders because of its ability to trigger angiogenesis, which is the formation of new blood cells.

The peptide has healing effects on joint and bone damage and can help repair damaged teeth, bones, muscles, and tendons. It achieves these benefits by promoting improved cell survival and cell migration. BPC-157 combined with hydrolyzed collagen (good for Skin and Joints), tart cherry juice or supplement (good for inflammation & pain reduction), and MSM (for joint & cartilage repair).

TB-500, also called Thymosin Beta-4, is a peptide has been sold as an anti-aging and fitness aid to promote lean muscle growth, speed up the healing process, and more.

The TB-500 peptide is a synthetic version of naturally occurring thymosin beta 4, a protein found in nearly all human and animal cells. The peptide can be injected into damaged muscle tissue—like that which is seen in cases of muscular dystrophy—to repair damaged cells.

While clinical studies are still being done on its efficacy, early studies suggest that it may also help speed up recovery time for athletic injuries as well.

One of the main benefits of using TB-500 over other medications or treatments is that it’s relatively easy to use. It can be taken orally, via injection, or applied topically; unlike some other treatments (such as stem cell therapy), there’s no need for invasive surgery or lengthy rehabilitation periods. There’s also no risk of infection from injections, since they’re sterile.

Pycnogenol

Perhaps a lesser known supplement but with some pretty significant anti-inflammatory properties as well.

This review summarized the effects of the standardized proprietary bark extract of the French maritime pine (Pycnogenol^® ) in mild osteoarthritis (OA), stage 1 and 2. The extract exerts antioxidative, anti-inflammatory, and chondroprotective effects.

“Pycnogenol as an anti-inflammatory and chondroprotective add-on supplement provided long-lasting positive effects such as enhanced physical mobility and pain relief for patients with mild OA. The use of NSAIDs could be significantly reduced, thus diminishing unwanted effects of NSAIDs.”

As always, none of this is medical advice.

The goal with these posts are only meant to help you understand there ARE proven treatments available.

If you or someone you know is dealing with arthritis, it’s important to realize that it’s not a death sentence. Explore your options and try to find a solution that works for you aside just succumbing a joint replacement. Surgery should ALWAYS be a last resort.

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See yah out there,

Ryan