When people hear the word osteoarthritis (OA), it can often come with a sense of dread. Many imagine joints that are completely breaking down, constant pain, and a future where movement is no longer possible. But what if that fear is based more on myth than fact?
Osteoarthritis is a condition that involves the gradual degeneration of joints. We now know that osteoarthritis isn’t just about cartilage wearing out — it’s a complex condition that affects the whole joint. That means the bones, cartilage, ligaments, and even the muscles around the joint can all be involved. That word — “degeneration” — tends to sound scary, but it’s not as ominous as it seems. In reality, degeneration is a normal part of the ageing process. Just as our skin develops wrinkles over time, our joint structures change as well. These are, quite literally, wrinkles on the inside — a natural shift in structure that doesn’t necessarily mean something is wrong.
One of the biggest misconceptions about OA is the relationship between joint changes and pain. While OA does involve structural changes in the joints, these changes aren’t always painful. In fact, many people with visible signs of OA on scans or X-rays experience no pain at all. Pain is far more complex than simply a reflection of what’s happening structurally. It’s influenced by a mix of physical, emotional, psychological, and social factors. Stress, poor sleep, low mood, and life pressures can all heighten our perception of pain and reduce our ability to adapt to changes. That’s why when we address pain in OA, we need to look beyond the joint itself — to understand what else might be turning up the volume on discomfort.
Another phrase that often causes worry is “bone on bone.” It’s a term that’s been thrown around a lot and sounds dramatic. But the truth is, it rarely tells the whole story. Being told you have “bone on bone” changes can make you feel fragile and fearful of movement — but in many cases, the pain you feel is more about a sensitised joint rather than severe structural damage. The body isn’t as delicate as that phrase makes it seem. This ties in with the common idea that OA is a result of “wear and tear” — the belief that loading or using our joints through activity or exercise will eventually break them down. This concept is outdated. Movement isn’t dangerous for joints; it’s essential. Our bodies are designed for motion, and joints respond positively to healthy, normal loads. Rather than thinking of it as “wear and tear,” a better way to understand it is as “wear and repair.” With appropriate movement and loading, our joints adapt, strengthen, and stay healthy. This is especially true with exercise, which can actually stimulate beneficial changes in the joint environment.
For many people diagnosed with OA, there’s a fear that they’re now “permanently benched” — no longer able to participate in sport, exercise, or even regular physical activity. But the science tells a different story. Exercise is not only safe for people with OA, it’s one of the most effective tools we have for managing symptoms. It doesn’t speed up joint degeneration, and in fact, it can reduce pain, improve mood, and enhance overall function. Living with OA doesn’t have to mean giving up on movement or resigning yourself to a future of pain. Your body is strong, resilient, and adaptable — and that includes your joints.
When it comes to managing OA, the first and most important step should always be about you — your goals, your lifestyle, and what matters to you most. That’s why first-line care is all about patient-centred approaches like exercise, education, and, if it’s relevant, support with weight management. These simple but powerful tools can make a real difference — helping to reduce pain, improve how you move, and boost your quality of life overall.
What about surgery? It’s usually something to consider further down the track — only if other strategies haven’t had enough of a positive impact on your quality of life or ability to do your normal daily activities. And even then, it’s not a guaranteed next step or something everyone will need.
So, what’s the bottom line? It’s time to let go of the old idea that osteoarthritis is just a slow, inevitable decline. The truth is, OA is a complex condition influenced by many factors — and that’s actually good news. Why? Because it means there are lots of different ways to manage it.
When we shift our understanding of OA, we open up new and more effective options for care — ones that can truly improve how you feel and how you move. With the right knowledge and support, you don’t just have to “put up with it” — you can stay active, live well, and even thrive.
References:
Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019 Oct;53(20):1268-1278. doi: 10.1136/bjsports-2018-099257. Epub 2018 Jun 9. PMID: 29886437; PMCID: PMC6837253.
Lo GH, Musa SM, Driban JB, Kriska AM, McAlindon TE, Souza RB, Petersen NJ, Storti KL, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, Suarez-Almazor ME. Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin Rheumatol. 2018 Sep;37(9):2497-2504. doi: 10.1007/s10067-018-4121-3. Epub 2018 May 4. PMID: 29728929; PMCID: PMC6095814.
Tang S, Zhang C, Oo WM, Fu K, Risberg MA, Bierma-Zeinstra SM, Neogi T, Atukorala I, Malfait AM, Ding C, Hunter DJ. Osteoarthritis. Nat Rev Dis Primers. 2025 Feb 13;11(1):10. doi: 10.1038/s41572-025-00594-6. PMID: 39948092.
Conley B, Bunzli S, Bullen J, O’Brien P, Persaud J, Gunatillake T, Dowsey MM, Choong PFM, Lin I. Core Recommendations for Osteoarthritis Care: A Systematic Review of Clinical Practice Guidelines. Arthritis Care Res (Hoboken). 2023 Sep;75(9):1897-1907. doi: 10.1002/acr.25101. Epub 2023 Mar 17. PMID: 36762545; PMCID: PMC10952362.
Leave a Reply