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Open Source Apothecary At Home / Muscles, joints and nerves
For the knee, the hip, the back and the tendon, exercise has better evidence than every herb in this handbook.
guideThis page exists because the most effective musculoskeletal interventions are not plants, and a handbook that omitted them would be promoting remedies by omission.
Knee osteoarthritis. Exercise therapy — land-based or water-based, strengthening and aerobic — reduces pain and improves function in randomised trials, with effect sizes at least as large as the supplements sold for the same condition. It is the first-line recommendation in every guideline. Quadriceps strength specifically predicts symptoms.
Chronic low back pain. Exercise is recommended, with the caveat that no single type is clearly superior; the exercise the person will do is the best one. The larger finding from the trials and guidelines is that staying active beats resting, and that the fear-avoidance cycle — resting because it hurts, then losing condition and hurting more — is what turns an acute episode into a chronic problem.
Tendinopathy. The evidence points to progressive loading, not rest. A tendon that is unloaded loses capacity; a tendon loaded progressively adapts. This is counter-intuitive and it is why the standard advice changed from rest to exercise over the last two decades.
Delayed-onset muscle soreness. Tart cherry and other polyphenol preparations have small trials showing reduced soreness and faster recovery after eccentric exercise. The effect is small and the products are expensive; adequate protein, sleep and progressive loading have larger effects and cost nothing.
Nutrition supporting the load. Adequate protein (roughly 1.2-1.6 g/kg daily for an active adult, more in older adults), adequate vitamin D and calcium for bone, and enough energy — under-eating with training is what makes the load destructive rather than adaptive.
The honest framing. Exercise is a drug with side effects, a dose, and a training effect. It has more evidence than anything else on this site for joints and back. It is also the intervention people most reliably talk themselves out of, which is why it is written here first rather than last.
RT programs effectively reduce pain intensity and disability in patients with NSCLBP.PubMed 41065407 ↗
In patients with knee osteoarthritis, aerobic exercise is likely the most beneficial exercise modality for improving pain, function, gait performance, and quality of life, with moderate certainty.PubMed 41093618 ↗
ET had a small beneficial effect on long-term disability in people with CLBP.PubMed 40747709 ↗
We are very uncertain whether strengthening exercise reduces pain compared to no treatment.PubMed 40421598 ↗
Aquatic exercise provides a short-term clinical benefit that is sustained for at least three months postintervention in terms of pain in people with knee osteoarthritis.PubMed 36320162 ↗
Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients.PubMed 38035307 ↗
Knee osteoarthritis — a starting programme
Chronic low back pain
Tendinopathy (Achilles, patellar, elbow)
Soreness after unaccustomed exercise
General