• Elana Gordon, PT, DPT, OCS

What is osteoarthritis (OA)?



OA is a dynamic process characterized by an imbalance between tissue break down and tissue repair. It is more complex than simply “wear and tear”.

Pain is the main symptom of OA and drives individual health care decisions. Pain comes from multiple sources:

  1. Inflammation can be a direct cause of pain

  2. With persistent pain, changes in the nervous system create increased awareness of pain and an abnormal response to painful and/or non-painful stimuli

What causes osteoarthritis (OA)?

OA has some risk factors that we are unable to change, and others that we are able to modify and control. It is important to focus your attention on the things you can change!

Do I need an x-ray before receiving treatment?

Diagnosis of OA can be achieved with clinical exam and is accurate without having X-rays taken. In fact, it is often common to find OA on X-ray images that is not symptomatic. It is more important to focus on the person than pictures taken of them!


Is surgery necessary?

Many people can see quite a bit of functional improvement with conservative interventions and may be able to move forward without pursuing surgery. Joint replacement surgery is considered for those with end-stage osteoarthritis. Conservative interventions (like exercise!) are attempted for at least 6 months first. The main indication for surgery is greatly reduced quality of life – These individuals may experience:

  • Disrupted sleep patterns

  • Severe reduction in walking distance

  • Inability to complete daily activities

What can I do to manage my pain from OA?

The most important thing you can do to manage your OA is EXERCISE! Exercise is as beneficial as NSAID medication and better than other medications at reducing pain from knee OA – without the negative side effects.

  • Aerobic, resistance, neuromuscular control, and performance-based exercise have all shown equally strong ability to improve pain and impairments for those with OA. Through an examination, physical therapists identify certain factors that guide which of these exercise types will produce the best outcome.

  • Aquatic therapy is also a good option for those who cannot tolerate full weight bearing.

If exercise is painful, do not worry! It is normal to experience some soreness during exercise. Keep pain to a manageable level (what you would consider mild or moderate pain; do not push to the point where pain is severe or sharp). Make sure that pain after exercise returns to baseline within 24 hours; That will give you an indication that you are not pushing your joints too hard.


When I first stand up my knees/hips really hurt but I loosen up as I move around. Why is that?

In a healthy joint, both joint surfaces are covered in smooth, shiny cartilage. That cartilage produces the lubrication that exists within your joint. If you have OA, you have less of that shiny, smooth cartilage to create lubrication. On the bright side, you still have some of that cartilage, you just have to help it to spread lubrication throughout the joint so you can move around more comfortably. Picture a piece of toast. You plop some jam onto your toast and then proceed to spread it around so that every bit of the bread is covered. The same goes for your joints! When you first stand up, you feel stiff and achy. The best thing you can do in that moment is move around. Spread that jam!


Action steps:

  1. A goal of 6,000 steps per day can protect against functional impairments and help you meet a weekly goal of 150 minutes of activity. Other aerobic activity like biking or walking with ski poles may be appropriate if walking is painful.

  2. If you believe you may have OA, a PT can further evaluate you and personalize a rehabilitation program!

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