Do you have a parent or sibling who has been diagnosed with arthritis, or have you been a caregiver for a parent after knee replacement surgery? Do you feel you're at risk, perhaps because an orthopaedic surgeon told you arthritis is genetic, and you want to do everything in your power to avoid going under the scalpel?
You are not alone.
Yes, osteoarthritis does have a genetic component, with 30-60% of its overall genetic contribution varying by joint, sex, and ethnicity.
However, this does not mean it cannot be managed or delayed. In this blog, we will share four easy mental models to build your defence against osteoarthritis and offer practical strategies that you can add to your lifestyle.
When dealing with OA, always remember:
Genetic Risk ≠ Destiny
Before we delve into OA, it is essential to understand that the genetic contribution to OA varies by joint. We will restrict our blog to Knee OA as it is the most common type of OA in India.
LAYER 1: Foundation – Reduce the Load
The first thing to know is that you need to minimise chronic, excessive stress on your joints. This is especially true for your weight-bearing joints, such as the knees, hips, and spine. This is the most fundamental, yet most overlooked aspect of OA prevention and care, particularly among folks who carry a genetic predisposition.
If your joints never feel overloaded, they’re less likely to wear out prematurely. - Dr. Pawan Chebbi
The Physics of Pressure:
Your joints do not bear your weight statically. Instead, they experience dynamic loads that are up to 10 times higher than the static load (i.e. the force experienced by your joints when you are standing. Here are three everyday activities that multiply your body weight and the force acting on your joints.
- Walking: 2-3 times your body weight
- Climbing Stairs: 4-5 times your body weight
- Running: 6-8 times your body weight
If you weigh 70 kg, your knees will experience up to 560 kg of weight when you run or jog.
Every kilogram matters
Because a small change here can have serious repercussions on the force that your joints bear, obesity is one of the strongest modifiable risk factors for knee OA, especially for folks with a genetic predisposition.
Furthermore, even a 5kg weight reduction results in a 40kg reduction in weight on your knees, substantially reducing your risk of wear and tear.
Not only your weight but also how you load your joints and muscles play a significant role in how your body experiences forces. This means that two people of the same body weight can experience very different levels of stress on their joints depending on how they move, stand, and align their bodies. Poor posture, improper gait, or misaligned joints can exacerbate pressure on specific areas, accelerating joint degeneration and increasing the risk of injury. On the other hand, when joints are properly aligned and muscles are engaged evenly, the force is distributed more efficiently throughout the body. This reduces localised stress and promotes better shock absorption during movement.
Posture, joint alignment, and ergonomics are critical in this regard. For example, walking with your feet turned outward or inward can place uneven stress on your knees or hips. Sitting for long periods with a slouched spine can overload your lower back. Similarly, improper workstation setup or lifting techniques can contribute to chronic joint pain and cumulative wear and tear. Optimising alignment through corrective exercise, strengthening key muscle groups, and making ergonomic adjustments in your daily life can significantly reduce abnormal joint loading, improve movement efficiency, and extend joint longevity. Read more about designing an ergonomic workspace that helps you avoid back pain.
Key Takeaways from Layer-1:
- Every kilogram matters (load magnification effect)
- Watch everyday ergonomics: sitting, standing, sleeping
- Awareness of movement mechanics: knees over toes, hips stacked, spine aligned
LAYER 2: Function – Strengthen the System
“Strong muscles act like shock absorbers.” - Dr Anurag Gupta (PT)
Once you've laid the foundation of Layer 1 (Load Management), addressing body weight, posture, and joint alignment, the next step is to build muscular strength and joint resilience. These layers are sequential, NOT optional, especially if you’re predisposed to osteoarthritis (OA) due to family history.
To guide this progression, we developed Maslow’s Hierarchy for MSK Health, inspired by conversations with leading orthopaedic surgeons and physiotherapists, and backed by literature. MSK health is like building a skyscraper. You can’t jump to the upper floors without reinforcing the base.
Build Mobility and Flexibility
Before starting strength work, ensure your body can move freely and fluidly. Tight muscles and stiff joints can increase your risk of injury.
- Daily goal: Walk at least 8,000 steps to keep your joints active
- Mobility drills: Focus on ankles, hips, spine, and shoulders, key joints that influence overall movement
- Yoga: One of the most effective ways to combine breath, movement, and flexibility
- Dynamic stretches: Especially important before workouts to improve range of motion
The focus here is on building a resilient body. Without this, adding further weight can do more damage than good.
Build Strength to Absorb Load
Once mobility improves, shift to strength training to support and stabilise joints. This is because strength matters as strong muscles absorb the daily shocks your joints would otherwise bear.
Start with bodyweight training:
- Core stability: Planks, bird-dogs, dead bugs
- Lower body: Squats, lunges, glute bridges
The focus here is to train at least 3 times per week for measurable and sustainable results.
Prioritise Low-Impact Cardio
If you're cautious about joint wear (especially in the knees), low-impact cardio is an ideal choice. This is because it provides the benefits of cardiovascular exercise without putting excessive stress on your joints. Standard options include cycling, an elliptical trainer, and swimming. We added these activities as they are available in most gyms in India.
The focus here is to build both endurance and muscle while significantly reducing joint impact.
Key Takeaways from Layer-1:
- Flexibility & Mobility before strength – walking, yoga, and stretching are the best
- Start with body weight exercises to build core – squats, planks
- Progressive loading with strength training – 3 times a week
- Shift to low-impact cardio – elliptical, and cycling to build muscles while reducing impact on knees
LAYER 3: Fuel – Lower the Inflammation
Osteoarthritis is mechanical, but inflammation turns up the pain. - Dr. Abhishek Shenoy
While osteoarthritis (OA) is fundamentally a mechanical condition driven by joint wear, alignment, and load, the pain and progression of the disease are often made worse by inflammation.
If Layer 1 focuses on reducing joint load, and Layer 2 on building shock-absorbing strength, then Layer 3 is about controlling the inner environment of your body, primarily through diet, hydration, sleep, and supplementation.
Why Inflammation Matters in OA
Inflammation in OA is typically low-grade but chronic, making joints more sensitive to pain, more likely to swell after activity, and slower to heal and recover.
Even if your joint mechanics are ideal, if your body is in a pro-inflammatory state, your musculoskeletal system will suffer.
Start with the Basics: Free and Effective
Before supplements or superfoods, dial in these two fundamentals:
Hydration
Dehydrated joints lead to stiffness. Water keeps cartilage hydrated and supports the flow of synovial fluid (your joint’s natural lubricant). Aim for at least 3 litres of water per day, more if you're active or live in a hot climate.
Sleep
During sleep, your body releases anti-inflammatory molecules and repairs soft tissue. Lack of sleep increases levels of cytokines, which are markers of inflammation. Adults need 7 to 9 hours of restful sleep to maintain joint health and hormonal balance.
Add Targeted Nutrients and Anti-Inflammatory Foods
Science-backed Supplements are critical in reducing and managing inflammation.
- Vitamin D: Critical for bone and immune health. Deficiency worsens inflammation
- Turmeric (Curcumin): A potent anti-inflammatory compound. Works best when taken with black pepper (piperine) for absorption
- Collagen (Type II or hydrolysed): Supports cartilage regeneration and joint lubrication
- Omega-3 Fatty Acids (Fish oil or flaxseed): Help reduce the production of inflammatory prostaglandins
Indian Foods That Naturally Help
- Haldi Doodh (Turmeric Milk)
- Methi (Fenugreek) soaked overnight and taken in the morning
- Amla (Indian gooseberry) is rich in antioxidants
- Ginger and garlic for their anti-inflammatory and immune-supportive effects
- Ashwagandha to support systemic inflammation and stress response
Avoid Foods That Accelerate Inflammation
What you avoid is as important as what you eat.
- Refined sugar triggers an insulin response that drives inflammation
- Seed oils like sunflower and soybean, which are high in omega-6 fatty acids
- Ultra-processed foods containing preservatives, artificial flavours, and trans fats
- Red meat or organ meat in excess, mainly when fried or processed
- Alcohol, which increases oxidative stress and gut inflammation
Key Takeaways from Layer 3
- Hydration and sleep are non-negotiable and cost nothing
- Turmeric, omega-3s, and collagen are practical tools to manage inflammation
- Focus on traditional Indian foods rich in antioxidants and anti-inflammatory compounds
- Cut down refined sugar and processed food to protect your collagen and cartilage
LAYER 4: Early Detection – Early Action
You can’t manage what you don’t measure. - Dr. Anurag Gupta (PT)
In India, over 60% of osteoarthritis (OA) diagnoses occur when the disease has already progressed to Grade 3 or beyond. At this stage, cartilage loss is significant, pain is persistent, and treatment options are often limited to symptom management or surgical intervention.
While X-rays and MRIs are now more accessible and affordable, the bigger problem lies in our cultural mindset. Many people learn to live with pain, dismissing it as “normal” or simply a part of ageing. This delays diagnosis and allows the disease to progress unchecked.
Why Early Detection Matters
Osteoarthritis, especially in the knee and hip, does not develop overnight. It takes years, sometimes decades, of cumulative wear and tear before symptoms become severe. However, once symptoms do appear, much of the structural damage is often already done.
Early detection allows for:
- Timely lifestyle and biomechanical interventions
- Preventing or slowing further degeneration
- Delaying or avoiding surgery
When should you get checked?
- If you have a family history of OA or arthritis. Especially if parents or siblings have been diagnosed with Osteo-arthritis
- If you experience recurring joint pain, stiffness, or instability. This especially applies to your knees.
- If you lead a sedentary life or have a job that involves repetitive joint use (e.g., squatting, standing, lifting)
Early screening is crucial for women over the age of 40, who are more prone to OA due to post-menopausal bone and cartilage changes.
What to Do?
- Baseline MSK assessment: Includes posture, joint loading, flexibility, and early signs of joint degeneration. A physiotherapist can assess your MSK health with high degree of accuracy.
- X-ray or MRI (as advised): Especially of the knees and hips, if there is pain or instability
- Annual follow-ups: Helps track changes in joint space and structure over time
- Simple functional tests: Such as one-leg balance, sit-to-stand, or timed walking, can also serve as red flags when performance declines
Key Takeaways from Layer 4
- OA is not sudden; it is slow and progressive
- In India, diagnosis is often delayed by mindset, not by lack of access
- Early screening can help those with genetic risk or early symptoms take preventive action
- Annual checks can guide decisions on intervention, exercise, and pain management
