Joint Health & Musculoskeletal Conditions

Musculoskeletal conditions affect over 20 million people in the UK. This article explores the causes of joint issues including osteoarthritis and back pain, the role of diet and exercise, and the evidence behind key supplements such as glucosamine, omega 3, turmeric and ginger.

Joint Health & Musculoskeletal Conditions

Musculoskeletal conditions, which can include arthritis and back pain, affect over 20 million people in the UK,1 with many more affected by shorter term soft tissue injuries. Early signs of joint issues include stiffness, particularly after inactivity or upon waking, discomfort, a reduction in range of motion and grinding, crunching or clicking noises – often collectively called crepitus.

Causes

There are many factors involved in the development of joint issues, some of which are non-modifiable, such as age, gender, genetics and ethnicity, and some which can be changed such as body weight and bone metabolism. Other factors such as physical exercise and occupation can also play a role in an individual's susceptibility to developing joint problems. Many joint issues have historically been considered a disease of wear and tear, caused by overloading the joints and poor movement. However, it is now widely accepted that inflammation plays a significant role in the development and progression of these issues.

Being overweight or obese is strongly associated with joint issues2 and excess weight can increase damage to the cartilage, which is then more likely to develop into osteoarthritis (OA). Those who are overweight also tend to have a quicker progression of the condition and more severe symptoms. Weight and fat loss can decrease the risk of development of OA and reduce the symptoms in existing disease.3,4 Excess fat is also known to increase the production of inflammatory compounds, which can affect joint tissues.

Osteoarthritis

Osteoarthritis is one of the most common musculoskeletal conditions in the UK and occurs when the cartilage which cushions the joints becomes damaged. An increasingly ageing population means that cases of OA are becoming more common. Other parts of the joints including the joint fluid, ligaments and bones can also be affected, with bone spurs developing. Eventually there is a complete loss of cartilage, and this can affect other joints as movement and posture become affected.

The knee is the main joint affected by OA and is involved more than twice as often as the hip and three times as often as the hands and wrists, according to Arthritis UK. It becomes more common with age and NICE figures confirm that it affects more women than men.

Originally OA was considered to develop due to wear and tear and dysfunctional movement of the joints, but more recently studies have found that inflammation plays a significant role. Increased inflammation can trigger or accelerate the breakdown of joint tissues such as collagen and cartilage. As the cartilage in the joints, which acts as a cushion between the bones, has no blood vessels or nerves, it cannot repair itself. Therefore, as we age, damage to the joint tissues accumulates and worsens.

Back Pain

Lower back pain is another musculoskeletal issue which is common in the UK and can be caused by a number of different underlying issues. Often poor posture or lifting incorrectly or inappropriate weights can cause short term discomfort, and the back can also be affected by arthritis as well as structural issues such as bulging or slipped discs.

Diet and Lifestyle

The importance of a healthy diet cannot be underestimated for joint health, and this should focus on foods to reduce inflammation. A Mediterranean style diet is probably a good basis for a joint healthy diet. It focuses on fruits and vegetables, foods such as nuts and seeds which contain both minerals and omega 3 and 6 fatty acids, olive oil and lean meats and oily fish, such as herring, mackerel, salmon, and sardines which are also rich in omega 3 fats. Processed foods are avoided, and the emphasis is on the consumption of fresh, unprocessed, or minimally processed foods which are naturally much lower in sugar, salt and trans and hydrogenated fats. This diet is also high in foods which reduce inflammation such as omega 3 fatty acids and herbs and spices, and lower in added sugars, red meat and carbonated beverages which are associated with inflammation. Following this diet has been shown to decrease both BMI and the incidence of OA.5,6

Gentle exercise is also recommended for those with joint issues and back pain, to help strengthen and support the affected areas, and there is some evidence to suggest that it may help improve both discomfort and joint function.7 Many people choose low impact activities such as swimming and avoid the higher impact exercises such as jogging or running. However, most evidence suggests that running is good for joint health as long as precautions are taken. These include wearing well fitted, suitable speciality footwear, assessing form and correcting any issues, and running on softer surfaces where possible.8

Supplements

One of the best researched supplements for joint health and OA of the knee in particular is glucosamine. Glucosamine is found in most body tissues and in the highest concentration in cartilage. It is needed to produce compounds called glucosaminoglycans (GAGs) which are found in cartilage, synovial fluid and discs in the back.9,10

A randomised trial of glucosamine versus placebo showed that patients taking glucosamine had an improvement in symptoms compared to a worsening in those taking the placebo. Measurements of joint space narrowing showed minimal or no loss in the glucosamine group, whilst those on placebo showed progressive loss of joint space.11 Studies comparing glucosamine sulphate to ibuprofen have found it to be comparable or better at relieving knee pain.12,13

Other ingredients such as chondroitin and MSM are believed to have similar roles to glucosamine in the body. These compounds are often found in supplement form, either singularly or in combination with glucosamine. Both ingredients have been shown to reduce symptoms of OA14,15 and a 2017 study showed that the combination of glucosamine, chondroitin and MSM worked better than the combination of glucosamine and chondroitin and a placebo.16

Reducing chronic inflammation is also important for reducing the symptoms and progression of OA and supporting joint health. Omega 3 fatty acid supplements which provide EPA and DHA should be considered, as NDNS data shows that the intake of oily fish is low in the UK and omega 3 intakes are particularly poor when compared to other fats. Numerous studies have found a strong link between the use of fish oil and the reduction of inflammation. Studies suggest that fish oil can reduce symptoms such as pain associated with OA17 and knee function, as well as improving walking speed18 and reducing the need for painkillers and anti-inflammatory medications.19

Turmeric is also very closely involved in reducing inflammation20 and in trials of those with OA, it reduced discomfort and improved joint function21 and was better than placebo.22

Ginger is another herb which may reduce inflammation, and in 2001 a randomised, double-blind, placebo-controlled trial of 247 participants showed that ginger reduced knee pain on standing and walking in 6 weeks.23 A further review in 2015 confirmed that ginger reduced discomfort associated with OA.24

Both rosehip and quercetin have been shown to reduce inflammation: rosehip by reducing C-reactive protein and quercetin by affecting IL-1β, TNF-α, IL-6, and IL-10. An analysis of three trials including 287 patients found that rosehip powder reduced OA pain compared to placebo.25 Several studies have suggested that quercetin reduces the production of inflammatory compounds in the body and it has been shown to be useful for OA.

References

  1. NHS England. Musculoskeletal best practice solutions. england.nhs.uk
  2. Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review. Obes Rev. 2014;15(7):578–86.
  3. Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med. 1992;116:535–539.
  4. Toda Y, Toda T, Takemura S, Wada T, Morimoto T, Ogawa R. Change in body fat, but not body weight or metabolic correlates of obesity, is related to symptomatic relief of obese patients with knee osteoarthritis after a weight control program. J Rheumatol. 1998;25:2181–2186.
  5. Pitaraki EE. The role of Mediterranean diet and its components on the progress of osteoarthritis. J Frailty Sarcopenia Falls. 2017;2(3):45–52.
  6. Veronese N, Stubbs B, Noale M, et al. Adherence to a Mediterranean diet is associated with lower prevalence of osteoarthritis: Data from the osteoarthritis initiative. Clinical Nutrition. 2016:1–6.
  7. Mohammadi V, Mohebitabar S, Mohammad Rahimi GR. Effects of a Targeted Exercise Program on Pain, Balance, Proprioception, and Function in Adults With Knee Osteoarthritis. Biol Res Nurs. 2026 Feb 8. doi: 10.1177/10998004261425677.
  8. Arthritis UK. Running with arthritis: physiotherapist's tips on running and avoiding injury. 2024. arthritis-uk.org
  9. Casale J, Crane JS. Biochemistry, Glycosaminoglycans. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. ncbi.nlm.nih.gov
  10. Dahmer S, Schiller RM. Glucosamine. Am Fam Physician. 2008;78(4):471–6.
  11. Reginster JY, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001;357(9252):251–6.
  12. Lopes Vaz A. Double-blind clinical evaluation of the relative efficacy of ibuprofen and glucosamine sulphate in the management of osteoarthrosis of the knee in out-patients. Curr Med Res Opin. 1982;8(3):145–9.
  13. Müller-Fassbender H, Bach GL, Haase W, Rovati LC, Setnikar I. Glucosamine sulfate compared to ibuprofen in osteoarthritis of the knee. Osteoarthritis Cartilage. 1994;2(1):61–9.
  14. Schneider H, Maheu E, Cucherat M. Symptom-modifying effect of chondroitin sulfate in knee osteoarthritis: a meta-analysis of randomized placebo-controlled trials performed with Structum®. Open Rheumatol J. 2012;6:183–9.
  15. Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF. Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial. Osteoarthritis Cartilage. 2006;14(3):286–94.
  16. Lubis AMT, Siagian C, Wonggokusuma E, Marsetyo AF, Setyohadi B. Comparison of Glucosamine-Chondroitin Sulfate with and without Methylsulfonylmethane in Grade I–II Knee Osteoarthritis: A Double Blind Randomized Controlled Trial. Acta Med Indones. 2017;49(2):105–111.
  17. Kuszewski JC, Wong RHX, Howe PRC. Fish oil supplementation reduces osteoarthritis-specific pain in older adults with overweight/obesity. Rheumatol Adv Pract. 2020;4(2).
  18. Peanpadungrat P. Efficacy and Safety of Fish Oil in Treatment of Knee Osteoarthritis. J Med Assoc Thai. 2015;98 Suppl 3:S110–4.
  19. Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006;65(4):326–31.
  20. Akaberi M, Sahebkar A, Emami SA. Turmeric and Curcumin: From Traditional to Modern Medicine. Adv Exp Med Biol. 2021;1291:15–39.
  21. Wang Z, et al. Efficacy and Safety of Turmeric Extracts for the Treatment of Knee Osteoarthritis: a Systematic Review and Meta-analysis of Randomised Controlled Trials. Curr Rheumatol Rep. 2021;23(2):11.
  22. Dai W, et al. Effectiveness of Curcuma longa extract versus placebo for the treatment of knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Phytother Res. 2021;35(11):5921–5935.
  23. Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001;44(11):2531–8.
  24. Bartels EM, et al. Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials. Osteoarthritis Cartilage. 2015;23(1):13–21.
  25. Christensen R, Bartels EM, Altman RD, Astrup A, Bliddal H. Does the hip powder of Rosa canina (rosehip) reduce pain in osteoarthritis patients? – a meta-analysis of randomized controlled trials. Osteoarthritis Cartilage. 2008;16(9):965–72.
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