Best Natural Treatments & Remedies

One of the things my patients ask me most when I visit them at home for a physiotherapy session? What’s the best natural treatment for osteoarthritis and knee pain ?

What drug-free remedy works to reduce pain and osteoarthritis? How to treat osteoarthritis of the knee naturally?

I’m going to answer this question as rigorously and precisely as possible . As usual, I’ll be relying on :

• my experience as a physiotherapist since 2009;
• my research and in-depth reading of studies published in international medical literature. All references are at the end of the article.

My aim is not to propose a miracle cure for osteoarthritis. Unfortunately, I don’t think such a thing exists. And you’ll already find plenty of sites and programmes promising you wonders for your osteoarthritis!

My aim is simply to present you with the extent of our current knowledge on effective non-drug solutions for osteoarthritis of the knee. And perhaps to save you time and money (I’m thinking of one of my patients who was spending up to 250 euros a month on a food supplement supposed to prevent cartilage degradation…).

For those in a hurry, here’s a one-sentence summary of what I have to say:

2 to 3 sessions of physical exercise (muscle strengthening, walking or cycling with shortness of breath) is by far the most likely to bring you relief from pain and improved ability to perform everyday tasks.

My 5000+ word article summarized in less than 50 words 🙂

But I urge you to read the whole article to find out more!

♻️ Last updated: 16 décember 2024
Financial links of interest: none with the subject of this article, except that I’m a physiotherapist. Full declaration in legal notice.
Written by Nelly Darbois, physiotherapist and scientific editor

A quick reminder about osteoarthritis and knee pain

Osteoarthritis is the most common rheumatic disease. Over 80% of people over the age of 80 have osteoarthritis of the knee! But it doesn’t necessarily cause pain.

Because some people have osteoarthritis of the knee without having any pain or discomfort in the joint!

Between 40% and 80% of people who have osteoarthritis on their x-rays experience discomfort or pain. For others, it’s said to be asymptomatic: it doesn’t trigger any symptoms or problems.

Osteoarthritis mainly affects :

• articular cartilage ;
• subchondral bone;
• a synovial joint (the knee is a synovial joint!).

On the X-ray of a knee with gonarthrosis, we can see:

• osteophytes on the edges of the joint,
• joint space narrowing;
• subchondral sclerosis;
• subchondral cysts;
• chondrocalcinosis.

You may have seen these terms on your X-ray report. It doesn’t really matter, because it doesn’t change the treatment modalities behind it!

How does the pain of gonarthrosis usually evolve?

1. Initially, pain is intermittent (= not continuous) and is most often associated with theuse of the joint.
2. For many people (not all!), the symptomatic disease progresses, and the pain becomes more chronic and may occur at rest and during the night. The joint becomes “stiff”, resulting in typical pain and difficulty when starting to move after a period of rest.
3. People in the advanced stages of the disease may experience deep creaking or crackling in the knee when they move, and the joint’s range of motion is often limited. Knee osteoarthritis is more responsible than any other disease for theinability to walk, climb stairs and do housework in non-institutionalized people aged 50 and over.

Osteoarthritis does not always cause pain. For some people with osteoarthritis of the knee, pain doesn’t necessarily get worse over time (no matter what you do).

Let’s take a look at treatments for osteoarthritis and its symptoms.

Natural treatments for osteoarthritis of the knee: an endless list!

(And constantly renewed.)

Before writing this article, I had the pleasure of finding out from all my current patients what non-drug treatments they had already used for osteoarthritis.

Here is the list of natural solutions proposed by my patients :

Important note: we’ll see at a later date if we have any proof of the effectiveness of these various natural treatments. This list is simply intended to illustrate the vast number of solutions available for osteoarthritis, and not all of them are necessarily effective!

1. taking dietary supplements purchased in pharmacies or on the Internet (Collagen Vital Power is a name that often comes up, as are glucosamine or chondroitin sulfate or omega-3 fatty acids from fish oils or gamma-linolenic acid);
2. green clay poultices (and even kale for one of my patients);
3. application of tiger balm ;
4. homeopathy (Medorrhinum 5 CH, Dulcarama 7 CH);
5. CBD in various forms, including herbal tea;
6. essential oils, phytotherapy (harpagophytum is often used) ;
7. apply heat or cold to the painful joint;
8. Adopt a diet rich in antioxidants;
9. Platelet-rich plasma injections;
10. use the Revitive Medic.

A quick search on the Internet can expand this list in a matter of seconds. For example, the Health section of Le Journal des femmes suggests :

Top Santé suggests tai chi or qi gong.

Some even suggest homemade recipes for “cartilage regeneration”.

And maybe you’ll even see ads like this on my page if you haven’t activated your ad blocker!

And it would probably take several hours to come up with an exhaustive list of everything on offer.

So, how do you sort through all this? Because it would clearly take a lifetime to try treatment after treatment on yourself, hoping to identify which ones really make a difference…

That’s what we’re going to see now.

The list of natural remedies for osteoarthritis of the knee is endless. It’s just a matter of sorting them out!

Natural treatments: relieving pain or delaying the worsening of osteoarthritis?

The first thing to do to identify which treatments are most likely to workis to agree onyour precise expectations. What action do you want the treatment to take? On which parameter do you mainly want it to have an effect?

It can be :

• relieve knee pain . And for how long? Just for the moment? A few minutes? Several days, months?
• avoid orthopedic deformities of the knee joint;
• delaying the fitting of a knee replacement;
• reduce the rate of cartilage damage, reduce the process of cartilage destruction;
• reform cartilage that has already been destroyed;
• regain mobility and flexibility in the knee;
• to enable you to walk longer or resume walking;
• feel better ;
• etc.

Identifying your own precise expectations is an essential step. How else can you assess the effectiveness of this solution?

You may be tempted to answer “a little bit of everything”. I understand how tempting that is! However, by having such high, generalized expectations, I think we’re taking the risk:

• to be disappointed;
• not being able to really identify the effectiveness of the treatment.

That’s why, in the rest of this article, I’ ll be specifying as far as possible what each natural treatment is potentially effective at: pain, cartilage, walking, etc.

Another point that is often underestimated is that, just as a substance or technique can be effective against a problem, it can also have potential side-effects. Just because something is “natural” doesn’t mean that undesirable effects aren’t possible!

I’ll take the time to report on known side effects too.

Identifying what you want the treatment to have the most effect on (pain, cartilage wear, stiffness, etc.) is important in assessing the success of the treatment behind it.

Let’s take a look at the different ways of determining whether a treatment is effective. Whether it’s a drug or a “natural” solution.

Testimonials

It’s what you come across most easily. Through friends and family, on TV, on the Internet.

There are several problems with testimonials. Firstly, we don’t necessarily know everything the person did before/alongside using this treatment. Nor do we know whether the problems she encountered and her expectations were similar to ours.

You’ve probably noticed it yourself: the symptoms of osteoarthritis are not necessarily constant. Some days it hurts more than others.

How can we know, just on the basis of a simple testimonial , whether the treatment has been effective on this or that symptom, or whether the pain or any other symptom has simply fluctuated, regressed or diminished naturally?

Then there is a sorting out of the testimonies:

• companies selling this or that solution will put more emphasis on positive testimonials;
• patients who are very happy (or very dissatisfied) are more likely to testify than those who are indifferent.

Take a look at these 2 testimonials for the same plant-based product for osteoarthritis of the knee:

For all these reasons, I don’t think it’s enough to rely on testimonials alone to decide which treatment to turn to.

Opinions of professionals and experts

Some people devote dozens of hours a week to :

• treating people suffering from knee pain (physiotherapists, doctors, surgeons, other health professionals);
• conduct laboratory research on the physiology of osteoarthritis (research teams), or on the evolution of pain and other symptoms in people suffering from osteoarthritis.

These professionals have therefore developed a certain expertise on the subject. It’s reasonable to assume that their opinion is probably a little better than anyone else’s. But you have to be sure. But you have to be sure:

• that they really are experts specifically on the subject: osteoarthritis of the knee;
• that they are not completely off the mark, and that what they say and think is not in fact completely discredited by a large proportion of people with the same expertise. Your theories and hypotheses need to be based on knowledge that is widely accepted, or that is reasonable and logical.

You probably have in mind examples of experts who are certainly controversial (I won’t name names!).

If the trust you can place in a few testimonials or the words of a single expert is limited, then where do you turn? Scientific publications have developed precisely to compensate for this!

And that’s just as well: there’s an awful lot about osteoarthritis of the knee, more than any other joint!

To date, 15,819 studies have been published on the subject. More than 1,000 studies are published on the subject every year. A large proportion of them concern natural treatments.

Results of clinical studies and scientific publications

Of course, there are also major limitations to the scientific publication system. But these publications can still shed a different light, one that is superior (or at least complementary) to that provided by testimonies and expertise.

Personally, it’s these publications (or the words of experts who rely on them) that I prefer to rely on when deciding whether or not to use a treatment, whether natural or unnatural.

Because to write something that is published in a scientific journal :

1. we take our time;
2. we formulate hypotheses and see if they hold up;
3. and above all, we submit our thoughts and findings to other experts. Who criticize our work.

Just because some treatments are “natural” doesn’t mean they haven’t been studied. Far from it. For example, all the solutions tested by my patients in the list I’ve presented have been the subject of scientific evaluation and publication. But that doesn’t mean they’ve been proven effective!

I’m now going to present you with the results of studies published specifically on osteoarthritis of the knee. And give you my opinion as a physiotherapist on the natural treatment(s) most likely to be effective against this or that symptom.

What do studies tell us about natural solutions for osteoarthritis of the knee?

When there are a lot of studies on a subject, researchers carry out what are known as “systematic reviews” or “meta-analyses”. They select the best-quality studies, and try to draw conclusions about the most effective treatments.

And one international association does this particularly well. It’s called the Cochrane Collaboration. It is known for being extremely rigorousin its approach.

In October 2022, it published a systematic review on precisely the subject that interests us!

Why did she become interested in natural treatments for osteoarthritis?

It is based on the following observation: international recommendations on the management of osteoarthritis of the knee state that the main effective non-drug solution is physical exercise (I’ll come back to this later).

In the top 24 most important and recent international recommendations, here are themost recommended non-drug solutions for knee osteoarthritis , in orderfrom most to least recommended (Zhang 2022):

1. aerobic exercise: movement or activity that causes continuous shortness of breath;
2. lose weight ;
3. learn to manage your pain;
4. use walking aids ;
5. tai chi.

The Cochrane review also says that very often, people bothered by their osteoarthritis are suggested to use other things to reduce their symptoms, in addition to exercise.

So she set out to find out whether all the other solutions often suggested for knee osteoarthritis really offer anything more than exercise alone.

Has she found many studies on natural treatments?

Yes, there really are a lot of studies on natural treatments. Here’s the (non-exhaustive!) list of tested treatments:

• dietary interventions: food supplements, diets, intake of certain foods ;
• numerous manual therapies;
• herbal teas and capsules;
• pelotherapy (application of medicinal mud);
• application of creams, balms, poultices ;
• homeopathy;
• bandages, kinesiotaping ;
• whole-body vibrations;
• CBD:
• essential oils ;
• etc. etc.

Some, however, are very poorly conducted, and nothing credible can be drawn from them. The Cochrane has therefore selected those of higher quality (although they are not perfect).

In all, the results of 60 studies were analyzed, involving over 6,000 people suffering from osteoarthritis of the knee.

So are any of these treatments effective?

Here, in summary (and a bit complicated… I’ll explain it more simply later!), is what the Cochrane tells us about the effectiveness of natural solutions tested against pain :

Comparing adjunctive therapies plus terrestrial exercise therapy to placebo therapies plus exercise therapies up to six months (short-term), we found low-confidence evidence suggesting a reduction in pain and function, which does not meet our pre-specified threshold for a clinically important difference.

In fact, the research team compared the evolution of pain in 2 groups of people with knee osteoarthritis:

• those whoexercised and also took a natural treatment;
• those whoexercised and took a placebo (when possible), or nothing.

And the pre- and post-treatment pain of these 2 groups was similar. It decreased slightly after treatment, but in the same proportions whether a placebo, a natural treatment or nothing else was used.

And what about the other discomforts associated with osteoarthritis? 3 other things were sufficiently studied to be able to say something:

• structural changes in the joint, measured by X-ray: has the cartilage or joint changed?
• Physical function: can people do certain things better?
• Quality of life: are people more satisfied with their daily lives?

And here again, the same result: onaverage, natural treatments don’t make any significant difference . In the days, weeks and 6 months following treatment.

On the other hand, 13% of studies (8/60) reported adverse effects (but they don’t seem to be more frequent when natural treatments are added compared to exercise alone).

Should we be disappointed by these results? Does this mean that there’s absolutely nothing we can do about knee osteoarthritis, that we’re doomed to let things develop as they are?

I don’t think so.

And so I’ll turn now to my more personal opinion: how I interpret the results of these studies, and what you can do concretely to maximize your chances of getting better.

The 60 best-quality studies on natural solutions for knee osteoarthritis (other than exercise) show no significant effect on pain, joint function, discomfort or quality of life.

My physiotherapist’s opinion on the best natural treatment for osteoarthritis of the knee

Passive” natural solutions to knee osteoarthritis, such as applying poultices or taking anti-oxidant-rich foods, are not effective beyond what might be expected from a placebo.

But there is an effective “natural” solution! It’s exercise. It’s even the best natural anti-inflammatory for osteoarthritis of theknee.

And that’s what I recommend to my patients. But let’s see:

• what type of exercise ;
• how often, how intensively ;
• and exactly what results to expect. Does it really hurt less? Can it help preserve cartilage?

What kind of exercise?

Here’s the kind of exercise that gets results:

• functional and aerobic training sessions ( walking, cycling);
• muscle strengthening ;
• with simple lying or standing exercises without equipment, such as squats, sit-ups, elastics, or sometimes weights or weight machines;
• supervised individually or taught as part of a course (this can also be done on your own if you feel you have the skills);
• or Tai Chi / Qigong (which are, quite simply, a specific type of muscle-strengthening exercise!).

A priori, exercise on a stationary bike or walking alone on flat ground at a leisurely pace, without “straining” your breath, is not enough to combat osteoarthritis if it doesn’t involve a minimum sensation of effort and continuous breathlessness.

It’s all about doing exercises and movements that put a little more strain on the muscles and heart.

The amount of exercise is also important:

• 20 to 60 minute sessions ;
• 2 to 3 times a week (or even 1 to 5 times);
• for 1 to 6 months.

What are the effects on pain and cartilage?

These are theconcrete results achieved by regular exercisers compared to non-exercisers.

Symptom	People who have exercised	Non-exercisers
Pain 0 no pain 100 maximum pain	32/100	44/100
Functional capacities 0 maximum capacity 100 no capacity	28/100	38/100
Quality of life 0 worst possible 100 best possible	47/100	43/100
Side effects	Increased knee or back pain reported in 8/60 studies (but not in all participants)	None reported

By exercising regularly, you’re likely to experience (a little) less pain, and your functional abilities and quality of life will be better than if you didn’t.

As you can see, we’re talking about a small effect. Roughly speaking, a 10% improvement (provided you’re not one of the few people for whom it increases pain). That may not sound like much, I grant you.

But it’s the best we have to offer today. After all, physical exercise is by far the No. 1 intervention (natural or unnatural, for that matter) in terms of effect. For the others, we can expect, at best, even weaker effects.

How does exercise help?

For people with osteoarthritis of the knee, improving muscle strength is one of the main objectives of exercise, as weakness is common.

Sufficient strength training can remedy muscle weakness by improving muscle mass and/or recruitment.Pain must be taken into account, and may be an obstacle to under-dosing.

Improving lower-limb strength can :

• reduce stress on the knee,
• reduce pain,
• improve physical condition ;
• reduce joint loading or localized stress in articular cartilage.

Poor physical condition is another deficiency reported in people with knee osteoarthritis.

Aerobic exercise (e.g. walking, cycling) of sufficient intensityincreases oxidative enzymes and muscle capillarization, which in turn increases peak oxygen uptake. Greater oxygen uptake is inversely proportional to morbidity and mortality, and makes every daily task easier (in terms of effort).

Thus, improved fitness can enhance quality of life by enabling a wider range of available daily tasks, thus improving physical function.

Physical exercise is also beneficial for other aspects of physical and mental health, killing several birds with one stone!

See also: how to motivate yourself to walk more?

What about antioxidant-based foods, supplements and plants?

Antioxidants were the subject of a great deal of research in the 1990s. As a result, the media gave them enormous prominence. Tons of antioxidant-based dietary supplements were marketed and sold.

Antioxidants can be found everywhere:

• in thenormal diet (turmeric, artichoke, plum, walnut, avocado, soya, etc.):
• as a dietary supplement ;
• in plants, i.e. in phytotherapy/aromatherapy/Chinese or Ayruvedic medicine (boswellia, harpagophytum).

And there are lots of studies to see if :

• a diet rich in antioxidants;
• taking dietary supplements or herbal remedies containing antioxidants;

had a positive effect on gonarthrosis sufferers.

It’s quite easy to take these treatments, and to make placebos of these substances. Much more so, for example, than for physical exercise. We can therefore look forward to very high-quality studies on the subject that will enable us to draw definitive conclusions!

Unfortunately, the studies are highly discordant. Many find no positive effect of antioxidants on pain or other parameters in knee osteoarthritis. Some show a (small) effect.

Studies showing an effect tend to be much more widely published than those showing no effect or a negative effect. This is the well-known publication bias. And it is all the stronger if the people conducting the studies have a financial interest in positive results.

When you do a lot of studies, and look at a lot of different things, it’s by chance that you sometimes find positive results. But this has nothing to do with the efficacy of the treatment… It’s simply the fact that we do a lot of tests, and out of the mass, a few are positive.

That’s why I don’t think we should expect too much from these natural treatments.

Here, for example, is one research team’s conclusion on the subject:

turmeric, devil’s claw, methylsulfonylmethane (MSM), Boswellia, white willow bark and green tea have contradictory or minimal evidence to support their use for inflammation relief. Despite the lack of medical evidence, passionate consumers continue to use these modulators as supplements or alternatives to conventional pharmacotherapy.

Georgia-Eurini, 2020

Of course, you’ll always find authors who come to much more enthusiastic conclusions about antioxidants. But for all the reasons I set out above, my support goes more to those who are more measured.

Conclusion: what you can do about knee osteoarthritis

This is what I say today to my patients seeking natural solutions for osteoarthritis of the knee:

1. the natural treatment most likely to improve your pain and make it easier for you to carry out your daily activities is exercise. Take the time, at least 3 times a week, to exercise for 20 to 30 minutes in a way that takes your breath away a little and puts your legs to the test. I adapt the suggested activity to suit my patients. Do it gradually, so as not to increase the pain.
2. you shouldn’t expect a phenomenal improvement. But pain can also go away on its own, or never get worse, no matter what you do! And they’ll be able to enjoy the other physical and mental health benefits of exercise.

In general, my patients very often ask me for my opinion on ointments, herbs or food supplements available in pharmacies. Depending on how they formulate their question, I give them more or less detailed answers.

I tell them I completely understand why they want to turn to this type of solution, as it’s very easy to implement. But to date, we can’t expect it to be effective in preventing osteoarthritis from worsening. And if there is an effect on pain, it will be weak, and probably more related to the placebo effect.

Of course, the final decision rests with the person who is bothered by his or her osteoarthritis (you!), based on the information that most appeals to you!

***

Any questions or comments? See you in comments!

The excellent Cochrane review on natural solutions in addition to exercise.

French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database of Systematic Reviews 2022, Issue 10. Art. No.: CD011915. DOI: 10.1002/14651858.CD011915.pub2. Accessed 06 January 2023.

Synthesis of studies on the effect of physical exercise.

Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD004376. DOI: 10.1002/14651858.CD004376.pub3

Zhang L, Wang Y, Ye T, Hu Y, Wang S, Qian T, Wu C, Yue S, Sun X, Zhang Y. Quality of clinical practice guidelines relevant to rehabilitation of knee osteoarthritis: A systematic review. Clin Rehabil. 2022 Dec 20:2692155221144892. doi: 10.1177/02692155221144892. Epub ahead of print. PMID: 36540949.

Sasaki R, Honda Y, Oga S, Fukushima T, Tanaka N, Kajiwara Y, Nakagawa K, Takahashi A, Sakamoto Y, Morita H, Kondo Y, Okita S, Kondo Y, Goto K, Kataoka H, Sakamoto J, Okita M. Effect of exerciseand/or educational interventions on physical activity and pain in patients with hip/knee osteoarthritis: A systematic review with meta-analysis. PLoS One. 2022 Nov 21;17(11):e0275591. doi: 10.1371/journal.pone.0275591. PMID: 36409668; PMCID: PMC9678259.

Bell EC, Wallis JA, Goff AJ, Crossley KM, O’Halloran P, Barton CJ. Does land-based exercise-therapy improve physical activity in people with knee osteoarthritis? A systematic review with meta-analyses. Osteoarthritis Cartilage. 2022 Nov;30(11):1420-1433. doi: 10.1016/j.joca.2022.07.008. Epub 2022 Aug 12. PMID: 35970256.

Antioxidants.

Nejadhosseinian M, Djalalinia S, Haerian H, Alikhani M, Mansour A, Mousavian AH, Mardani-Fard HA, Kasaeian A, Faezi ST. The effects of antioxidants on knee osteoarthritis: A systematic review and meta-analysis. Front Nutr. 2022 Dec 19;9:1026450. doi: 10.3389/fnut.2022.1026450. PMID: 36601076; PMCID: PMC9806224.

Deligiannidou GE, Papadopoulos RE, Kontogiorgis C, Detsi A, Bezirtzoglou E, Constantinides T. Unraveling Natural Products’ Role in Osteoarthritis Management-An Overview. Antioxidants (Basel). 2020 Apr 23;9(4):348. doi: 10.3390/antiox9040348. PMID: 32340224; PMCID: PMC7222394.

Advertising bans on dietary supplements for osteoarthritis on vidal.fr

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