Non-pharmacological treatments for osteoarthritis include patient education, exercises, weight loss, physical aids, diet, and hydrotherapy. These treatments have effects on symptoms and function equivalent to medications but without serious side effects. Specific exercises recommended for osteoarthritis locations include strengthening and range of motion exercises for the knees, hips, fingers, and thumb. Lifestyle recommendations include weight loss for overweight patients, pacing activities, and use of walking sticks.

1. and
present
Non-pharmacological treatmentsNon-pharmacological treatments
for osteoarthritisfor osteoarthritis

2. Why use non-pharmacological
treatments?
 The international recommendations for osteoarthritis
of the lower limbs and hands stress the importance of
individualised care combining non pharmacological measures
with medicinal treatments
 Utility:
 Effects on symptoms and function at least equivalent
to those of medicinal treatments
 No serious side effects
 Structural effects not demonstrated as yet
2
Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.

3. What exactly are they?
Patient education
Exercises
Technical aids: insoles, crutches, braces, etc.
Dietary advice
Hydrotherapy
Weight loss, for overweight patients with knee osteoarthritis
3
Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.

4. Weight loss
 Most effective non-pharmacological
treatment for knee osteoarthritis
 Must be at least 5% of initial weight
to be fully effective
 Improves function and decreases
pain.
 Also has cardiovascular benefits,
which is important given the high
incidence of comorbidities in these
patients
4

5. Treatment education (1)
The aim is to boost autonomy and compliance
with osteoarthritis recommendations
Improves treatment management
This is not the same as patient information
and should be planned in several stages
Several healthcare professionals are involved
It is a part of the patient's treatment and must
be assessed
5 Beauvais C. Éducation thérapeutique en rhumatologie. Rev Prat Med Gen 2012 ;26 :155-60.

6. 6

7. Treatment education (2)
 Main treatment and educational goals
for osteoarthritis*:
 compliance with non-pharmacological
treatments
 management of pain-relief and analgesics
 physical exercise and specific home
exercises (compliance, regularity)
 weight loss if necessary
7
Beauvais C. Education thérapeutique en rhumatologie. Rev Prat Med Gen 2012;26:155-60.
*Osteoarthritis in the legs and fingers

8. Lifestyle measures*
 Weight loss for overweight patients
 Avoid standing for long periods, long walks
and carrying heavy loads during painful
episodes (relative rest) – “pacing of
activities”
 Recommend strengthening exercises
between flares and regular aerobic activity
 Use a walking stick on the contralateral side
 Suitable footwear, cushioning soles
8 Sellam, J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.
* Osteoarthritis of the legs

9. Endurance-building sports*
 Type: rapid walking (30 minutes 3 times a week),
exercise bike or exercises in water
 Improve the aerobic capacity of patients and their quality of life
 Help maintain cardiorespiratory function
 Have an impact on joint range of motion, strengthen muscles, enhance
motor function and improve proprioception and balance disorders
 Improve sleep restoration, reduce pain, and improve energy
and well-being
9 Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
Bonan I. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.
* Osteoarthritis of the legs

10. Knee osteoarthritis: two types of specific
exercises
Muscle strengthening
 Aimed at the stabilising muscles of the knee:
obviously the quadriceps but also the hamstrings
 Reduce pain and improve function
 Static exercises or exercises against gravity,
natural resistance or weights
For example: ask the patient in a sitting position
to hold their leg out straight (static) or to alternate
bending and straightening the knee (dynamic)
10
Range of motion
 Exercises designed to fight knee flexion deformity
Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.

11. Patello-femoral osteoarthritis: specific
exercises
 Isometric rehabilitation of the internal portions
of the quadriceps (vastus medialis)
 Helps prevent the kneecap from rubbing
on the trochlear as a result of subluxation
11
Sellam J, Berenbaum F. Arthrose. Rev Prat 2011;61:675-85.

12. Knee osteoarthritis: prescription
for rehabilitation (example)
12 physiotherapy sessions at a rate of 2 sessions a week
Relaxing massages
Fight against knee flexion deformity
Gentle motor reinforcement
of the quadriceps and hamstrings,
isometric exercises followed
by dynamic exercises
Proprioceptive rehabilitation
Stamina building exercises
Exercises for home use
12
Bonan I, Carson P. Rôle de la rééducation dans le traitement de la gonarthrose. Rev Prat 2009;59:1246-47.

13. Knee osteoarthritis: sole orthotics
or insoles
 Advice on shoes: sports shoes, thick, flexible soles
 Cushioning soles:
 recommended, irrespective of the joint compartment affected
(internal or external tibio-femoral, patello-femoral)
 can help relieve pain and improve walking
 custom-made by a podiatrist or purchased from the pharmacy
 Sole orthotics:
 with a posterior-external pronator corner to relieve the internal
compartment (internal tibio-femoral knee osteoarthritis)
 or a posterior-internal supinator wedge (external tibio-femoral knee
osteoarthritis)
 decrease pain and NSAID consumption
13
Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.
Zhang W, et al.
EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutic

14. Knee osteoarthritis: Knee orthotics
 Flexible, non-adhesive orthoses or elastic knee braces
with or without a peripatellar device
 Can reduce pain, enhance stability and decrease
the risk of falls
 Recommended for young subjects, to allow reintroduction
of sports and for all other subjects with a view to delaying
the need for joint replacement
14
Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres
inférieurs. Rev Prat 2012;62:651-53.
Zhang W, et al.
EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeu

15. Hip osteoarthritis: specific exercises
 Preserve joint range of motion
 Strengthen the hip stabiliser muscles
 Prevent angular deformity and loss of back-step function
 Reduce pain
15
Rannou F. Prescrire les traitements non pharmacologiques dans l’arthrose des membres inférieurs. Rev Prat 2012;62:651-53.

16. Finger osteoarthritis:
 The following are recommended:
 Exercises: to protect the joints, improve mobility
and enhance muscle strength
 The application of heat (paraffin, heated dressings, etc.),
especially before taking exercise
 Braces for osteoarthritis of the carpo-metacarpal joint
of the thumb
 Orthoses for the prevention and correction of angular
deformities during lateral extension and flexion
16
Zhang W, et al.
EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Thera
Ann Rheum Dis. 2007;66:377-88.

17. Sample prescription for thumb
osteoarthritis
 Osteoarthritis located between the trapezoid bone
and the first metacarpal, most often bilateral
 Common (8 to 22% of women), affects more women (80%) than men
17
Prescription 1
Increase in range of motion, stretching and self-stretching exercises aimed at the space between the
thumb and index
Strengthening of the intrinsic and extrinsic muscles of the hand and thumb-index pincer
Functional exercises
Aerobic exercises
Home training
No ultrasound, no massage
Prescription 2
Resting splint for the thumb-index pincer to be worn at night
Rannou F, La rhizarthrose. Rev Prat 2012, 62:639.