Four Ways to Naturally Reduce Bone and Joint Pain
- Symptomatic knee OA occurs in 10% of men and 13% of women aged 60 or older.
- Osteoporosis is also widespread and closely linked with osteoarthritis. About 54 million Americans have osteoporosis.
- Exercise can reduce chronic pain, as well as improve physical and mental health, but it must be the right exercise so it doesn’t create more damage.
- MK4, a form of vitamin K, has been widely studied for its remarkable protective effect on bone—helping protect against osteoporosis and fractures while promoting collagen production and other health benefits.
- Proteolytic enzymes such as bromelain, or a blend of enzymes promote healthy inflammation associated with reducing bone and joint pain.
by Dr. John Neustadt
Since 2001, the month of September has been Pain Awareness Month, officially established by the American Chronic Pain Association.1 With over eighty supporting organizations, the goal is to raise awareness of pain and find better approaches to manage and treat chronic pain. About 20% (50 million) of U.S. adults suffer from chronic pain and it’s one of the most common reasons adults visit the doctor, according to the Centers for Disease Control and Prevention (CDC). 2
While chronic musculoskeletal pain (CMP) is pain felt in bones, joints, and other tissues of the body that persists longer than 3 months, it’s debilitating consequences show up much earlier. Chronic pain causes poor sleep, fatigue, anxiety, depression, which reduces the ability of people to enjoy the activities they love and lowers the quality of life.
Two of the most common causes of chronic pain are osteoporosis and osteoarthritis. Osteoarthritis (OA) is the most prevalent joint disorder in the U.S. Symptomatic knee OA occurs in 10% of men and 13% of women aged 60 or older. 3
Osteoporosis is also widespread and closely linked with osteoarthritis.4 About 54 million Americans have osteoporosis, which not only can lead to severe bone pain but brings an increased risk of fracture and chronic pain. Nearly half of all women and one-fourth men age 50 and older will break a bone due to osteoporosis.5 Bone fractures are the most painful and dangerous risk for people with osteoporosis. As people age, the risk for breaking a bone increases while the ability of bone to heal decreases. Unfortunately, some fractures will either take a long time to heal or may not heal at all, leading to a life of pain and limited dexterity and mobility. For instance, fractures of the hip due to osteoporosis can lead to long-term disability and are linked to more frequent nursing home or rehabilitation hospital admissions.6
Before we look at some natural approaches to chronic bone pain, you need to understand a little about bone. Although often people think of the skeleton as something that’s fixed and unchanging, like a steel beam in a building, our skeletons are living tissue. Through the process of bone remodeling, old and worn-out bone is broken down and new, healthy bone is created. The entire adult skeleton replaces itself every decade.7,8
It’s also important to realize that bone is not just a scaffold but a living connective tissue that plays an important role in nourishing our immune system. Consider the fact that your bone marrow produces both red and white blood cells, as well as fat and cartilage. Keeping your bones and joints healthy is important for maintaining health throughout your body.
With these fundamental insights—that bone constantly remodels itself and requires movement and exercise; and that bone is a living connective tissue intertwined with the immune system9—we can arrive at some helpful, natural solutions for reducing joint and bone pain.
Your body’s immediate response to any kind of injury and pain is instinctive: protect the injured area and give it time to heal. But where joints and bones are concerned, even with bone fractures, a different approach is necessary. Bones and joints need movement and stimulation. Experts now advise careful, gentle exercise and movement to help heal from fractures and improve osteoarthritis pain and joint mobility. If pain is due to a fracture, even a poorly healing fracture, the recommendation is to move and place weight on the fractured bone as soon as the fracture is stabilized by the doctor.10
Exercise can strengthen muscles and improve cardiovascular health, mood, and sleep. Researchers who reviewed 264 studies with nearly 20,000 participants that compared the effects of exercise versus not exercising in adults with chronic pain, concluded that physical function was significantly improved as a result of exercise and movement. Activities included aerobic exercise, strength and flexibility exercises, core or balance training programs, as well as yoga, Pilates, and tai chi.11 Fortunately, there are many exercises you can do at home while working them into your daily routines. For example, the Stork Exercise is a simple one you can do while brushing your teeth to improve balance and reduce the risk of falls and injury.
The exercise chosen must be appropriate for the particular condition. For osteoarthritis pain, non-weight bearing exercises such as swimming or riding a bicycle, rather than lifting weights or pounding the pavement as a jogger, are most appropriate. It’s important to find the right type and amount of physical activity that’s both safe and effective.12 If there is a flare-up of pain from over-exertion, resting, and resuming at a lower level of activity is recommended.13
Exercising in a heated pool where water helps provide gentle buoyancy can be effective for osteoarthritis. In a randomized, controlled study of hydrotherapy in 73 women aged 645 and older and suffering from knee osteoarthritis, hydrotherapy in a heated pool twice a week for six weeks helped increase flexibility and strength. Not only was knee pain significantly reduced, but knee flexibility and strength were also improved. Exercises included stretching and walking in water, exercises with floats, breathing exercises, and finally relaxation exercises using circular floats.14
Hydrotherapy is an ancient approach that uses water to improve health. Most people are already familiar with some applications of this approach. Exercising in water, which I described above, is a form of hydrotherapy. Immersing an ankle in ice water immediately after a sprain is a form of hydrotherapy.
There is one form of hydrotherapy, however, that most people don’t seem to know about, and that’s contrast hydrotherapy. This approach can be done at home and has been used to increase circulation to a specific area of the body, flush out toxins, and increase oxygen delivery. Contrast hydrotherapy involves the alternating application or hot water to the affected area for three minutes, followed by thirty seconds of ice-cold water. This approach also acts as a local analgesic and can reduce pain for several hours.
According to a review on the topic published in the Journal of Lymphoedema, “In Europe in particular, it is a respected treatment for patients with cardiovascular disease and heart failure, with Japanese studies validating its use.”15 In a 2019 clinical trial published in the International Journal of Research in Pharmaceutical Sciences, volunteers with knee osteoarthritis were randomized to receive contrast hydrotherapy or placebo.16 Those who received twice-daily contrast hydrotherapy for seven days experienced a significant decrease in their pain compared to those in the control group.
This approach, however, isn’t for everyone. People with peripheral vascular disease and decreased blood flow, limb paralysis, and restricted movement should discuss this approach with their healthcare provider and ensure it is appropriate prior to doing it.
MK4 for Bone and Joint Pain
Breaking a bone is a dramatic and traumatic event. As we age, the risk for fractures increases, so anything you can do to strengthen your bone and reduce fracture risk is important. But frequently overlooked are the pain and discomfort caused by microfractures. These tiny fractures are subtle, can occur without experiencing major traumas, and can easily be missed by clinicians. When they do occur, microfractures can take up to eight months to heal. 17
One of the most remarkable nutrients for bone strength and health is a form of vitamin K called MK4. Instead of being a single vitamin, Vitamin K is a category that of structurally similar vitamins, and MK4 is a naturally occurring form of vitamin K2 that has been shown to promote fracture healing and grow stronger bones.
People typically know about vitamin K for its ability to support the clotting of blood. Less well known, however, is the vast amount of research showing that the MK4 form of vitamin K also promotes healthy platelet and blood production,18,19 grows stronger bones and reduces fractures,20,21,22,23 lowers markers of inflammation,24,25 is associated with producing healthy nerves in the brain,26,27 and promotes connective tissue (collagen) production.28 Additionally, MK4 deficiency has been associated with increased arterial calcifications that cause heart disease.29
The ability of vitamin K to promote fracture healing has been known since 1960.30 In animal experiments, MK4 has been shown to speed bone healing after fractures, reducing bone turnover and stimulating new bone formation.31,32 MK4’s benefits for osteoporosis have been studied in 28 human clinical trials with more than 7,000 people. It has been shown to improve bone laboratory markers and bone density and to help reduce the risk of fractures.
For example, in one 24-month, randomized, controlled, open-label study of 241 osteoporotic women (average age of 67) MK4 significantly reduced new fractures. About half the women (121) simply took 150 mg of calcium daily, while the other half (120) received 150 mg of calcium daily plus 45 mg per day of MK4. Over the two-year period, the number of new fractures in the MK4 group was significantly lower than in those volunteers who only received calcium. There were only 13 fractures (10.9%) in the women who supplemented with 45 mg/day of MK4 compared to 30 new fractures (30.3%) in the women who did not take the MK4.33 That’s a 200% relative decrease in fracture risk.
A second study evaluated the ability of MK4 to reduce fractures in people taking prednisone (30-60 mg/day). Long term use of corticosteroids like prednisone increases the risk for osteoporosis and fractures. Sixty volunteers (21 men and 39 women) took MK4 (45 mg/day) for 18 months while continuing to take prednisone. The MK4 group maintained bone density while those not taking MK4 saw their bone density decrease.34
In 2006 in the Archives of Internal Medicine, a systematic review of clinical trials was published that evaluated whether MK4 improves fracture risk in people with osteoporosis. Their analysis of data from seven clinical trials determined that MK4 (45 mg/day) reduced the risk for vertebral fractures by 60%, hip fractures by 77%, and all nonvertebral fractures by 81%.35
MK4 has been approved since 1995 by the Japanese Ministry of Health for the treatment of osteoporosis and bone pain caused by osteoporosis. In the US, MK4 has not been approved by the FDA as a medication to treat, cure, or prevent disease, but is instead available as a dietary supplement to naturally promote your health.
Bone fractures initiate a response that begins with inflammation, and inflammation is an underlying cause for the tissue and joint degeneration seen in osteoarthritis. Promoting healthy inflammation by breaking down inflammatory proteins is an important approach for reducing pain. Numerous herbs for pain and enzymes can help promote healthy levels of inflammation and reduce swelling and discomfort.
One example is bromelain, which is a mixture of enzymes and molecules derived from the stem and fruit of the pineapple plant (Ananas comosus). Bromelain has a long history of use by herbalists for pain and inflammation, is absorbed from the gut without losing its potency or activity.36 Bromelain is available in dietary supplements, frequently in combination with synergistic nutrients.
One study of forty patients with knee osteoarthritis found that bromelain significantly improved pain and function, and reduced blood markers of inflammation.37 And a review of ten separate studies on bromelain and knee osteoarthritis—from case reports to randomized trials—found that bromelain reduced tissue swelling, pain, and/or joint stiffness.
1 American Chronic Pain Association. September is Pain Awareness Month. [Report]
2 Dahlhamer J, Lucas J, Zelaya C et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. [Article]
3 Zhang Y, Jordan JM. Epidemiology of osteoarthritis [published correction appears in Clin Geriatr Med. 2013 May;29(2):ix]. Clin Geriatr Med. 2010;26(3):355-369. [Article]
4 Mattia C, Coluzzi F, Celidonio L et al Bone pain mechanism in osteoporosis: a narrative review. Clin Cases Miner Bone Metab. 2016;13(2):97-100. doi:10.11138/ccmbm/2016.13.2.097 [Article]
5 National Osteoporosis Foundation. What is Osteoporosis and What Causes It? 2020. [Report]
6 Gruber R, Koch H, Doll BA et al. Fracture healing in the elderly patient. Exp Gerontol 2006;41(11):1080–93. [Article]
7 Lian JB, Gravallese EM, Stein GS. Osteoblasts and their signaling pathways: new frontiers for linkage to the immune system. In: Lorenzo J, Choi Y, Horowitz M, et al., eds. Osteoimmunology: Interactions of the Immune and Skeletal Systems. Elsevier; 2011:101-40
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9 Lorenzo J, Choi Y. Osteoimmunology. Immunol Rev. 2005;208:5-6. [Article]
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11 Geneen LJ, Moore RA, ClarkeC, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD011279. [Article]
12 Booth J, Moseley GL, Schiltenwolf M et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal Care. 2017;15(4):413-421. [Article]
13 Traeger AC, Hübscher, M., Henschke, N., et al. Effect of primary care‐based education on reassurance in patients with acute low back pain: Systematic review and meta‐analysis. JAMA Internal Medicine, 2015, 175(5), 733–743. [Article]
14 Dias JM, Cisneros L, Dias R, et al. Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther. 2017;21(6):449-456. [Article]
15 Baker PW. Is there a role for contrast hydrotherapy? Journal of Lymphoedema. 2011;6:72-80. [Article]
16 Thenmozhi P, Nisha P, Prema J, Shreeba R. Effectiveness of contrast hydrotherapy on knee pain among osteoarthritis patients. International Journal of Research in Pharmaceutical Sciences. 2019;10(4):3217-3222. [Article]
17 Reeve J, Loveridge N. The fragile elderly hip: mechanisms associated with age-related loss of strength and toughness. Bone. 2014;61:138-148. [Article]
18 Takami A, Asakura H, Nakao S. Menatetrenone, a vitamin K2 analog, ameliorates cytopenia in patients with refractory anemia of myelodysplastic syndrome. Annals of hematology. 2002;81(1):16-19. [Article]
19 Akiyama N, Miyazawa K, Kanda Y, et al. Multicenter phase II trial of vitamin K2 monotherapy and vitamin K2 plus 1[alpha]-hydroxyvitamin D3 combination therapy for low-risk myelodysplastic syndromes. Leukemia Research. 2010;34(9):1151-1157. [Article]
20 Kodama Y. Effectiveness of vitamin K2 on osteoporosis in adults with cerebral palsy. Brain and Development. 2017;39(10):846 – 850. [Article]
21 Je SH, Joo N-S, Choi B-h, et al. Vitamin K Supplement Along with Vitamin D and Calcium Reduced Serum Concentration of Undercarboxylated Osteocalcin While Increasing Bone Mineral Density in Korean Postmenopausal Women over Sixty-Years-Old. Journal of Korean Medical Science. 2011;26(8):1093-1098. [Article]
22 Shikano K, Kaneko K, Kawazoe M, Kaburaki M, Hasunuma T, Kawai S. Efficacy of Vitamin K2 for Glucocorticoid-induced Osteoporosis in Patients with Systemic Autoimmune Diseases. Internal Medicine. 2016;55(15):1997-2003. [Article]
23 Jiang Y, Zhang ZL, Zhang ZL, et al. Menatetrenone versus alfacalcidol in the treatment of Chinese postmenopausal women with osteoporosis: a multicenter, randomized, double-blinded, double-dummy, positive drug-controlled clinical trial. Clinical interventions in aging. 2014;9:121-127. [Article]
24 Ozaki I, Zhang H, Mizuta T, et al. Menatetrenone, a Vitamin K2 Analogue, Inhibits Hepatocellular Carcinoma Cell Growth by Suppressing Cyclin D1 Expression through Inhibition of Nuclear Factor kB Activation. Clinical Cancer Research. 2007;13(7):2236-2245. [Article]
25 Ohsaki Y, Shirakawa H, Miura A, et al. Vitamin K suppresses the lipopolysaccharide-induced expression of inflammatory cytokines in cultured macrophage-like cells via the inhibition of the activation of nuclear factor kappaB through the repression of IKKalpha/beta phosphorylation. J Nutr Biochem. 2010;21(11):1120-1126. [Article]
26 Carrié I, Portoukalian J, Vicaretti R, Rochford J, Potvin S, Ferland G. Menaquinone-4 Concentration Is Correlated with Sphingolipid Concentrations in Rat Brain. The Journal of Nutrition. 2004;134(1):167-172. [Article]
27 Ferland G. Vitamin K and the nervous system: an overview of its actions. Adv Nutr. 2012;3(2):204-212. [Article]
28 Shiraki M, Itabashi A. Short-term menatetrenone therapy increases gamma-carboxylation of osteocalcin with a moderate increase of bone turnover in postmenopausal osteoporosis: a randomized prospective study. J Bone Miner Metab. 2009;27(3):333-340. [Article]
29 Fusaro M, Noale M, Viola V, et al. Vitamin K, vertebral fractures, vascular calcifications, and mortality: VItamin K Italian (VIKI) dialysis study. J Bone Miner Res. 2012;27(11):2271-2278. [Article]
30 Bouckaert JH, Said AH. Fracture healing by vitamin K. Nature. 1960;185:849. [Article]
31 Weng SJ, Xie ZJ, Wu ZY, et al. Effects of combined menaquinone-4 and PTH1-34 treatment on osetogenesis and angiogenesis in calvarial defect in osteopenic rats. Endocrine. 2019;63(2):376-384. [Article]
32 Iwamoto J, Seki A, Sato Y et al. Vitamin K2 promotes bone healing in a rat femoral osteotomy model with or without glucocorticoid treatment. Calcif Tissue Int. 2010;86(3):234-241. [Article]
33 Shiraki M, Shiraki Y, Aoki C, Miura M. Vitamin K2 (Menatetrenone) Effectively Prevents Fractures and Sustains Lumbar Bone Mineral Density in Osteoporosis. Journal of Bone and Mineral Research. 2000;15(3):515-522. [Article]
34 Shikano K, Kaneko K, Kawazoe M et al. Efficacy of Vitamin K2 for Glucocorticoid-induced Osteoporosis in Patients with Systemic Autoimmune Diseases. Internal Medicine. 2016;55(15):1997-2003. [Article]
35 Cockayne S, Adamson J, Lanham-New S, Shearer MJ, Gilbody S, Torgerson DJ. Vitamin K and the Prevention of Fractures: Systematic Review and Meta-analysis of Randomized Controlled Trials. Arch Intern Med. 2006;166(12):1256-1261. [Article]
36 Castell JV, Friedrich G, Kuhn CS et al. Intestinal absorption of undegraded proteins in men: presence of bromelain in plasma after oral intake. Am J Physiol. 1997;273(1 Pt 1):G139-146. [Article]
37 Kasemsuk T, Saengpetch N, Sibmooh N et al.. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016;35(10):2531-2540. [Article]
38 Brien S, Lewith G, Walker A et al. D. Bromelain as a Treatment for Osteoarthritis: A Review of Clinical Studies. Evid Based Complement Alternat Med. 2004;1(3):251-257. [Article]
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