The Effect of Cabbage Leaf Application on Pain, Physical Function and Quality of Life Levels of Patients With Knee Osteoarthritis

Osteoarthritis, which develops under the influence of genetic, mechanical, or biochemical factors, is a chronic inflammatory degenerative joint disease characterized by morphological alterations of the synovial membrane and joint capsule, including synovial inflammation, progressive cartilage degradation, the formation of osteophytes, and subchondral bone sclerosis, particularly in weight-bearing joints. Due to the greater degree of degeneration in weight-bearing joints, the knee is the most commonly affected joint in symptomatic osteoarthritis. In addition to the knee, the hip, spine, hand, foot, and fingers are among the other joints frequently involved. Progressive cartilage loss in the knee joint leads to limitations in range of motion, severe chronic pain, and significant muscle atrophy. Knee pain-often sharp, dull, continuous, or intermittent-is one of the most common symptoms associated with osteoarthritis. Crepitus during physical examination, stiffness and swelling, restricted motion, morning stiffness, and muscle weakness are also frequently observed. Pain that initially occurs during activity may progress to pain at rest as the disease advances, making it one of the leading reasons for clinical visits.

According to 2019 data, approximately 528 million individuals worldwide were living with osteoarthritis, representing a 113% increase since 1990. Nearly 73% of patients with osteoarthritis are over 55 years of age, and approximately 60% are women. As osteoarthritis is more common among older adults (with about 70% of cases occurring in individuals over 55 years of age), global prevalence is expected to rise with population aging. Based on data from the Turkish Statistical Institute (TUIK), 11.2% of the population in Türkiye reported arthritis-related problems in 2019.

Several risk factors contributing to the development and progression of OA have been identified. The onset and progression of the disease are influenced by genetics, age, sex, nutrition, obesity, bone density, joint stress resulting from sports activities, smoking, ethnicity, physical inactivity, occupational joint strain, and trauma. Moreover, more than 25% of osteoarthritis cases are accompanied by comorbid conditions such as obesity, diabetes, pulmonary and cardiovascular diseases, hypertension, metabolic and musculoskeletal disorders, and depression. The chronic pain and stiffness experienced by individuals with osteoarthritis lead to physical limitations that impair daily living activities, result in inadequate self-care, deteriorate functional status, disrupt social relationships, and ultimately contribute to decreased quality of life. Age-related increases in musculoskeletal conditions within society negatively affect functional capacity, quality of life, and healthcare costs. Education, weight management, and regular exercise are effective strategies for improving quality of life. Challenges in nutrition, transportation, elimination, and social interaction further impair quality of life among older individuals. Therefore, improving quality of life should be prioritized in the self-management of osteoarthritis.

Although there is no direct cure for osteoarthritis, treatment strategies aim to reduce symptoms, slow disease progression, minimize the negative impact on mobility and quality of life, and lessen healthcare needs. Pharmacological treatments include analgesics, anti-inflammatory agents, and opioids, while surgical interventions involve arthroscopy, osteotomy, and total knee replacement. Non-pharmacological therapies constitute one of the strongly recommended components in osteoarthritis management, particularly in knee osteoarthritis, as emphasized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Strongly recommended approaches include patient education, weight loss when applicable, and structured exercise programs consisting of aerobic and strengthening exercises, alongside lifestyle modifications. Additionally, modalities suggested by the European League Against Rheumatism (EULAR)-such as laser therapy, spa therapy, pulsed electromagnetic field therapy, acupuncture, transcutaneous electrical nerve stimulation (TENS), herbal remedies, and vitamin supplementation-are commonly used non-pharmacological treatment options.

Herbal remedies are widely recommended as complementary and supportive treatments in many healthcare systems across the world. Some self-care guidelines frequently advise the use of bandages or compresses for osteoarthritis symptoms. Among these traditional practices, cabbage leaf compresses have been used for centuries. Leaves from white or Savoy cabbage are applied to the painful knee joint for several hours to reduce pain. The health-promoting properties of cabbage leaves have long been recognized, and they have been used to treat various conditions, including breast engorgement. Cabbage leaves are rich in dietary fiber, vitamin C, vitamin K, folate, manganese, iodine, potassium, beta-carotene, and calcium. They are also known to possess strong antioxidant, anticancer, and anti-inflammatory properties. The sulfur compounds in cabbage leaves are believed to help alleviate pain and swelling. Their analgesic effects are attributed to physiological mechanisms such as dilation of capillaries, reduction of tissue congestion, decreased edema, localized anesthetic effects, and reduction in muscle spasticity and stiffness.