Osteoarthritis
Why exercise is the first-line treatment for osteoarthritis, and what the term "wear and tear" gets wrong.
Last revised
The most common form of joint disease, involving changes to cartilage, bone and surrounding tissue that produce pain and stiffness. It is not simply mechanical wear, and it is not an inevitable consequence of age.
Not just wear and tear
The old framing of osteoarthritis as joints wearing out is misleading and discourages the treatment that works best. It is an active process involving cartilage breakdown, bone remodelling and low-grade inflammation, and the joint attempts repair throughout. This matters practically: people told their joints are worn out reasonably conclude they should use them less, which is the opposite of the advice.
Exercise is the first-line treatment
NICE recommends therapeutic exercise as a core treatment for everyone with osteoarthritis, including both muscle strengthening and aerobic activity. The evidence is consistent for pain reduction and improved function, and the effect is comparable to that of common analgesics. It is normal for exercise to cause some discomfort initially; that is not a sign of damage.
Weight and other measures
For osteoarthritis of the knee or hip, weight loss in people carrying excess weight produces meaningful symptom improvement. Other supported measures include walking aids where appropriate, suitable footwear, and heat or cold locally. Topical NSAIDs are preferred over oral where the joint is accessible, such as knees and hands, because systemic exposure is lower.
X-rays are often unhelpful
The correlation between what an X-ray shows and how much pain someone has is poor: substantial radiographic change is common in people with no symptoms, and significant pain occurs with minimal change. Diagnosis in adults over 45 with typical activity-related pain and no morning stiffness beyond thirty minutes can usually be made clinically without imaging.
At a glance
| Term | Detail |
|---|---|
| First-line treatment | therapeutic exercise, both strengthening and aerobic |
| Clinical diagnosis possible | over 45, activity-related pain, morning stiffness under 30 minutes |
| Preferred analgesia for knees and hands | topical NSAIDs before oral |
| Weight loss | meaningfully improves knee and hip symptoms where weight is excess |
| Correlation between X-ray change and pain | poor |
| Expected during early exercise | some discomfort; it does not indicate damage |
When to get help
See a GP if a joint is hot, red and swollen, particularly with fever — a joint infection is an emergency. Also seek assessment for morning stiffness lasting more than thirty minutes, joint swelling in multiple joints, or symptoms starting before 45, which may indicate inflammatory arthritis rather than osteoarthritis and needs different treatment. Sudden inability to weight-bear after an injury needs urgent assessment.
Where to go next
Where this comes from
- NICE - Osteoarthritis in over 16s: diagnosis and management
- NHS - Osteoarthritis
- Versus Arthritis - exercise and osteoarthritis
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
