| What We Treat
Osteoarthritis
Been told you have wear and tear, and that there’s nothing to be done but manage it? That’s not what the evidence says. Osteoarthritis responds to exercise better than to almost anything else — and better than most people are led to expect.
Overview
What Is Osteoarthritis?
Osteoarthritis is a condition of the whole joint — cartilage, bone, ligaments, the joint lining and the surrounding muscles. It is not simply cartilage wearing out like a car tyre, and it is not an inevitable consequence of use. Symptoms fluctuate, correlate poorly with what a scan shows, and respond to treatment at every stage. National guidance is unambiguous that therapeutic exercise is a core treatment, whatever the X-ray looks like.
Knee Osteoarthritis
Pain with weight-bearing activity, stairs and getting up from a chair, with morning stiffness lasting under 30 minutes. Exercise therapy and weight management are the core treatments, with strength training producing improvements comparable to some surgical interventions in trials.
Symptoms
How It Tends to Feel
Osteoarthritis has a recognisable pattern that distinguishes it from inflammatory joint conditions:
Activity-Related Pain
Pain that comes on with use and eases with rest, at least in earlier stages.
Short Morning Stiffness
Stiffness first thing lasting under 30 minutes. Longer stiffness suggests an inflammatory cause instead.
Stiffness After Sitting
The joint feeling stiff after a period of rest, easing after the first few minutes of movement.
Reduced Range
Gradual loss of full movement at the joint, often noticed in specific tasks first.
Grinding or Crunching
Very common, generally harmless, and not a marker of severity.
Fluctuating Symptoms
Good weeks and bad weeks rather than a steady decline — which is often reassuring to hear.
Causes & Risk Factors
What Drives It
Osteoarthritis develops through a combination of factors, several of which are modifiable.
Age
Prevalence rises steadily with age, though osteoarthritis is not simply an inevitable consequence of getting older.
Previous Joint Injury
A significant injury — particularly an ACL rupture or a fracture involving the joint — substantially increases later risk.
Body Weight
Increases mechanical load and also has metabolic effects on joint tissue. Weight management has good evidence in knee and hip osteoarthritis.
Genetics
Family history accounts for a meaningful proportion of the variation, particularly for hand and hip osteoarthritis.
Muscle Weakness
Weak muscles around a joint mean more load reaches the joint surfaces, and this is both a cause and a consequence.
The Programme
What Treatment Actually Involves
The evidence for exercise in osteoarthritis is strong and consistent. What varies is whether the programme is dosed properly and continued long enough.
Getting started
Establish a tolerable baseline
- Assessment of strength, range and the specific tasks that limit you
- Understanding that pain during exercise is expected and not harmful
- Beginning at a load you can manage comfortably, which is often lower than you’d expect
- Clear guidance on what an acceptable flare looks like and what to do about it
Tap through the stages. The main reason exercise programmes fail in osteoarthritis is that they stop.
How We Can Help You
Treatment & Management
This is one of the areas where physiotherapy has the strongest evidence, and where expectations are frequently set far too low.
What the evidence says
NICE guidance on osteoarthritis recommends therapeutic exercise as a core treatment for everyone with osteoarthritis, alongside weight management where relevant. It advises that imaging is often unnecessary for diagnosis, and specifically recommends against acupuncture and electrotherapy.
The guidance also notes that exercise may initially cause some discomfort, and that this is expected rather than harmful — a point worth emphasising, because fear of causing damage is one of the main reasons people stop.
When to Seek Help
Red Flags — Don’t Ignore These
Osteoarthritis is a benign condition. These features suggest something else:
⚠ Seek prompt medical assessment if you notice:
- A hot, red, swollen joint with fever or feeling generally unwell (possible joint infection — seek emergency care)
- Morning stiffness lasting more than an hour, or multiple joints affected symmetrically (possible inflammatory arthritis)
- Inability to weight-bear after a fall, particularly in an older adult (possible fracture — attend A&E)
- Constant, unrelenting night pain unrelated to position, with unexplained weight loss or a history of cancer
- Rapidly worsening pain and loss of function over weeks rather than months
These symptoms can point to a cause that needs medical rather than physiotherapy assessment. Please don’t wait for a physiotherapy appointment — contact your GP, call 111, or attend A&E as appropriate.
Common Questions
Frequently Asked Questions
Will exercise wear my joint out faster?
No. This is the most common and most damaging misconception about osteoarthritis. There is no evidence that appropriate exercise accelerates joint changes, and considerable evidence that it improves pain and function. Weakness and inactivity make things worse, not better.
Is it normal for exercise to hurt?
Some discomfort during and shortly after exercise is expected and is not a sign of damage. National guidance specifically makes this point. A useful rule is that discomfort should settle within 24 hours — if it does, the dose was reasonable.
Do I need a scan?
Usually not. Osteoarthritis can be diagnosed clinically in people over 45 with activity-related joint pain and short-lived morning stiffness. Scan findings correlate poorly with symptoms, and a frightening-sounding report can measurably increase pain and avoidance.
Will I need a joint replacement?
Not necessarily. Many people manage well for years or indefinitely with exercise, weight management and load modification. Replacement becomes a reasonable option when pain and function remain significantly limiting despite good conservative treatment — it’s a decision, not an inevitability.
Osteoarthritis Is More Treatable Than You’ve Been Told
A proper strength assessment, a programme dosed to actually work, and honest expectations about what’s achievable.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.