Them bones, them bones...

FAQ: My doctor told me my knees are ‘bone on bone’, now what do I do?

The knee is one of the most common joints for people to experience pain in. It’s also one of the most common joints where someone will be diagnosed with osteoarthritis. Whilst it’s a description that isn’t particularly accurate or helpful, the ‘bone on bone’ conversation is a common one that medical professionals have with their patients.

There are a couple reasons why this description is unhelpful. Firstly, it carries with it the connotation that the person’s knees are ‘stuffed’, ‘shot’, ‘buggered’ or whatever other verb you want to use. The reality is, though, that the knee is not just like a part of a car that can simply be swapped out for a newer part. Knee ‘replacement’ surgery is not quite the best term for that operation, but that is generally what the masses consider it to be. If it were as simple as just swapping old parts for new, then this procedure would generally be a whole lot more successful, with the sum of most evidence suggesting that as many as a third of those who have this surgery still having ongoing problems.

The second problem with being told your knees are ‘bone on bone’ is that this is usually given as the sum total explanation for someone’s pain. This generally though doesn’t fit with the natural history of how osteoarthritis develops, the way most knee pain of this nature transpires and the prevalence of these changes in the population. Joint changes happen slowly over time, largely as a process of joint inflammation that has occurred during various stages of the persons life. Knee pain, however, tends not to coincide with this slow progressive change to the joint and can happen at any time, often without incident of injury and usually without the insight of the person in pain and are far more closely correlated with changes in a person’s overall function. What’s more, joint changes observable on imaging are widespread amongst the pain-free population, meaning that it’s very possible to have a person with pain and a person without pain both having a similar looking joint. Joint changes are a lot more like ‘wrinkles’ on the inside, signs of knees that have done what they’ve needed to do over a persons life.

The worst thing about this advice, though, is that typically hope of relief and the ability to have a life without impairment is squashed. The reality is, and the bulk of the scientific evidence suggests, that the best treatment for someone with knee pain is rehabilitation. Increased muscle mass and function improves pain and reduces disability profoundly, as well as improving joint health, but it wont happen by accident or by simply walking the dog or even putting all your hopes in hydrotherapy. Genuine rehabilitation needs specialist programming that actually causes your muscles to change. And, for the pessimists, even if rehabilitation provides only partial improvements and surgery is still elected, the odds of a positive surgical outcome are significantly improved – it’s a win-win scenario. So if you’ve got knee pain, are suspicious of or have been told that you’re knees might not be as youthful as you’d like them to be, movement is the most trustworthy medicine you can take.