The revised S3 guideline on knee osteoarthritis [1], the most important German-language recommendation for action, has provoked mixed reactions and provided ample cause for discussion with regard to the recommended treatment methods [2, 3].
lowing “strong” recommendations stand out in the summary and deserve special attention in this article:
- For more sustainable healthcare, we recommend the following: […]
- Promotion of environmentally friendly lifestyles: Education and counseling on plant-based nutrition, active mobility (such as walking and cycling), and sustainable everyday practices.
- Prioritizing resource-saving treatment options (where therapies are equivalent): recommending non-surgical measures such as exercise therapy, behavioral modification, and weight
management before considering invasive procedures. [1]
In addition to promoting an active lifestyle with a focus on mobility (e.g., walking and cycling in everyday life, taking the stairs instead of the elevator), exercise therapy is an evidence-based treatment method of undisputed fundamental importance, which should now finally be taken into account in healthcare practice. But what exactly should this exercise therapy look like? To give this originally sports medicine-related and at the same time highly translational field more contour, it is worth taking a look at the recently published systematic review and meta-analysis by Yan et al. [4]. The team of authors compared six training methods in terms of their effect on pain reduction, function, gait pattern, and quality of life. Among these, aerobic exercise (walking, running, cycling, swimming) performed best as a first-line treatment. In addition, strengthening, flexibility, and coordination exercises, as well as so-called mind-body exercises [5], were also examined and rated positively. The latter form of exercise, as part of mind-body medicine [6], which has already been considered in earlier studies on knee osteoarthritis [7, 8], can make a valuable contribution to the treatment of osteoarthritis symptoms, shifting the focus from the painful knee joint to the whole person. This is entirely in line with the holistic concept of whole-person health [9], which is also becoming increasingly important in the context of prehabilitation [10]. The affected person becomes an active part of the treatment team, which focuses on self-efficacy and teamwork and promotes adherence. Interventions from mind-body medicine can also be used when “traditional” therapeutic approaches such as aerobic exercise cannot be carried out due to physical condition or other obstacles.
Targeted Nutrition
In addition to exercise as therapy and behavioral adjustment in the sense of strengthening self-efficacy, the S3 guideline also explicitly mentions plant-based nutrition [1] as an important component of osteoarthritis treatment, thus emphasizing the concept of targeted nutrition [11]. Key aspects include sufficient protein intake with a targeted amino acid composition, the intake of collagen [12, 13] and fiber [14, 15], as well as supplementary systemic enzyme therapy [12, 13, 16, 17], multi-substance mixtures [18], and phytopharmaceuticals. Curcuma [19 – 24] in particular is playing an increasingly scientifically proven role in pain reduction and functional improvement in degenerative diseases such as osteoarthritis.
This knowledge deserves to be taken into account in daily care and tested in practice – not as a replacement, but as a supplement to established forms of therapy. We should seize the opportunity to further examine, apply, and critically observe such approaches in order to expand the field of conservative and regenerative medicine with valuable biological options.
Mind-body medicine and shared medical appointments
Mind-body medicine is considered to be of additional importance in reducing inflammatory biomarkers [25] and in the individual management of psychosocial stress [26]. Self-management and patient education are individual and closely linked to lifestyle medicine. They require targeted training and continuing education strategies for both patients and therapists. These approaches must now be consistently integrated into real-world care – analogous to the already established sports and exercise therapy. Oncology provides an interesting, differentiated, and precise approach with the concept of exercise oncology [27], while the currently evolving field of prehabilitation [10] can serve as a framework. The “open window” that is emerging in relation to prehabilitation offers the opportunity to anchor these innovative approaches in the long term. Let’s take advantage of it and make the necessary changes in medical care a reality. As already emphasized in the article by Lison & Lison, there is virtually no alternative to all these developments [28].
The salutogenic potential is far from exhausted – rather, it paves the way for a new era of medical care, in line with the mind-body medicine concept coined by Professor Herbert Benson and Professor Jon Kabatt-Zinn [29] [6, 30].
The cost-efficient concept of shared medical appointments (SMA) [31, 32] also appears to be particularly forward-looking in this context. This model of joint medical consultations [29] enables the efficient, interdisciplinary, and team-oriented implementation of mind-body approaches as well as lifestyle medicine – with patients as active members of their therapeutic process.
In the recent article “Bashing Doctors Instead of Science,” published in Orthopedics and Trauma Surgery 2025 15(5), the authors, Dr. Burkhard Lembeck (President of the BVOU) and Janosch Kuno (BVOU Press Officer), emphasize “that patients rightly expect their healthcare providers to exhaust all conservative therapies before resorting to surgery, even if the evidence for them is weak. This applies in particular to chronic conditions such as osteoarthritis or tendon irritation, when standard therapies do not help.” Especially from this perspective, the article “Integrative Osteoarthritis Therapy” seems more relevant and important to us than ever. We look forward to further developments in this field.
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“It is evident that over the past 30 years, medicine has recognized that the mysterious dynamic balance we call health encompasses both body and mind and can be strengthened through certain qualities of attention – qualities that can have a nourishing, regenerative, and healing effect. We all possess this ability – let’s put it to use.” Jon Kabat-Zinn from the book “Coming to Our Senses” (2005)
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Study Tip Tai Chi helps with knee pain and improves knee function in people with knee osteoarthritis. Zhu SJ, et al. Online Unsupervised Tai Chi Intervention for Knee Pain and Function in People With Knee Osteoarthritis: The RETREAT Randomized Clinical Trial. JAMA Intern Med. Published online October 27, 2025. doi:10.1001/jamainternmed.2025.5723
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Autoren
ist Diplom-Sportwissenschaftler mit Professional Master’s Degree in Sports Medicine sowie postgradualen Weiterbildungen in Mind-Body-Medizin (Harvard Medical School), Psychoneuroimmunologie und Lifestyle Medicine (American College of Lifestyle Medicine); Verleger der sportärztezeitung.
is a certified sports scientist with a professional master's degree in sports medicine and postgraduate training in mind-body medicine (Harvard Medical School), psychoneuroimmunology, and lifestyle medicine (American College of Lifestyle Medicine); publisher of the sportärztezeitung.
ist Facharzt für Orthopädie und Unfallchirurgie mit den Zusatzbezeichnungen Sportmedizin und Manuelle Medizin. Er leitet als Oberarzt die Sportorthopädie der Sport- und Rehabilitationsmedizin des Universitätsklinikums Ulm mit dem Schwerpunkt der Betreuung von Mannschaftssportarten (u.a. TVB 1898 Stuttgart). Er ist Vorsitzender des AGA-Komitees „Prävention, konservative Therapie und Rehabilitation“ sowie Vorsitzender der DVSE-Kommission „Konservative Therapie“. Darüber hinaus ist Dr. Henze stellvertretender Vorsitzender der Handballärzte Deutschland und seit 2022 wiss. Beirat der sportärztezeitung.
ist Facharzt für Orthopädie und Unfallchirurgie und ärztlicher Leiter des UKE Athleticum am Universitätsklinikum Hamburg Eppendorf. Er hat seit 2021 eine Professur für Orthopädische Sportmedizin am UKE. Außerdem ist er leitender Mannschaftsarzt der HSV Fußball AG. Sein klinischer Fokus liegt im Bereich der regenerativen Knorpeltherapie, der Behandlung von Sportverletzungen und Überlastungsschäden. Prof. Welsch ist wiss. Beirat der sportärztezeitung.
