Osteoarthritis (OA) affects about 40 million people in the USA. In this post, we discuss what causes OA, what traditional therapies are missing, and explore hugely promising new research that shows the far-reaching benefits of PEMFs for OA.
Joints are complex structures including muscle, ligaments, and tendons, as well as blood, nerve and lymphatic supply. Joint cartilage is a connective tissue that is not able to repair itself because it does not have a good blood, nerve or lymphatic supply, and because cartilage cells do not replace themselves easily. For these reasons, either high-energy acute or continual low-level trauma and extensive stress on the joint lead to the development of osteoarthritis.
It often takes years for osteoarthritis to develop, and that is why it is most common in the elderly. Changes in the fundamental structures of the joint tissues (that is, the “extracellular matrix”) and the presence of inflammation play a key role in OA by inducing an imbalance between tissue growth and tissue breakdown – favoring breakdown. Connective tissue cells also play a role in OA because they secrete a wide range of inflammatory molecules.
Currently, in conventional medicine, therapies for OA are aimed at improving the quality of life, reducing pain and swelling and not disease progression. Therapies primarily focus on medications or procedures. Unfortunately both of these have drawbacks (and potentially long-term side effects), with limited effectiveness in OA, because of the degree of underlying impairment of joint cells in the presence of an extensive tissue breakdown environment.
Safe and non-toxic alternative therapies are necessary. Pulsed electromagnetic field (PEMF) stimulation of tissue is a relatively new approach to treating OA, emphasizing stimulation of tissue repair. Most studies to date have shown that PEMFs are effective in treating pain and improving function in OA, typically, at 8 weeks following treatment, and with virtually no toxicity or side effects.
Previous research both on living and nonliving tissues shows significant benefits of PEMFs in various models of OA. Various researchers have found positive effects of PEMFs in cartilage cells and tissue cells with field intensities between 15 and 30 Gauss (1,500 to 3,000 microTesla), often using a 75 Hz signal. In these studies PEMF stimulation increased cell growth and extracellular matrix (ECM) production.
ECM molecules include collagen II, glycosaminoglycans (GAGs), and proteoglycans (PGs), IL-1b and IGF-1. PEMFs inhibited inflammation producing prostaglandin E2 (PG-E2) production, helping to reduce inflammation, and increased joint capsule cells.
Breakdown of the joint capsule by the presence of inflammation and a reduction in support molecules is critically important in the development of OA. In addition, local joint tissue stem cells, proteoglycan (PG) molecule (not PG-E2) and collagen synthesis increased with PEMFs. Proteoglycans provide lubrication to joints. Stem cells help to repair and regenerate tissues. Collagen forms the basic structure of the soft tissues of the body, including joints. All of these molecules are necessary to maintain joint health. One study showed positive results between PEMF of 5-20 Gauss field intensity and duration of exposure of 1-24 hrs and PG production regardless of frequencies between 2 – 110 Hz, even if 4-24 hrs after stimulation. On the other hand, another study showed no benefit from 16.7 Hz PEMF stimulation. An important consideration in looking at these results is that it is not always certain what the value is from results on nonliving tissue/molecular laboratory studies, when it comes to considering a living human. Studying living tissue is more relevant directly to human needs.
New PEMF Study for OA
A new study has surfaced, which I consider to be one of the most important studies on OA I have seen in years, that finally shows us that there is much more happening with PEMF therapy in OA than simply improving function and reducing pain. Reducing pain and improving function are very important, but unless the underlying changes in the tissues that are part of the OA process are actually affected directly, then the underlying problem continues to progress and more aggressive measures will need to be taken years later, including joint replacement.
The right and best approach would be to prevent progression of the OA process at the earliest stages possible. The later the stage and the more severe the problem, the more challenging it is to treat no matter what you do, short of joint replacement. We already know that people with chronic joint pain will use large amounts of nonsteroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen, chronically, often resulting in gastrointestinal bleeding. This complication or side effect of NSAIDs unfortunately causes 30,000 deaths per year in the US alone. This is an unacceptable consequence of a poor chronic treatment option in OA, further emphasizing the need for different way of looking at the treatment of OA.
This new study, done in guinea pigs, which develop arthritis very quickly, often with fairly severe arthritis at about 2 years of age, and evidence of arthritis beginning between 3 to 6 months of age, shows that the fundamental underlying process of progression of arthritis can be slowed or stopped, even in the presence of fairly severe arthritis (OA). Guinea pigs have a much shorter lifespan and are therefore often used as a research model for the development of arthritis in humans. So, whatever happens in guinea pigs is very likely to happen in humans, but over longer periods of time. Guinea pigs are already considered to be “old” at about 21 months of age.
The guinea pigs were studied in 3 groups, with 2 groups using 75 Hz or 37 Hz at a peak intensity of 15 Gauss , and treated for 6 hours a day for 3 months, and another no PEMF exposure group (sham). At their deaths, the joints were examined at autopsy for various components of joint health and breakdown.
The sham group showed increased cartilage surface degeneration compared to the two PEMF groups. In other words, their arthritis got significantly worse in the short 3 months of the study. On the other hand, in the PEMF groups, cartilage thickness was significantly greater. The PEMF group also had much lower evidence of cartilage damage and degeneration. Bone thickness underlying the joint capsule typically increases significantly in OA. This is why the whole joint area becomes much enlarged compared to normal.
PEMF treatment with both frequencies significantly reduced bone thickness in almost all areas of the knee compared to the sham group. Both PEMF treatments were able to counteract OA progression, by acting on both cartilage and the underlying bone. Both frequencies maintain cartilage structure, PG content, cell appearance and general cell integrity compared to the sham group. Both PEMFs significantly reduced cartilage surface irregularities and resulted in greater cartilage thickness, with 75 Hz being better than 37 Hz.
Even in those animals already at the later stages of OA, PEMFs were still effective at counteracting the progression of OA especially in cartilage breakdown, and less on cartilage thickness, compared to earlier stages of OA. Other aspects of the study showed that the beneficial PEMF effects were not much different between 75 Hz and 37 Hz for most cartilage components even with more severe OA.
In the general PEMF literature on the treatment of OA, there are no specific indications about the length of exposure, duration, and how long PEMF should be applied. In the laboratory setting the same PEMF reactions were seen after 4, 9, and 24 hours of stimulation of cartilage. In a live tissue study, a cartilage response was seen when 7 to 9 hours per day of treatment were used at 60 Hz. In other studies, PEMFs at 75 Hz, 15 Gauss at 6 hours per day obtain better clinical outcomes, with decreased use of NSAIDs and reduced knee pain. Daily exposure times longer than 6 hours may not necessarily increase cartilage preservation, and are generally harder to adhere to. Other studies found an increase in the natural growth factors and a decrease in the inflammatory markers in the joint fluid after PEMF treatment, helping to preserve joint health.
While the results of this study seem to favor 75 Hz versus 37 Hz, other research indicates that it is unknown whether other signals can produce similar results in reducing the progression of arthritis. For those individuals wanting to replicate the most beneficial frequencies in this study, there are devices on drpawluk.com that will allow choice. The downside of using specific devices in this category is that they require electrical current. On the other hand there are battery-operated devices that, while they do not have the same signal, do allow use throughout the day during activity, by being battery operated. As the above study showed, the best results were obtained with many hours a day of daily use.
My own experience with arthritis and joint inflammation is that even though a signal may not be 75 Hz, it could still be very useful for existing arthritis treatment. While the study stopped at 3 months, I believe that most people with arthritis will need to continue therapy for the rest their life in order to reduce or prevent progression of their arthritis. Whether the arthritic process can be reversed is still subject to further research.
The above research shows us that PEMF therapies can be a very important tool for the treatment of arthritis. Most adults will develop arthritis during their lifetime, with it becoming progressively worse as the person ages. Many people already have evidence of arthritis in their 50s, often in their 60s and definitely beyond that. This is one of the reasons that joint replacements have become so common. So, the use of PEMFs even with mild arthritis will decrease the progression, probably allowing the person to avoid procedures and eventually joint replacement. What has to be accepted by anybody with arthritis is that treatment will have to be lifelong, whether the arthritis is mild or severe.
In vivo effect of two different pulsed electromagnetic field frequencies on osteoarthritis. Veronesi F, Torricelli P, Giavaresi G, Sartori M, Cavani F, Setti S, Cadossi M, Ongaro A, Fini M. Orthop Res. 2014 May;32(5):677-85.