At this point, I’m still on a steady diet of kitchari and from a cooking perspective, there isn’t much new going on in the Crunchy Kitchen.  My partner, who has been suffering with a bum knee for over a decade, asked me for more “Knee Pills” yesterday, so it ushered in the topic of the week barring recipe creativity: an herbal and dietary approach to severe osteoarthritis.

But before I start.

Disclaimer:  Just because this is what has kept my partner’s pain manageable doesn’t mean it is appropriate or recommended for you.  It is provided purely as brain candy to the herbal geek.  Consult with a skilled herbalist prior to taking any plant-based medicine since it’s just that – medicine.

Introduction:  Joint and articular pain comes in numerous varieties and presentations.  Some are “cold”-type pain, some are “hot”-type pain, some have creaking and cracking, some display fluid accumulation.  Success therefore isn’t a one-size fits all type of treatment.   Addressing the type of presentation, changing treatments as the symptoms evolve and considering the innate and unique constitution of the person taking the remedies are all important components of holistic treatment.

So Who are We Treating?

Caucasian male, late fifties, traditional Québec diet (meat and potatoes).  Not particularly interested in herbal treatment, compliance to herbal protocols is problematic, any type of topical rub must be administered by a third-party (…me…).

What are We Treating?

Osteoarthritis in the left knee.  During periods of intense pain, the joint becomes red, inflamed and extremely tender.  The pain gets worse in windy weather, cold weather and damp weather – but windy and cold are the real culprits.

How are We Going to Treat?

Daily Herbals:

While a semi-regular tonic of Plant-Based Golden Milk and Castor Oil packs would be a set of helpful suggestions close to my heart – it just ain’t gonna happen.  A capsule is the best bet here in order to ensure compliance.  ”It looks like a regular pill, not some weird-ass treatment” would be my partner’s assessment.  So for the first seven years, treatment consisted of:

• Knee Pills: a home-made three-ingredient formula of Turmeric, Willow Bark and Rosemary.  Overall energy of the formula is neutral, not hot, not cold (based on the respective quantities of each herb). 2x 00 capsules daily.  As time passed and the state of the joint degenerated, dosage increased to 2x 00 capsules 3x daily.

In the past two years, the condition of the knee was classified ”severe,” the pain becoming more important. Some muscular degeneration from lack of activity resulting from inability to use the affected member.  Development of pain in the opposite hip as a result of compensation for the problematic leg.  The following changes were made:

• Knee Pills: modification of the original formula to include Ashwaghanda and Black Pepper.  Energetics of the formula are a bit warmer, but still relatively neutral.  Dosage remains stable at 2x 00 capsules 3x daily;
• Surface Rubbing Oil during episodes of extreme pain: an infused oil of fresh St-John’s-Wort augmented with Wintergreen essential oil to a concentration of 10% methyl salicylate in the overall formula.  Another widely available alternative is Kwan Loong Oil, which is a mixture of methyl salicylate, eucalyptus and menthol in a mineral oil base.

Diet:

The meat and potatoes weren’t and won’t be going anywhere for my partner no matter what I say or do.  Given that, the foods introduced as side-dishes and the snack choices are where there’s a chance of change.  The point is to reduce as much as is possible any inflammatory foods or substances and increase the foods that help with pain – even if the Cochrane Institute is currently ”uncertain whether diets improve pain, stiffness and the ability to move better.”  It goes without saying that the less refined sugars, alcohol, greasy red meat cuts, cold cuts and processed foods, the better.  In addition to that piece of common sense, which is good for pretty much everything, is the following:

• Reduce consumption of the solanaceae botanical family, commonly known as nightshades (peppers, tomatoes, potatoes, eggplants, tomatillos – that also means chili powder, cayenne powder, paprika).  Evidence on this one is debatable from an empirical scientific study point of view, but it is recommended in a number of traditional folk medicines.  In our case, we work under the : if we grew it and it’s in season, we’ll eat it – otherwise steer clear;
• Regularly make buckwheat as a side-dish or in pancakes and home-baked goods.  Buckwheat contains rutin which appears to show some promise in relieving inflammatory pain – particularly when taken along with Papaya (papain) or Pineapple (bromelain);
• Include and favour all forms of local berries and fruit (local organic apples, wild blueberry, wild raspberry, wild strawberry) as snack food and in home-baked goods.  Their quercetin content is purported to help prevent the body from producing inflammatory mediators.

Lifestyle & Exercise:

• Pretty much on hold, but moving remains essential to keep the muscles from wasting and ensure that the supporting structure around the joint can help out.  Light gardening and short walks as the limb permits.  Consider activities such as swimming which are low impact but nonetheless demanding from a muscular and cardiovascular point of view;
• Avoid overextending and going beyond the knee’s limit on any given day since this will only cause more pain (bad day…) soon after;
• Ensure that the joint is kept warm in windy, cool and clammy weather.  Long underwear – rejoice! – you will no longer be hidden in the back drawer.

How are We Doing?

A decade into herbal treatment and countless sessions of capsulation later, the condition is degenerating.  This is to be expected since there isn’t a new knee on the man or grease fittings on the existing joint (maintenance mechanic’s joke…).  What the treatment does do is  to keep the pain at a manageable level on most days and avoid having to fall back on a knee replacement surgery for the moment.