By Auckland Physiotherapy | Evidence-Based Arthritis Management
If you're living with arthritis, you've likely received conflicting advice over the years. Perhaps you've been told to rest your joints, avoid certain activities, or that there's little you can do except manage pain with medication. However, the latest research is challenging many long-held beliefs about arthritis management and revealing more effective approaches to maintaining joint health and reducing pain.
At Auckland Physiotherapy, we stay current with the latest arthritis research to provide our patients with evidence-based treatment strategies. The good news is that recent studies show you have far more control over your arthritis symptoms than previously thought. From exercise and strength training to supplements and lifestyle modifications, let's explore what the current evidence tells us about managing this common condition.
Arthritis isn't a single disease but rather a term encompassing over 100 different conditions affecting joints and surrounding tissues. The two most common types are osteoarthritis (OA), which involves the breakdown of joint cartilage and underlying bone, and rheumatoid arthritis (RA), an autoimmune condition causing joint inflammation. In New Zealand, arthritis affects approximately one in six people, making it one of the most prevalent chronic health conditions.
For decades, arthritis was viewed as a wear-and-tear condition—inevitable joint deterioration that worsens with age and use. However, modern research reveals a much more complex picture. We now understand that arthritis involves inflammation, changes in bone structure, alterations in surrounding muscles and tendons, and importantly, many modifiable factors that influence disease progression and symptoms.
Perhaps the most significant shift in arthritis management over the past decade is the overwhelming evidence supporting exercise as a primary treatment. This represents a complete reversal from older recommendations to rest arthritic joints.
What the Research Shows
Multiple high-quality studies and systematic reviews now demonstrate that exercise for people with arthritis reduces pain levels as effectively as pain medication, improves physical function and mobility, enhances quality of life, slows disease progression, and reduces the need for joint replacement surgery. A landmark 2020 study published in the British Journal of Sports Medicine found that exercise therapy was as effective as surgery for knee osteoarthritis, challenging the assumption that joint replacement is inevitable for many patients.
Importantly, research shows that appropriate exercise does not damage arthritic joints or accelerate cartilage loss. In fact, the opposite is true—controlled joint loading through exercise promotes cartilage health by improving nutrient delivery, stimulating beneficial cartilage cell activity, and strengthening supporting structures.
Types of Exercise That Help Arthritis
The evidence supports several exercise modalities for arthritis management:
Aerobic exercise such as walking, cycling, and swimming has been shown to reduce pain and improve cardiovascular health without stressing joints excessively. Studies indicate that even gentle walking for 30 minutes most days significantly improves arthritis symptoms and overall health. For Auckland residents, our numerous walking paths along the waterfront and through parks provide excellent low-impact exercise opportunities.
Strength training, which we'll discuss in detail shortly, has emerged as particularly beneficial for arthritis. Research consistently shows that strengthening muscles around affected joints reduces pain, improves function, and may slow disease progression.
Flexibility and range of motion exercises help maintain joint mobility and prevent stiffness. While once considered the primary exercise for arthritis, we now know these are important but shouldn't be the only form of exercise.
Balance and proprioception training reduces fall risk and improves joint stability, particularly important for those with lower limb arthritis. Tai chi has shown particular promise in research studies for improving balance and reducing arthritis pain.
One of the most exciting developments in arthritis research is the compelling evidence supporting strength training, even for people with moderate to severe arthritis.
Why Strength Training Works
When you have arthritis, the muscles around affected joints often become weak, either from disuse, pain avoidance, or the inflammatory process itself. This muscle weakness creates a vicious cycle where weak muscles provide less joint support, leading to increased pain, causing further reduction in activity, resulting in more muscle loss. Strength training breaks this cycle.
Research published in recent years demonstrates that strength training for people with arthritis reduces joint pain by 30-50%, improves physical function and daily activity performance, increases muscle mass and strength around affected joints, enhances joint stability and protection, and improves bone density, particularly important for those at osteoporosis risk.
Is Strength Training Safe for Arthritic Joints?
This is the question we hear most frequently at Auckland Physiotherapy, and the evidence provides a clear answer: yes, when done appropriately. Multiple studies have monitored people with arthritis performing strength training over months and years, finding no evidence of joint damage or accelerated cartilage loss. In fact, appropriate strength training appears to have protective effects on joints.
The key is "appropriate" strength training. This means starting with lighter weights and higher repetitions, progressing gradually based on individual response, using proper technique to distribute forces correctly, working within tolerable pain levels (mild discomfort during exercise is acceptable, but sharp pain is not), and ideally working with a physiotherapist initially to ensure correct form and progression.
What Type of Strength Training Is Best?
Research supports various approaches to strength training for arthritis:
Progressive resistance training, where you gradually increase weight or resistance over time, has the strongest evidence base. This can be performed with weights, resistance bands, or body weight. Studies show that training 2-3 times per week at moderate intensity (60-80% of maximum strength) provides optimal benefits.
Isometric exercises, where muscles contract without moving the joint, can be particularly useful during arthritis flares when movement is more painful. Research shows these still provide strength benefits while minimizing joint stress.
Functional strength training that mimics daily activities—such as sit-to-stand exercises, step-ups, and carrying tasks—helps translate strength gains into improved daily function.
Getting Started with Strength Training
If you're new to strength training with arthritis, the evidence suggests:
Start with bodyweight exercises or very light resistance. Focus on major muscle groups around affected joints—for knee arthritis, this means quadriceps, hamstrings, and hip muscles; for hip arthritis, focus on hip abductors, extensors, and core muscles. Begin with 1-2 sets of 10-15 repetitions, performed slowly with control. Progress gradually, increasing resistance only when exercises become comfortable. Allow at least one day of rest between strength training sessions for the same muscle groups.
At Auckland Physiotherapy, we design individualized strength training programs based on your specific arthritis presentation, fitness level, and goals. Professional guidance ensures you're exercising effectively while minimizing injury risk.
The supplement industry for arthritis is enormous, with countless products claiming to relieve pain, rebuild cartilage, or cure arthritis entirely. Let's examine what the evidence actually shows.
Glucosamine and Chondroitin
These supplements have been extensively studied, with mixed results. Recent meta-analyses and systematic reviews suggest that glucosamine sulfate may provide modest pain relief for some people with knee osteoarthritis, though effects are generally small. Chondroitin shows similar modest benefits in some studies. However, these supplements do not rebuild cartilage or reverse arthritis progression as once hoped.
The current evidence-based position is that glucosamine and chondroitin are safe and may be worth trying for 2-3 months to see if you notice benefits, but they're not miracle cures and work for only some people. If you notice no improvement after 2-3 months of consistent use, continuing is unlikely to help.
Omega-3 Fatty Acids (Fish Oil)
The evidence for omega-3 supplements in arthritis management is more promising, particularly for rheumatoid arthritis. Studies show that omega-3 fatty acids reduce inflammatory markers, may decrease pain and morning stiffness in RA, and might reduce the need for anti-inflammatory medications. For osteoarthritis, the evidence is less clear but suggests possible modest benefits.
Dosage matters—research typically uses 2-3 grams of EPA and DHA combined daily, which is higher than many standard fish oil supplements provide. Quality also matters, as some fish oil supplements contain less omega-3 than claimed on the label.
Vitamin D
Low vitamin D levels are common in people with arthritis, and research increasingly links vitamin D deficiency with increased arthritis pain and progression. Several studies suggest that correcting vitamin D deficiency reduces arthritis pain, though the evidence is still emerging.
Given that vitamin D deficiency is common in New Zealand, particularly during winter months, and that vitamin D is important for bone health, immune function, and muscle strength, testing your vitamin D levels and supplementing if deficient makes sense for most people with arthritis.
Turmeric and Curcumin
Turmeric has gained significant attention for arthritis management. Research shows that curcumin, the active compound in turmeric, has anti-inflammatory properties and several studies demonstrate modest pain reduction in knee osteoarthritis. However, curcumin is poorly absorbed, so supplements with enhanced bioavailability or added black pepper (piperine) are more effective than standard turmeric powder.
While evidence is promising, effects are generally modest and curcumin shouldn't replace proven treatments like exercise and weight management.
What About Collagen Supplements?
Collagen supplements have become extremely popular, with claims about rebuilding cartilage and reversing arthritis. The evidence, however, is limited and mixed. Some small studies suggest possible benefits for joint pain, but high-quality research is lacking. The body breaks down collagen supplements into amino acids during digestion, so the idea that consuming collagen directly rebuilds joint cartilage is oversimplified.
Supplements with Little Evidence
Many other supplements are marketed for arthritis with minimal scientific support, including MSM (methylsulfonylmethane), SAMe (S-adenosylmethionine), green-lipped mussel extract, and various herbal preparations. While some people report benefits, robust evidence is lacking.
The Bottom Line on Supplements
Supplements might provide modest symptom relief for some people but are not primary treatments for arthritis. Exercise, weight management, and physiotherapy have much stronger evidence and larger effect sizes than any supplement. If trying supplements, give them 2-3 months to assess effectiveness, choose reputable brands with third-party testing, and discuss with your healthcare provider to avoid interactions with medications.
For people with lower limb arthritis, weight management deserves special attention. Research consistently shows that excess body weight increases arthritis risk, accelerates disease progression, and worsens symptoms. Every kilogram of excess weight places approximately 3-4 kilograms of force on knee joints during walking.
However, the good news is equally compelling: studies demonstrate that even modest weight loss (5-10% of body weight) significantly reduces arthritis pain, improves physical function, and may slow disease progression. For someone weighing 90 kilograms, losing just 5-9 kilograms can substantially improve symptoms.
Weight loss is particularly effective when combined with exercise. Research shows that the combination of weight loss and strengthening exercises provides greater benefits than either intervention alone.
Older arthritis advice often emphasized avoiding activities that stress affected joints. Current evidence takes a more nuanced approach, recognizing that complete avoidance of activities you enjoy reduces quality of life and that appropriate activity modification allows continued participation.
What the Research Shows About Impact Activities
For years, people with arthritis were told to avoid running and other high-impact activities. However, recent research challenges this blanket advice. Studies show that recreational running doesn't increase arthritis risk in people with healthy joints and that runners have similar or lower rates of knee arthritis compared to non-runners.
For people who already have arthritis, the evidence is more complex. Running may be possible for some people with mild to moderate arthritis if they have good biomechanics, adequate strength and conditioning, appropriate footwear, and are willing to modify training based on symptoms. However, high-mileage running and competitive running do appear to increase stress on arthritic joints.
The key message is individualization—some people with arthritis can continue running with modifications, while others need to transition to lower-impact activities like cycling or swimming.
Sports Participation with Arthritis
Research increasingly supports the idea that staying active in sports you enjoy, with appropriate modifications, provides better outcomes than complete activity cessation. Benefits include maintained strength and fitness, better weight management, improved mood and quality of life, and continued social engagement.
The evidence supports working with physiotherapists to identify necessary modifications—such as reduced training volume, appropriate rest and recovery, strengthening supporting muscles, and using proper equipment and technique.
While medications have their place in arthritis management, research increasingly emphasizes multimodal approaches to pain control.
Exercise as Pain Management
We've already discussed exercise extensively, but it's worth emphasizing that exercise is one of the most effective pain management strategies for arthritis. Studies show that exercise reduces pain as effectively as many pain medications, with benefits lasting as long as exercise is continued.
Manual Therapy and Physiotherapy
Research supports hands-on physiotherapy techniques for arthritis pain management. Studies show that joint mobilization reduces pain and improves mobility, soft tissue massage decreases muscle tension around affected joints, and taping techniques can provide short-term pain relief. While these passive treatments are helpful, evidence indicates they work best when combined with active exercise programs.
Heat and Cold Therapy
Research supports both heat and cold applications for arthritis pain. Heat therapy before activity can reduce stiffness and improve flexibility, while cold therapy after activity can reduce inflammation and pain. Many people with arthritis find alternating heat and cold provides optimal relief.
Pain Neuroscience Education
Emerging research shows that understanding pain itself—how it's produced by the nervous system and doesn't always reflect tissue damage—can reduce arthritis pain and disability. This approach, called pain neuroscience education, helps people understand that some arthritis pain relates to sensitization of the nervous system rather than ongoing joint damage, movement and activity are safe even with some pain, and pacing strategies can help manage symptoms.
At Auckland Physiotherapy, we incorporate pain neuroscience education into arthritis management programs.
Research continues to explore new arthritis treatments:
Platelet-Rich Plasma (PRP) Injections
PRP involves injecting concentrated platelets from your own blood into affected joints. Research results are mixed—some studies show modest improvements in pain and function, while others show no benefit beyond placebo. Current evidence suggests PRP is not a cure for arthritis but might provide temporary symptom relief for some people.
Stem Cell Therapy
While promising in theory, current evidence for stem cell therapy in arthritis is limited and based mostly on low-quality studies. More rigorous research is needed before this can be recommended as a standard treatment.
Dietary Interventions
Research is exploring various dietary approaches for arthritis management. The Mediterranean diet shows promise for reducing inflammation, anti-inflammatory diets may help some people with RA, and eliminating specific trigger foods helps some individuals. However, no single diet cures arthritis, and dietary changes should complement rather than replace proven treatments.
Based on current research, an effective arthritis management plan should include:
Foundation: Exercise and Physical Activity
Weight Management (if relevant)
Professional Physiotherapy
Selective Supplement Use
Pain Management Strategies
Lifestyle Modifications
While exercise and conservative management work well for most people, some situations warrant consideration of injections or surgery:
However, research consistently shows that even candidates for surgery often benefit significantly from pre-surgical physiotherapy and exercise programs. Some people improve enough to delay or avoid surgery altogether.
If you're living with arthritis, the evidence is clear: you have more control over your symptoms and disease progression than you might think. Exercise, particularly strength training, represents one of the most powerful treatments available. Combined with appropriate weight management, targeted supplements if desired, and expert guidance from physiotherapists, most people can significantly improve their quality of life.
At Auckland Physiotherapy, we specialize in evidence-based arthritis management. We stay current with the latest research to provide you with treatments proven to work, not outdated advice or unproven gimmicks.
We provide:
Don't let arthritis limit your life. The latest evidence shows that with the right approach, you can reduce pain, improve function, and maintain an active lifestyle.
Contact Auckland Physiotherapy today:
Visit www.aucklandphysiotherapy.co.nz or call to book your comprehensive arthritis assessment. Let us help you develop an evidence-based management plan tailored to your specific needs and goals.
Remember: arthritis is not a condition you simply endure—it's a condition you can actively manage. The research shows that what you do matters enormously. Start taking control of your arthritis today.
The information provided in this blog is for educational purposes and should not replace professional medical advice. Always consult with your physiotherapist or healthcare provider regarding your specific arthritis management needs. If you experience sudden severe joint pain, significant swelling, or signs of infection, seek immediate medical attention.
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