Hip Arthritis: what do we know about the effectiveness of “natural” treatments?

You’re suffering fromosteoarthritis of the hip (coxarthrosis), it’s bothering you or causing you a lot of pain, and you’re looking for a treatment, if possible a natural one… That’s a perfectly coherent reaction.

However, when looking for information on this subject, you may be confronted with contradictory information. Or with so much information that you don’t know who to believe, so many people read or hear one thing and its opposite.

My aim with this article is to answer this question as factually and rationally as possible: which natural treatment for osteoarthritis of the hip is most likely to be effective in relieving pain and improving quality of life, in as many people as possible?

At the end of this article, you’ll find my selection of the most relevant scientific publications on the subject.

Enjoy your reading!

♻️ Last update: 12 august 2024
👩‍⚖️ Declaration of financial interests: no affiliated links. My complete declaration of financial interests is available in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

A quick reminder about osteoarthritis and hip pain

Osteoarthritis is the most common rheumatic disease.

2.5% of adults aged 45 to 49 have hip osteoarthritis.

And among adults aged 80 and over, it’s more than 1 in 4: 28.6%.

📚 Source: Prieto 2014

However, osteoarthritis does not necessarily cause pain.

Because some people have coxarthrosis (= hip osteoarthritis) without experiencing pain or discomfort in the joint!

Around 40% of people with osteoarthritis on the X-ray experience discomfort or pain. For the rest, osteoarthritis is said to be asymptomatic: it doesn’t trigger any symptoms or problems.

📚 Source: Roemer 2020

Osteoarthritis mainly affects :

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

On the X-ray of a hip with coxarthrosis, 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 osteoarthritis-related hip pain 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 is “stiff”, resulting in typical pain and difficulty when starting to move after a period of sitting or lying down.
3. People in the advanced stages of the disease may experience deep creaking or crackling sounds when they move, and the joint’s range of motion is often limited. Still, it is less disabling than knee osteoarthritis.

Osteoarthritis does not always cause pain. For some people with osteoarthritis of the hip, the 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 hip: an endless list!

(And constantly renewed.)

Before writing this article, I had the fun of asking all my current patients what non-drug treatments they had already used for osteoarthritis (regardless of location).

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 efficacy 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 comes up frequently, as do glucosamine, chondroitin sulfate, omega-3 fatty acids from fish oils and gamma-linolenic acid);
2. green clay poultices ;
3. application of tiger balm ;
4. homeopathy ;
5. CBD in various forms;
6. essential oils, phytotherapy (harpagophytum comes up a lot);
7. adopt a diet richer in natural antioxidants.

You may also have other things in mind that someone close to you or a pharmacy assistant has already recommended!

My goal with this article is to help you sort through it all!

Natural treatments to relieve pain or delay the aggravation of osteoarthritis?

The first thing to do to identify which treatments are most likely to work? Agree on your 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 pain in the hip area, groin, back, etc;
• avoid orthopedic deformities and joint stiffening;
• delaying the fitting of a hip prosthesis;
• reduce the rate of cartilage damage;
• reform cartilage that has already been destroyed;
• 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 might be tempted to answer “a little bit of everything”. I understand that it’s tempting! 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 remainder 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 will therefore take the time to report on any known side effects.

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

How do I know which natural treatment works best?

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.

• First of all, we don’t necessarily know everything else the person did before/alongside using this treatment, which may also have influenced the results they obtained.
• As you’ve probably noticed, the symptoms of osteoarthritis are not necessarily constant. Some days it hurts more than others. If there’s improvement or deterioration, it’s hard to be sure it’s due to what you’ve been using.
• If the event happened a long time ago, the person may have forgotten certain details.

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 that sell this or that solution will put more emphasis on positive testimonials (even if their employees or managers are sincere and motivated by such altruistic goals);
• 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 “natural treatment” for osteoarthritis of the hip:

Try it out: look at any item on Amazon offered for osteoarthritis that has at least 100 reviews. You’ll find positive and negative testimonials every time.

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 :

• caring for people suffering from hip 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 still need to be sure:

• that they really are experts specifically on the subject: osteoarthritis of the hip;
• 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. Their 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 just as well: after the knee, the hip is the most studied joint for osteoarthritis. Over 5,000 studies to date!

And a large proportion of these studies 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.

At least that’s how I see it, and I think I’ve provided you with some evidence to back up my position 🙂.

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 natural or unnatural treatment.

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, most of 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 summaries of studies published specifically on osteoarthritis of the hip. 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 hip?

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 rigorous in 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 hip osteoarthritis state that the main effective non-drug solution is physical exercise.

For example, the American College of Rheumatologists lists the top 3 drug-free treatments:

1. the exercise ;
2. self-education and pain management programs;
3. weight loss.

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 hip 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;
• bandaging, kinesiotaping ;
• whole-body vibrations;
• cannabidiol (CBD):
• essential oils ;
• etc. etc.

However, some studies are very poorly conducted, and no credible conclusions can be drawn from them. The Cochrane has therefore selected those of the highest quality (although they are not perfect).

The results of 2 studies focusing on hip osteoarthritis were exploited, in addition to those of 58 other studies on knee osteoarthritis (which has many features in common with hip osteoarthritis).

So are any of these treatments effective?

Here, in brief (and a little 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 hip 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 to 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: on average, natural treatments don’t make any significant difference. In the days, weeks and 6 months following treatment.

Should we be disappointed by these results? Does this mean that there’s absolutely nothing we can do about hip 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 best-quality studies on natural solutions for coxarthrosis (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 hip 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 physical exercise. It’s even the best natural anti-inflammatory for hip osteoarthritis.

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

• what type of exercise (spoiler: there is no such thing as ONE or MORE miracle exercises for osteoarthritis, it’s all about getting moving that’s good);
• 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 actually a specific type of muscle-strengthening exercise, plain and simple! Like Pilates, Zumba classes, fitness and even… adapted CrossFit!).

A priori, walking alone on flat ground at a leisurely pace without getting out of breath, or riding an exercise bike “without straining” are not enough if they don’t involve a minimum feeling 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 hip, knee or back pain reported in 8/60 studies (but not in all participants)	None reported

If you exercise 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 hip osteoarthritis, 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 can be an obstacle to under-dosing.

Improving lower-limb strength can :

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

Poor physical condition is another deficiency reported in people with hip 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 makes every daily task easier (in terms of effort).

A better physical condition can improve quality of life by enabling a wider range of daily tasks to be performed.

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

What about antioxidant-based foods, supplements and plants?

Antioxidants were the subject of much 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’s 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 our expectations of these natural treatments should be low.

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 hip osteoarthritis

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

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 makes you a little out of breath and puts pressure on your legs. Do it gradually, so as not to increase the pain. There isn’t ONE or SOME exercise you should do more than others; it’s really the fact of being in motion that counts. Physiotherapists are among the professionals who can help you find the activities and exercises best suited to your situation.
2. you shouldn’t expect a phenomenal improvement. But pain can also go away on its own, or never get worse, whatever you do! And you can 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!