Rethinking Osteoarthritis
If you've ever been told you have "wear and tear" or "bone on bone arthritis," you're certainly not alone.
Osteoarthritis is the most common form of arthritis, affecting around 10 million people across the UK. It commonly affects the knees, hips, hands and shoulders and is one of the leading causes of pain and reduced mobility as we get older.
For decades, osteoarthritis was thought to be an inevitable consequence of ageing—a condition where years of use gradually wore away the cartilage until the joint simply stopped working properly.
Fortunately, our understanding has changed dramatically.
Modern research shows that osteoarthritis is far more complex than simple wear and tear, and perhaps most importantly, there is far more we can do about it than people once believed.
What Is Osteoarthritis?
A healthy joint is far more sophisticated than two bones rubbing together.
The ends of our bones are covered by a smooth layer of cartilage that allows movement with remarkably little friction. Surrounding the joint is a capsule filled with synovial fluid, which lubricates and nourishes the cartilage, while muscles, ligaments and tendons provide stability and absorb forces during movement.
Together, these tissues create an incredibly resilient system capable of tolerating thousands of movements every day.
Osteoarthritis develops when this system gradually changes over time.
Rather than affecting cartilage alone, osteoarthritis involves the entire joint. Cartilage may become thinner, the underlying bone can remodel, the joint lining may become irritated and the surrounding muscles often become weaker.
Importantly, this doesn't mean the joint has "failed."
Like wrinkles appearing on our skin or grey hair developing with age, many changes seen on joint scans are simply part of the ageing process.
Why "Wear and Tear" Isn't the Whole Story
One of the biggest myths surrounding osteoarthritis is that using your joints simply wears them out.
If this were true, exercise would make arthritis worse.
Instead, research consistently shows the opposite.
Unlike the tyres on a car, your joints are living tissues. They continually repair, remodel and adapt to the demands placed upon them.
A helpful analogy is to think of your joints as a garden rather than a machine.
A garden flourishes when it's looked after properly. Too little use and it becomes neglected. Too much stress without recovery can also cause problems. However, with the right balance of movement, strength and care, it continues to thrive.
Our joints behave in much the same way.
This is one reason why physiotherapy focuses on improving joint capacity rather than simply protecting joints from movement.
Why Do Some People Have Severe Arthritis But Very Little Pain?
Perhaps the most surprising discovery in osteoarthritis research is that pain and X-rays don't always match.
Many people have severe arthritic changes visible on an X-ray while remaining active with very little pain. Others experience significant pain despite only mild changes appearing on their scans.
So why is this?
The answer is that cartilage itself contains no nerve endings.
Pain is influenced by several other tissues around the joint, including bone, muscles, ligaments and the joint lining. It is also affected by factors such as sleep, stress, fatigue, confidence, previous experiences and how sensitive our nervous system has become.
An X-ray provides valuable information, but it is only one piece of the puzzle.
It tells us what the joint looks like—not necessarily how well it functions.
Movement Really Is Medicine
For many years, people with arthritis were encouraged to rest.
Today, organisations including NICE, Versus Arthritis and the Osteoarthritis Research Society International all recommend education and exercise as the first-line treatment for osteoarthritis.
Movement benefits your joints in several ways.
Firstly, cartilage relies on movement to receive nutrients. Like a sponge being gently squeezed, movement helps circulate synovial fluid through the cartilage, delivering nutrients and removing waste products.
Secondly, stronger muscles reduce the forces placed directly through the joint. They act as the body's natural shock absorbers, improving stability and making everyday activities easier.
Finally, regular exercise improves confidence, balance, cardiovascular health and overall wellbeing—all of which contribute to better long-term outcomes.
Walking, swimming, cycling, resistance training and strength exercises have all been shown to reduce pain and improve function.
The best exercise isn't necessarily the hardest.
It's the one you enjoy enough to keep doing.
Living Well With Osteoarthritis
Although there is currently no cure for osteoarthritis, there is a great deal you can do to manage it successfully.
Some of the most effective strategies include:
Staying physically active.
Building strength around affected joints.
Maintaining a healthy body weight.
Managing flare-ups without stopping all activity.
Prioritising sleep and general health.
Seeking early advice rather than waiting until pain becomes severe.
Perhaps the most important message is that arthritis doesn't mean the end of an active lifestyle.
Many people continue walking, running, cycling, hiking and playing sport for decades after being diagnosed with osteoarthritis.
With the right advice and rehabilitation programme, there's every reason to believe you can too.
How Physiotherapy Can Help
At Centre of Gravity Physiotherapy, we understand that every person's arthritis is different.
Rather than focusing solely on an X-ray, we assess your movement, strength, lifestyle and goals to create a personalised treatment plan designed to reduce pain, improve function and help you return to the activities you enjoy.
Treatment may include:
Individualised exercise programmes
Strength and mobility training
Education about pain and arthritis
Activity modification
Manual therapy where appropriate
Long-term self-management strategies
Our goal isn't simply to reduce pain—it's to help you build stronger, more resilient joints for the future.
Ready to Take Control of Your Joint Health?
If joint pain is stopping you from doing the things you enjoy, we're here to help.
Book an appointment with Centre of Gravity Physiotherapy and discover how evidence-based physiotherapy can help you move with confidence again.
📍 Farnborough, Hampshire
Written By
Harry Liniker BSc MSc MCSP
Lead Physiotherapist and Founder, COG Physiotherapy Farnborough
