Osteoarthritis: What It Means and How to Stay Active

Almost everyone develops some osteoarthritis if they live long enough.

Arthritis is commonly referred to as ‘wear and tear ‘and that term might lead you to believe a joint is wearing out like a tyre and that the damage is permanent. It would imply that the sensible thing to do would be to rest and use the joint less. Today this is not quite the correct approach and also not always an advisable course of action. I see reaction in patients who think their knee or hip is now rubbing literally “bone on bone” and  feel that physical activity should be avoided but I tell them that staying active is one of the most useful things they can do.

Plenty of peoples X-ray shows degenerative changes but they might feel very little pain, while others have sore, stiff joints and quite clear and minimal degenerative changes on their X-ray images. This demonstrates that what you might see on a scan or X-ray is a not an accurate measure of how a joint actually feels.

This page explains what osteoarthritis is, why the “wear and tear” terminology is misleading and how careful, hands-on chiropractic care can fits alongside an exercise regime that should always come first as a priority.

“Leslie an extremely friendly, professional and knowledgeable chiropractor”

“I have had joint problems due to hyper mobility and arthritis my whole life…It worsened last year and wanting to avoid further hospital treatment and steroid injections, a trip to Leslie was recommended to me. Not only is Leslie an extremely friendly, professional and knowledgeable chiropractor …I have learnt more from him over the last six months than I have in my life of dealing with joint issues and I won’t hesitate to go straight back to him in future. I highly recommend his services”

Katy W

What is Osteoarthritis?

Osteoarthritis is a change that affects the whole joint, not just the cartilage. It can present in a single joint of the body, an area of the body or it can have an affect throughout the whole body.

It happens because the smooth surfaces that lets bones glide may become thiner and roughened over time, the underlying bone remodels, small bony spurs can form at the edges and the surrounding tissues then become involved. It is best to think of it as a joint working a little differently rather than a joint that is broken.

It most often affects the knees, hips, hands and spine, however it can affect almost any joint in the body. Chiropractors may be able to diagnose arthritis clinically without a scan and this an accepted UK guideline: for example: NICE guidelines are that someone aged 45 or over, with joint pain related to activity and either no morning stiffness or stiffness that eases within about half an hour.[1]

Imaging is often unnecessary, because the severity of change on an X-ray is only weakly linked to how much pain or difficulty a person has. A systematic review of the evidence concluded that knee X-rays are an imprecise guide to whether pain or disability will be present and should not be relied on in isolation.[4] That is good news for sufferers as it means a “worn” joint is a not necessarily “the end of the line” of options.

What causes Osteoarthritis

Osteoarthritis has no single cause it has several cumulative contributors.

Age is the largest factor but ageing alone does not explain it. Because we all age it does not mean that arthritis is an inevitability. The joints of an active seventy-year-old often behave better than those of a sedentary fifty-year-old.  Family history plays a part and particularly in the hands. A previous significant joint injury, such as a serious knee twist years earlier, raises the risk in that joint of becoming arthritic in the future. Carrying extra body weight increases the load through the knees and hips and also seems to influence osteoarthritis through the body’s inflammatory chemistry therefore not just load bearing mechanics.

One thing is clear though and evidence supports, that ordinary use does not wear joints out. Regular movement helps keep cartilage nourished and the surrounding muscles strong, which is why active people’s joints tend to fare better longterm when activity is maintained rather than protected by rest.

What actually causes osteoarthritis

A whole-joint condition, not simple wear and tear. Some drivers you can change.

Age, usually 45 and over
Fixed		The strongest single association, but ageing alone is not the whole story. Plenty of older joints never become painful.
Carrying extra weight
Modifiable		Pooled odds of knee osteoarthritis onset of 1.98 for people who are overweight and 2.66 for people who are obese. Mechanical load and metabolic effects both play a part.
A previous joint injury
Partly modifiable		Anterior cruciate ligament or meniscal injury raises the odds of knee osteoarthritis four to six fold, whether or not the knee was surgically reconstructed.
Female sex
Fixed		Pooled odds of 1.68 for onset of knee pain and osteoarthritis. Hand and knee osteoarthritis both become more common around the menopause.
Genetics and joint shape
Fixed		Family history, hip dysplasia, femoroacetabular impingement and varus or valgus alignment all shift the odds.
Occupational loading
Modifiable		Years of kneeling, squatting, stair climbing and heavy lifting are associated with a higher risk of knee osteoarthritis.
Muscle weakness
Modifiable		Weak knee extensors tend to precede knee osteoarthritis rather than simply follow it, so strength is a factor you can change.
Metabolic and inflammatory factors
Modifiable		Type 2 diabetes, metabolic syndrome and low grade inflammation are part of the modern picture of who develops osteoarthritis.

Joints are not tyres. Osteoarthritis involves the cartilage, the bone underneath it, the ligaments and the joint lining, and the body attempts to repair it throughout. Normal use does not use a joint up, most people follow a stable course over time, and some improve.

Osteoarthritis: what it actually feels like

The typical pattern, the features that are not typical, and how a diagnosis is made.

The typical pattern

  • Pain that tracks your activity. It comes on with use and settles with rest, and it is often worse at the end of a busy day.
  • Stiffness that clears quickly. First thing in the morning or after sitting, easing within about 30 minutes.
  • Gelling after inactivity. Stiff and awkward for the first few steps out of a chair or the car, then it loosens.
  • Losing a bit of range. Reaching a top shelf, putting socks on, kneeling or turning to reverse gets harder.
  • Grating, creaking or crunching. Crepitus is common, usually painless, and on its own it is not a sign of damage.
  • Occasional mild swelling. A puffy or slightly warm joint after a heavy day that settles again within a day or two.
  • Good spells and bad spells. Symptoms fluctuate and flares come and go. Most people follow a stable course.

Not typical: see your GP first

  • Morning stiffness that lasts longer than 30 minutes, or stiffness in many joints at once
  • A hot, swollen, very painful joint, particularly with fever or feeling generally unwell
  • Symptoms worsening rapidly, or a joint changing shape over weeks rather than years
  • Significant recent trauma, a fall, or a joint that gave way and has not recovered
  • Pain that wakes you every night, unexplained weight loss, or a history of cancer

How osteoarthritis is diagnosed

1. Aged 45 or over
The clinical criteria apply from mid-life onwards.		2. Activity-related joint pain
Pain that is brought on or worsened by using the joint.		3. Stiffness of 30 minutes or less
No morning stiffness, or stiffness that clears within half an hour.

Why you may not need a scan

NICE advises diagnosing osteoarthritis clinically when all three of the above are met, without routine imaging. X-ray change and symptoms often disagree: severe pain alongside a near-normal film is common, and so is a poor-looking film in someone with very little trouble.

[1] National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. 2022. https://www.nice.org.uk/guidance/ng226
[2] National Institute for Health and Care Excellence. Osteoarthritis in over 16s. Quality standard QS87, statement 1: diagnosis. https://www.nice.org.uk/guidance/qs87/chapter/quality-statement-1-diagnosis
[3] Kloppenburg M, Namane M, Cicuttini F. Osteoarthritis. Lancet. 2025;405(10472):71-85. https://doi.org/10.1016/S0140-6736(24)02322-5
[4] Silverwood V, Blagojevic-Bucknall M, Jinks C, et al. Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2015;23(4):507-515. https://doi.org/10.1016/j.joca.2014.11.019
[5] Poulsen E, Goncalves GH, Bricca A, et al. Knee osteoarthritis risk is increased 4-6 fold after knee injury: a systematic review and meta-analysis. Br J Sports Med. 2019;53(23):1454-1463. https://doi.org/10.1136/bjsports-2018-100022
[6] Wang X, Perry TA, Arden N, et al. Occupational risk in knee osteoarthritis: a systematic review and meta-analysis of observational studies. Arthritis Care Res. 2020;72(9):1213-1223. https://doi.org/10.1002/acr.24333

Symptoms of Osteoarthritis

Most people describe the symptoms of arthritis as a deep ache in the joint that is worse after activity and eased by rest. It presents along with stiffness first thing in the morning that loosens within twenty or thirty minutes of getting going. Joints may feel stiff after sitting still, creak or grate when moved and loose a little of their full range of motion.

Symptoms typically come and go, with better spells and flare-ups, rather than steadily worsening over time.

It is important to know how this differs from inflammatory arthritis such as rheumatoid arthritis, where morning stiffness lasts much longer, several joints are often hot and swollen at once and the person may feel generally unwell.

Osteoarthritis of the spine has its own pattern and I cover it separately on the spinal osteoarthritis and spondylosis page. If the pain is more of a nagging muscular or referred ache than a joint one, the cause and the management can be quite different.

Osteoarthritis in specific joints

Osteoarthritis behaves differently depending on the joint it affects. These guides cover each area in detail:

Can Chiropractic treatment help osteoarthritis?

The core foundation of managing osteoarthritis is maintaining movement and is not singularly hands-on treatment by itself: it is exercise, movement and weight management and UK guidance places these first for all age groups regardless of how the joint looks on a scan.[1]

The hands-on chiropractic care I offer for osteoarthritis sits alongside that evidence. In practice I use manual therapy such as joint mobilisation and soft-tissue work on the local muscles to ease stiffness and help a painful joint move more comfortably. Then I spend time showing you how to load and strengthen the joint with specific tailored exercises.

The evidence for exercise is modest but supportive. UK guidance from NICE still recommends it. A large 2024 Cochrane review of exercise for knee osteoarthritis found that exercise probably improves pain and physical function in the short term, though the size of the benefit was of uncertain clinical importance and many of the trials were of limited quality.[2] The picture for hip osteoarthritis is similar, with the latest Cochrane review reporting small improvements in pain and function that may not always be noticeable in daily life.[3]

What this concludes: Treatment is a sensible, individualised plan: keep the joint moving, build the muscle around it, use hands-on chiropractic care to make that easier. Expect gradual gains rather than a quick fix. Every plan is shaped around your particular joint and your goals.

If osteoarthritis is getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

Book a free consultation

Or call for a chat on 01202 937568

Headshot of Leslie Budzynski DC, BCA registered Bournemouth Chiropractor at Bournemouth Chiropractic
A couple walking downhill in the pPurbecks overlooking the Bournemouth Coastline knowing that staying active is the best protocol for osteoarthritis

The core foundation of managing osteoarthritis is maintaining movement. Walking is a perfect exercise to partake in.

Red flags: When to see a doctor first

The great majority of aching, stiffening joints are simply caused by osteoarthritis, which is the most common type of arthritis and typically develops gradually over time. Even though it can cause significant pain and disability, it is generally not associated with more serious underlying conditions.

A few patterns may however point to something that needs a doctor. A single joint that becomes hot, red, swollen and very painful over hours, especially with a fever or feeling unwell, needs same-day medical assessment to rule out infection or a gouty flare-up. New pain and prolonged stiffness across both shoulders or both hips in someone over fifty, particularly with feeling generally unwell, can signal polymyalgia rheumatica and should be checked by your GP. Unexplained weight loss, night pain that wakes you regularly or a history of cancer alongside new joint pain go to a GP. If any of these apply then contact your GP or NHS 111 first.

Your first visit to Bournemouth Chiropractic

Your first appointment begins with a full history and a physical examination of the affected joints and the ones above and below them, checking how they move, where they are tender and how the surrounding muscles are working, so that I can explain what is going on and agree a realistic plan with you. You can read more about what to expect at your first visit before you come in. I also offer a free consultation, a chat, a chance for you to gather information and make an informed decision if chiropractic is a route you would like to take.

Frequently Asked Questions about Osteoarthritis

Chiropractic care can help some people manage the symptoms of osteoarthritis, particularly of the hip and knee, as an adjunct to the exercise and core treatment and UK recommendations that should come first. Hands-on chiropractic treatment may ease stiffness and make movement more comfortable, but it works best combined with a strengthening and exercise programme rather than on its own.

Rest is one of the least helpful responses to a diagnosis of osteoarthritis. Joints are nourished by movement and the muscles that support them weaken quickly when movement is reduced, which tends to make matters worse. Current guidance recommends staying active and exercising the joints as the first-line approach for osteoarthritis, not protecting them from use.

For the great majority of people exercise will not make your pain worse. Appropriate exercise is recommended as first-line care [1] and is more likely to reduce pain and improve function than to cause harm. It is normal to feel a little more sore when starting something new and this settles. If a joint is very inflamed, the type of exercise can be adjusted rather than stopped.

This assumption is not necessarily true, some people with moderate or even severe OA have little pain, while others with relatively mild X-ray changes can have significant pain. NICE specifically notes that imaging findings correlate poorly with OA symptoms.

It can be, with the right approach. Techniques are chosen to suit your joints and your bone health and gentler, lower-force methods are used where appropriate. Please tell me at your first visit if you have been diagnosed with osteoporosis or osteopenia, as this shapes which techniques I use. This is precisely why I take a detailed full medical history before chiropractic treatment begins.

Would you like to find out more about your osteoarthritis?

If a stiff or aching joint is starting to get in the way of what you enjoy, come and talk it through. If you would like to ask questions before committing to anything, I offer a free 15-minute consultation. This is a short, no-obligation chat to talk through what is going on and whether chiropractic might help. It is not an examination or treatment. A first full chiropractic appointment is different: it includes a full history, a physical examination and treatment. Whichever you choose, you will leave knowing more than when you arrived. I see patients from across Bournemouth and you do not need a GP referral.

Call, message or email, whatever's easiest and we'll take it from there.

references

[1] National Institute for Health and Care Excellence. Osteoarthritis in over 16s: assessment and management. NICE guideline NG226, 2022. Available at: nice.org.uk/guidance/ng226

[2] Lawford BJ, Hall M, Hinman RS, et al. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews. 2024;12:CD004376. doi:10.1002/14651858.CD004376.pub4

[3] Hall M, et al. Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews. 2026 update. doi:10.1002/14651858.CD007912.pub3

[4] Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskeletal Disorders. 2008;9:116. doi:10.1186/1471-2474-9-116

Medical Disclaimer: The information on this website is for general informational purposes only and does not constitute medical advice, nor is it a substitute for diagnosis, treatment, or guidance from a qualified healthcare practitioner. If you have any health concern, please consult your GP or another appropriately qualified clinician. Chiropractic treatment isn’t suitable for everyone. Suitability is assessed at your initial consultation, with referral to another healthcare professional made where appropriate. Treatment outcomes vary between individuals, and no guarantee of results is made or implied.

Practitioner: Leslie Budzynski D.C. | Doctor of Chiropractic | GCC registration: 00043 | BCA membership number: 0072

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