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Osteoarthritis: Understanding Your Joints and Treatment Options
Osteoarthritis (OA) is one of the most common causes of joint pain and stiffness, but there is a lot more to it than simply “wear and tear.” Whether you are experiencing knee pain when walking, stiffness in your hips, or discomfort in your hands, understanding what is happening inside your joints can help you make informed decisions about your treatment and stay active doing the things you enjoy.
Let’s break down what osteoarthritis is, what contributes to its development, and the treatment options available to help manage your symptoms.
What is osteoarthritis?
Osteoarthritis is a condition that affects the entire joint, not just the cartilage. It develops when the tissues within a joint change and the body can no longer repair and maintain them as effectively as needed.
To understand this, it helps to know a little about joint anatomy.
At the ends of the bones in a healthy joint is a smooth layer of articular cartilage. This cartilage helps the joint move smoothly and distributes forces as we walk, run, lift, and move throughout the day. The joint also includes the underlying bone, joint lining (synovium), ligaments, and surrounding muscles, all of which contribute to joint health and function.
With osteoarthritis, the cartilage can gradually become thinner and less effective at absorbing and distributing loads. The underlying bone may change, bone spurs can develop, and the joint lining may become inflamed. These changes can contribute to pain, stiffness, swelling, and reduced movement.
One important thing to understand is that the amount of change seen on an X-ray does not always match the amount of pain someone experiences. Some people have significant changes on imaging with very few symptoms, while others experience considerable pain with more subtle changes.
Osteoarthritis is a complex condition influenced by several factors, and having it does not mean your joints are destined to stop working or an indication that you will be in pain forever.
What causes osteoarthritis?
There is no single cause of osteoarthritis. It typically develops through a combination of factors that affect the health of our joints over time.
Some of the common risk factors include:
Age: 50+, The risk of developing osteoarthritis increases as we get older, partly because the body's ability to maintain and repair joint tissues changes over time.
Previous injuries: Injuries such as ACL tears, meniscus injuries, fractures, or other significant joint injuries can increase the risk of developing osteoarthritis in that joint later in life.
Genetics: Family history can influence your likelihood of developing osteoarthritis. If you father, mother, or siblings have significant osteoarthritis you are more at risk.
Body weight: Higher body weight can increase the mechanical load on weight-bearing joints, such as the knees and hips. Metabolic factors associated with excess body fat may also play a role.
Repetitive loading: Certain occupational or sporting activities involving repeated high joint loads may contribute to risk, particularly when combined with other factors. For example, we see a higher rate of knee osteoarthritis in construction works and mechanics, people on their feet and knees for large portions of the day.
Joint structure and biomechanics: Differences in joint shape, alignment, or the way forces are distributed through a joint can influence how it responds to loading over time.
It is important to remember that having one or more of these risk factors does not mean you will develop osteoarthritis. Equally, people who are active, maintain a healthy weight, and have no history of injury can still develop it.
The goal is not to avoid using your joints. In fact, appropriate movement and exercise are important for maintaining joint health and managing symptoms. It's all about balance!
Where is osteoarthritis most common?
Osteoarthritis can affect almost any joint, but we commonly see it in the following areas:
Knees: Knee osteoarthritis can cause pain with walking, climbing stairs, squatting, or getting up from a chair. Stiffness after sitting for a while is also common feedback.
Hips: Hip osteoarthritis often causes pain around the groin, buttock, or upper thigh, with stiffness or difficulty putting on shoes and socks, getting into a car, or walking longer distances.
Hands: Osteoarthritis can affect the small joints of the fingers and the base of the thumb, causing pain, stiffness, swelling, or changes in joint shape.
Spine: Osteoarthritis can affect the joints in the neck and lower back, sometimes contributing to stiffness and discomfort with certain movements.
Symptoms can vary from person to person. Some people notice discomfort mainly after activity, while others experience stiffness after rest or more persistent pain as the condition progresses.
If you are experiencing ongoing joint pain or changes in your ability to move, a healthcare professional can help determine what may be contributing to your symptoms and which treatment options are appropriate.
How is osteoarthritis treated?
There is currently no cure that reverses the underlying joint changes associated with osteoarthritis. However, there are effective ways to reduce pain, improve mobility, and help you continue doing the activities that matter to you.
At our clinic, we believe understanding your condition and having a plan that suits your goals are important parts of managing osteoarthritis.
This pyramid from GLA:D Canada helps to show a simple approach to osteoarthritis management. The key message is that education, exercise, and weight management when appropriate form the foundation of treatment. Other options can be added when needed, and surgery is considered for a smaller group of people with severe symptoms.
1. The foundation: Education, exercise, and weight management: These are the first-line treatments recommended for people with osteoarthritis.
Education and self-management
Understanding osteoarthritis can help you feel more confident about moving and managing your symptoms. Many people worry that exercise or everyday activities will cause further damage to their joints. While activities may need to be modified when symptoms flare up, movement is not something that should automatically be avoided.
Learning how to manage symptoms, pacing activities, and gradually build your tolerance can make a real difference.
Therapeutic exercise and physical activity
Exercise is one of the most effective treatments for osteoarthritis. A tailored program may include strengthening exercises, balance and movement-control training, mobility work, and aerobic activity.
Stronger muscles help support joint function, while regular physical activity can improve mobility, general health, and your ability to complete everyday tasks.
Exercise should be adjusted to your current abilities and progressed over time. You do not need to be completely pain-free before getting started, but your program should account for your symptoms and recovery.
Weight management, when appropriate
For people living with osteoarthritis who carry excess body weight, weight management may help reduce the load on the knees and hips and improve symptoms. It can be one part of a broader treatment plan, alongside exercise and other self-management strategies.
The aim is to support your overall health and function, not to suggest that body weight is the sole cause of osteoarthritis
2. Additional treatment options: Managing ongoing symptoms: If education, exercise, and weight management are not providing enough relief, other treatments may be considered alongside them.
These can include:
Medication: Certain topical or oral medications may help manage pain. The most appropriate option depends on your health, other medications, and potential side effects, so discuss this with your physician or pharmacist. Typical medications are diclofenac (voltaren), slow release acetominophen (tylenol arthritis), and anti-inflammatories like naproxen or ibuprofen (advil).
Assistive devices: Walking aids, braces, or shoe inserts may help some people reduce discomfort or improve function, depending on the joint involved and their individual needs.
Other pain-management approaches: Some people may benefit from selected hands-on treatments, heat or cold, or other strategies to help manage symptoms and support participation in exercise.
Injections: In some cases, a physician may discuss injections, such as corticosteroids, depending on the joint, symptoms, and individual circumstances.
These options can be helpful for some people, but they generally work best in conjunction with first line treatment, like weight management and exercise.
3. Surgery: When symptoms are severe: For a smaller group of people, osteoarthritis can cause persistent pain and significant limitations despite appropriate non-surgical treatment.
When symptoms substantially affect quality of life, a referral to an orthopedic surgeon may be appropriate to discuss surgical options. For severe hip or knee osteoarthritis, this may include joint replacement.
Surgery is not the first step for most people with osteoarthritis. The decision depends on your symptoms, function, goals, overall health, and response to other treatments.
The takeaway
A diagnosis of osteoarthritis does not mean you have to stop being active or give up the activities you enjoy.
While we cannot reverse all the structural changes that occur within an arthritic joint, we can work on improving strength, movement, confidence, and overall function. The right treatment plan will depend on your symptoms, goals, and the demands of your daily life.
If you are experiencing joint pain or stiffness, a physiotherapist can help you understand what may be contributing to your symptoms and develop a plan to help you move with greater confidence.
The goal is not simply to manage your joints. It is to help you keep moving and enjoying the activities you love.
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