Nonpharmacologic interventions include an umbrella-like group of approaches that should be universally considered in all patients. Advising and educating the patient as to treatment objectives and the importance of exercise, weight reduction, and joint protection is an important baseline initiative.

Joint Rest. Weight-bearing activity should be minimized, without unnecessarily limiting reasonable activities of daily living. Assistive devices such as canes or crutches are helpful in decreasing stresses across weight-bearing joints. Optimally, the cane or crutch should be used in the contralateral hand to the involved joint, although some patients find use of a nondominant hand difficult. Wheeled walkers may be necessary in the presence of bilateral disease. Excess stairs should be avoided if feasible. Knee braces can be helpful in reducing pain, with simple elastic supports more likely to be used by the patient than metal hinge supports. In patients with spine disc degeneration and facet joint osteoarthritis, a firm mattress or bedboard relieves strain on the back. The use of a high seat is beneficial in protecting the knees from stress in getting in and out of a chair or with toileting.

Physical Therapy. Local heat and appliances to restrict joint motion help to relieve pain and stiffness. Aerobic, muscle-strengthening, and range of motion exercises are effective in maintaining maximal function. Hip or knee osteoarthritis is benefited by use of appropriate footwear. Lateral wedged insoles can shift weight laterally in patients with medial tibiofemoral compartment knee involvement. Use of traction and a support collar can significantly reduce pain in the cervical region, and a firm corset can be used to support the low back region.