What works before a needle

How to build movement without overdoing it

Pick activity you can repeat without worse soreness tomorrow. Walk briefly or move the joint through an easy range. Then add strength work around the sore joint.

Nearby muscles take some load during standing and walking. They're like helpers lifting one end of a heavy box. Stronger muscles can make stairs and standing feel less tiring.

A physical therapist can change the exercise to suit you. You'll need to show which motion causes a sharp catch. Mild effort is expected, but rising soreness needs a change.

What to use for day-to-day relief

Use warmth before moving a stiff joint. After activity, cold may feel better. You'll need a cloth so the cold doesn't harm your skin.

Anti-inflammatory gel can help joints near the skin. A knee or hand is easier to reach than a hip. Don't add pills before checking your health and other medicines.

Supportive shoes can make walking more comfortable. A cane or brace can help when you feel unsteady. Take it to an appointment if it isn't helping.

When home care has done all it can

Ongoing soreness can make a clinic visit worthwhile. QC Kinetix provides regenerative treatment options, including care prepared from your blood. Medical providers means the clinic staff responsible for your exam and treatment.

You may hear about biologic therapies, which use prepared material from your body. To make platelet-rich plasma, or PRP, staff draw and spin your blood to gather platelets. The prepared part then goes into the sore joint.

Write down what your usual week requires from the joint. Note walking, chores, sleep, and the activity you miss. Those details help the provider understand your limits.

Sources

1. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 studies, with high-quality evidence from 44 trials (3,537 participants) that exercise reduces pain immediately after treatment, and further high-quality evidence that it improves physical function. Benefit attenuates but persists for at least two to six months after the programme ends.

   Fransen M, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database Syst Rev, 2015. DOI: 10.1002/14651858.CD004376.pub3.

2. The 2019 ACR/Arthritis Foundation guideline makes STRONG recommendations for exercise, weight loss in people with overweight or obesity, self-efficacy and self-management programmes, tai chi, cane use, hand orthoses for first-CMC joint OA, tibiofemoral bracing, topical NSAIDs for the knee, oral NSAIDs and intra-articular glucocorticoid injections for the knee; acupuncture, thermal modalities, radiofrequency ablation, acetaminophen, duloxetine and tramadol are only conditional.

   Kolasinski SL, et al. — 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee.. Arthritis Rheumatol, 2020. DOI: 10.1002/art.41142.

3. OARSI designates arthritis education plus structured land-based exercise (with dietary weight management for the knee) as CORE treatments for knee, hip and polyarticular OA. Topical NSAIDs are Level 1A for knee OA. Intra-articular corticosteroids, intra-articular hyaluronic acid and aquatic exercise are Level 1B/2 for the KNEE only and are NOT recommended for hip or polyarticular OA. Acetaminophen is conditionally not recommended, and no oral NSAID is recommended for people with cardiovascular comorbidity or frailty.

   Bannuru RR, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

4. The Cochrane review of topical NSAIDs for chronic musculoskeletal pain pooled 39 studies with 10,631 participants, all of which examined topical NSAIDs for the treatment of osteoarthritis, using 'clinical success' (at least 50% pain reduction or equivalent) as the primary outcome.

   Derry S, et al. — Topical NSAIDs for chronic musculoskeletal pain in adults.. Cochrane Database Syst Rev, 2016. DOI: 10.1002/14651858.CD007400.pub3.

5. In a randomized trial of 156 US Military Health System primary-care patients with knee osteoarthritis, physical therapy beat glucocorticoid injection at one year: mean WOMAC total scores were 37.0 with physical therapy versus 55.8 with injection (mean between-group difference 18.8 points, 95% CI 5.0 to 32.6, lower is better), with secondary outcomes in the same direction.

   Deyle GD, et al. — Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee.. N Engl J Med, 2020. DOI: 10.1056/NEJMoa1905877.

6. A BMJ systematic review of 13 randomized placebo-controlled trials found HIGH-quality evidence that paracetamol (acetaminophen) is ineffective for low back pain, and high-quality evidence that for hip or knee osteoarthritis it provides a statistically significant but NOT clinically important effect on pain (weighted mean difference -3.7 on a 0-100 scale, 95% CI -5.5 to -1.9) and disability (-2.9, 95% CI -4.9 to -0.9).

   Machado GC, et al. — Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials.. BMJ, 2015. DOI: 10.1136/bmj.h1225.

7. A network meta-analysis of 76 randomized trials in 58,451 patients found that all NSAID preparations improved osteoarthritis pain versus placebo, but only six reached at least 95% probability of exceeding the minimum clinically important effect (-0.37). Among maximally approved daily doses, diclofenac 150 mg/day (ES -0.57) and etoricoxib 60 mg/day (ES -0.58) had the highest probability of being most effective.

   da Costa BR, et al. — Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.. Lancet, 2017. DOI: 10.1016/S0140-6736(17)31744-0.

8. An updated systematic review and meta-analysis of six trials (2,059 patients) found duloxetine significantly reduced Brief Pain Inventory 24-hour average pain (MD -0.74, 95% CI -0.92 to -0.57) and improved the WOMAC physical function subscale (MD -4.22, 95% CI -5.14 to -3.30) in knee osteoarthritis.

   Chen B, et al. — An Updated Systematic Review and Meta-analysis of Duloxetine for Knee Osteoarthritis Pain.. Clin J Pain, 2021. DOI: 10.1097/AJP.0000000000000975.

9. The systematic literature review informing the 2018 EULAR hand osteoarthritis recommendations (127 references) found hand exercise and prolonged thumb-base splinting beneficial, topical and oral NSAIDs equally effective with fewer adverse events from topical, and NO clear benefit for paracetamol, intra-articular thumb-base glucocorticoid or hyaluronic acid injection, low-dose oral glucocorticoids, hydroxychloroquine or anti-TNF. No trial compared surgery with sham or non-operative treatment.

   Kroon FPB, et al. — Efficacy and safety of non-pharmacological, pharmacological and surgical treatment for hand osteoarthritis: a systematic literature review informing the 2018 update of the EULAR recommendations for the management of hand osteoarthritis.. RMD Open, 2018. DOI: 10.1136/rmdopen-2018-000734.