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Arthritis Myths: Changing the Conversation about Arthritis and Exercise

Let's change the conversation about arthritis and exercise.

You’ve heard the chatter about arthritis. “I can’t do ___ ever again because I have arthritis” or “I was told I need surgery because its bone on bone in there” patient points at their knee. Is this all TRUE?! It’s time to unravel some of the arthritis myths.

What is Arthritis? 

There are many forms of arthritis. Osteoarthritis, the type we will discuss today, or OA, is one of the most common musculoskeletal diseases. OA is most common at the knees and hips in the lower body. The incidence of OA increases with age, and is fairly rare in individuals under 40. The incidence increases between 40-60, and reaches 10% of men and 18% of women aged 60 or older.

Arthritis is a disease characterized by a gradually increasing breakdown of the cushioning cartilage tissue on the surfaces of a joint, and a subsequent buildup of bone in the surrounding area. You may notice a combination of:

  • Joint pain 

  • Joint stiffness (especially in the morning or with prolonged sitting) 

  • Noisy Joints or “crepitus” including cracking, clicking, and grinding noises when moving joints

  • Occasional joint welling

  • Pain and difficulty with bending the knee or hip.

Physical Therapists are able to recognize when arthritis is probable in a joint based on the information you give us about your symptoms and when you experience them, in combination with an examination, where we assess how you are moving. We also look at how the joint in question is moving. When there are arthritic changes within a joint, we will observe a limitation in the motion of that joint, in what we call a “capsular pattern”. This means that for each joint there is a “pattern” of motion loss that when present tells us the inside of the joint itself is involved.

“Bone on Bone”

If you’ve had an X-ray, and your doctor says it is “bone on bone” are you doomed? Is a joint replacement my only option?

This is a resounding NO.

Yes, sometimes joint replacements are necessary, and can be incredibly helpful for improving activity level and quality of daily life. However, X-ray findings alone should not determine your course of treatment. Many times, folks will have imaging done, and be told they are “bone on bone”, yet they jogged into the office, or are walking around without difficulty. In fact, I recently counseled a marathon runner in his 50s with a “bone on bone” diagnosis, who has since run another marathon, and has been managing quite well with exercise based treatment despite his grim diagnosis.  I have another running client in their late 60s with a knee arthritis diagnosis, who is now running 30 miles a week without pain.

Arthritis is a spectrum, and yes, sometimes when X-rays show changes in the joint, it is accompanied by pain, but x-rays alone should not be used to determine the severity of your arthritis. According to a systematic literature review “Radiographic knee osteoarthritis is likewise an imprecise guide to the likelihood that knee pain or disability will be present” [3 ]. Thus, X-rays are just one piece of the puzzle when it comes to diagnosis and determining the treatment pathway for osteoarthritis, and should be considered in combination with the pain, or lack of pain and symptoms you are experiencing. 

In essence, you are not your X-ray, and “bone on bone” is not a “death sentence” to your hobbies and activities.

Osteoarthritis can present differently for different folks at different times. What X-rays show us do not always correlate with what you are feeling in your joints.  Physical therapy should be the first line of defense for treatment. If you have questions or would like to see what we can do to help you, feel free to reach out here. Stay tuned for next week, when we will break down another prevalent osteoarthritis myth.

1 Wang W, Niu Y, Jia Q. Physical therapy as a promising treatment for osteoarthritis: A narrative review. Front Physiol. 2022 Oct 14;13:1011407. doi: 10.3389/fphys.2022.1011407. PMID: 36311234; PMCID: PMC9614272.

2 Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008 Sep 2;9:116. doi: 10.1186/1471-2474-9-116. PMID: 18764949; PMCID: PMC2542996.

3 Pereira D, Ramos E, Branco J. Osteoarthritis. Acta Med Port. 2015 Jan-Feb;28(1):99-106. doi: 10.20344/amp.5477. Epub 2015 Feb 27. PMID: 25817486.

4 Miller RH. Joint Loading in Runners Does Not Initiate Knee Osteoarthritis. Exerc Sport Sci Rev. 2017 Apr;45(2):87-95. doi: 10.1249/JES.0000000000000105. PMID: 28145908.

5 Miller RH, Edwards WB, Brandon SC, Morton AM, Deluzio KJ. Why don't most runners get knee osteoarthritis? A case for per-unit-distance loads. Med Sci Sports Exerc. 2014 Mar;46(3):572-9. doi: 10.1249/MSS.0000000000000135. PMID: 24042311.

6 Alentorn-Geli E, Samuelsson K, Musahl V, Green CL, Bhandari M, Karlsson J. The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther. 2017 Jun;47(6):373-390. doi: 10.2519/jospt.2017.7137. Epub 2017 May 13. PMID: 28504066.

7 Burfield M, Sayers M, Buhmann R. The association between running volume and knee osteoarthritis prevalence: A systematic review and meta-analysis. Phys Ther Sport. 2023 May;61:1-10. doi: 10.1016/j.ptsp.2023.02.003. Epub 2023 Feb 13. PMID: 36809693.

8 Ponzio DY, Syed UAM, Purcell K, Cooper AM, Maltenfort M, Shaner J, Chen AF. Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners. J Bone Joint Surg Am. 2018 Jan 17;100(2):131-137. doi: 10.2106/JBJS.16.01071. PMID: 29342063.

9 Vincent KR, Vasilopoulos T, Montero C, Vincent HK. Eccentric and Concentric Resistance Exercise Comparison for Knee Osteoarthritis. Med Sci Sports Exerc. 2019 Oct;51(10):1977-1986. doi: 10.1249/MSS.0000000000002010. PMID: 31033900; PMCID: PMC6746593.

10Bartels EM, Juhl CB, Christensen R, Hagen KB, Danneskiold-Samsøe B, Dagfinrud H, Lund H. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016 Mar 23;3(3):CD005523. doi: 10.1002/14651858.CD005523.pub3. PMID: 27007113; PMCID: PMC9942938.

11Yvonne M. Golightly , Kelli D. Allen & Dennis J. Caine (2012) A Comprehensive Review of the Effectiveness of Different Exercise Programs for Patients with Osteoarthritis, The Physician and Sportsmedicine, 40:4, 52-65, DOI: 10.3810/psm.2012.11.1988

12van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care. 2020 Dec;18(4):575-595. doi: 10.1002/msc.1492. Epub 2020 Jul 9. PMID: 32643252.

13Lucie Brosseau, Lucie Pelland, George Wells, Lynn Macleay, Catherine Lamothe, Guillaume Michaud, Judith Lambert, Vivian Robinson & Peter Tugwell (2004) Efficacy of Aerobic Exercises For Osteoarthritis (part II): A Meta-analysis, Physical Therapy Reviews, 9:3, 125-145, DOI: 10.1179/108331904225005061

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