Weight Loss, Manual Therapy, Modalities and Injections

Osteoarthritis risk rises by up to 35% with each 5 kg/m² increase in BMI. In one trial, 10% weight loss through diet and exercise halved pain, and diet plus exercise beat either alone. A meta-analysis found disability improved once weight dropped by more than 5.1%, ideally over about 20 weeks, and losing 5 to 10% over 48 months slowed cartilage degeneration on MRI. Evidence for manual therapy is mixed: some trials show added benefit with exercise, others do not. Anthony keeps it to about 10 minutes early in care to ease pain and stiffness before exercise. TENS and ultrasound are inconclusive and neuromuscular electrical stimulation is not appropriate. A two-year trial of repeated corticosteroid injections found more cartilage volume loss and no better pain relief than saline. Chondroitin and glucosamine show no benefit. Guidelines on hyaluronic acid injections conflict, while platelet-rich plasma shows promising results up to 12 months, though Anthony is not yet confident recommending it.