Knee arthritis: the part you can change
A worn knee is not a broken one. Here is a test that measures what the leg can do, and the one thing that reliably takes load off the joint.
Get the one-page sheetThe scan is not the whole story
You will have heard that scans and pain do not match up. That is half true and it is worth getting right.
Compare one person to another and it holds. Plenty of people walk around with wear on a scan and no pain at all. Compare your own two knees, though, and the picture does track the symptoms fairly closely. So a scan describes the joint. It does not describe the pain, and on its own it will not change the first thing we would do.
What is going on inside the joint
Osteoarthritis affects the whole joint, not only the cartilage surface. Cartilage thins, the bone underneath thickens, and the lining of the joint becomes irritated. Small bony spurs form at the edges and the capsule stiffens.
None of that is a reason to stop using the leg. Cartilage has no nerve supply, so the wear itself is not what hurts. The pain comes from the lining, the capsule and the bone underneath.
Things worth unlearning
Wear and tear. A knee is not a brake pad. The framing predicts that using it makes it worse, which is the opposite of what happens.
Running ruins your knees. Recreational runners have less knee and hip arthritis than people who do not run, not more.
Bone on bone, so nothing can be done. That phrase describes a gap on an X-ray. Among people already on the list for a knee replacement, most of those given a proper non-surgical programme instead had still not had one a year later.
What to expect, and when
The number on its own means less than what it does over eight weeks. This is a capacity problem, and capacity is trainable at any age. The sit to stand test in the guide is not a measure of how damaged the joint is. Someone going from nine to fourteen has changed something real about how that leg works, whatever an X-ray says about it.
The first fortnight may feel worse. That is expected. People who are not warned take it as proof they were right to stop, and stop.
Four to six weeks is the earliest most people notice stairs, getting out of a chair and walking distance changing. Eight to twelve weeks is where the published programmes measure their results. About half the people who finish one get a pain reduction big enough to matter. That means about half do not, and you should hear that from us.
Flares are not damage. Drop to half your usual distance for a few days rather than stopping. The hardest part of a flare is starting again.
Try this first
- Do the sit to stand test today and write the number and the date down
- Walk the distance you can manage without a flare the next day, then add a tenth
- Build strength twice a week, and keep it up past the point it stops hurting
- Expect the first fortnight to feel slightly worse, and keep going anyway
Get it looked at if
- A hot, red, very swollen knee with fever or feeling unwell, which needs seeing the same day
- A knee that becomes hot and swollen within days of an injection or surgery
- Calf pain, swelling or warmth, particularly after surgery or long travel
- Morning stiffness well over thirty minutes, or several joints involved
- A knee that locks solid, gives way repeatedly, or will not take weight after a fall
What we would do
We test the leg rather than looking at it, so we are comparing sides with numbers instead of impressions. Then the programme is built around what we find and retested, so you can see whether it is working rather than being told it is.
Want this as a one-page sheet?
The version we hand out in clinic. Print it, stick it on the fridge, work through it.
Related: Knee osteoarthritis treatment · All patient guides · Our blog
This guide is general information about a common problem, not a diagnosis of yours. If something is not settling, or it does not match what is written here, come and get it looked at.