Understanding Osteoarthritis – More Than Just “Wear and Tear”

August 11, 2025

Understanding Osteoarthritis – More Than Just “Wear and Tear”

What is Osteoarthritis?

Osteoarthritis (OA) is the most common form of arthritis worldwide. It is a chronic, degenerative condition that primarily affects older adults and is characterized by the breakdown of cartilage and changes in the underlying bone. These changes can lead to joint pain, stiffness, and reduced function. However, OA varies greatly in its clinical presentation—it can range from an incidental, symptom-free finding on an X-ray to a severely disabling disease.

…movement is medicine for osteoarthritis…

Types of Osteoarthritis

Primary OA: This is the most common form of the condition and occurs without an obvious underlying cause. It is often linked to risk factors such as increasing age, female gender, obesity, biomechanical stress, and muscle weakness.
Secondary OA: This type develops as a result of a preexisting joint abnormality. Causes include previous injury or surgery, as well as other medical conditions such as inflammatory arthritis.

In healthy joints, smooth cartilage covers the ends of bones, allowing them to glide over one another with ease. In osteoarthritis, this cartilage gradually wears down. As the protective layer erodes, bones may begin to rub against each other, causing pain, stiffness, and sometimes the formation of bony outgrowths called osteophytes (bone spurs).

Symptomatic vs Asymptomatic Osteoarthritis

Many people show signs of osteoarthritis on X-rays, such as joint space narrowing and osteophytes, without having any symptoms. This is known as radiographic osteoarthritis, and it’s at least twice as common as symptomatic osteoarthritis, which involves pain, stiffness, or reduced joint function. This distinction is important: seeing changes on an X-ray doesn’t necessarily mean someone is in pain or needs surgery. In fact, many people with structural changes live active lives without discomfort. Imaging alone cannot predict how a joint feels or functions.

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More Than Just “Wear and Tear”

You’ve probably heard osteoarthritis described as “wear and tear” or been told a joint is “bone-on-bone.” While these phrases are commonly used, they can be misleading and even harmful. They often create fear and the impression that the joint is irreparably damaged, leading people to avoid physical activity out of concern that movement will make things worse.

But here’s the truth: movement is medicine for osteoarthritis. Avoiding activity often leads to more stiffness, muscle weakness and poorer outcomes. Understanding that osteoarthritis is not simply a result of “wearing out” but a complex, manageable condition can empower people to stay active and engage in effective treatment strategies—especially physiotherapy and therapeutic exercise.

While it’s tempting to rest, avoiding movement can actually lead to more stiffness and weakness over time. Both the Osteoarthritis Research Society International (OARSI) and the American College of Rheumatology (ACR) recommend exercise as a first-line treatment for managing knee and hip osteoarthritis.

Regular safe movement and targeted exercises can help with the following:

Reducing pain, stiffness and inflammation
Lubricating your joints by improving flow of synovial fluid
Strengthening the muscles around the joint
Improving joint movement and function
Boost confidence and independence in functional activities
Delay or avoid the need for joint replacement surgery

Preparing for Joint Replacement Surgery: The Importance of Prehabilitation

While many individuals with knee or hip osteoarthritis manage their symptoms effectively through physiotherapist-prescribed exercise, there may come a time when conservative treatment is no longer sufficient, and joint replacement surgery becomes the appropriate next step.

In such cases, prehabilitation—a targeted physiotherapy program delivered in the weeks leading up to surgery—can play a critical role in improving outcomes. Research shows that prehabilitation enhances postoperative function, reduces pain, shortens hospital stays, and helps patients regain mobility more quickly. By focusing on strengthening, mobility, balance, and education, prehabilitation helps patients enter surgery in the best possible condition—both physically and mentally—leading to faster, safer, and more effective recovery.

Here at Potgieter & Partners Physiotherapists, we treat knee and hip osteoarthritis with personalised exercise programs tailored to your needs, activity level and lifestyle. We work closely with orthopaedic surgeons and have years of experience helping patients reduce pain and improve mobility pre- and post-operatively.

References

Bannuru, R. R., et al. (2019). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578–1589. https://doi.org/10.1016/j.joca.2019.06.011
Kolasinski, S. L., et al. (2020). 2020 American College of Rheumatology guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 72(2), 149–162. https://doi.org/10.1002/acr.24131

Chen, X., et al. (2022). Effectiveness of prehabilitation for patients undergoing total knee arthroplasty: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 17(1), 135. https://doi.org/10.1186/s13018-022-02933-4
Wang, L., et al. (2014). The effect of preoperative exercise on outcomes of total knee arthroplasty: A systematic review and meta-analysis. Clinical Orthopaedics and Related Research, 472(1), 134–144. https://doi.org/10.1007/s11999-013-3030-4
Gill, S. D., & McBurney, H. (2013). Does preoperative physiotherapy improve outcomes in primary total knee arthroplasty? A systematic review. Physiotherapy Research International, 18(2), 87–94. https://doi.org/10.1002/pri.1532

For More Help:

For more information and help, please contact Janika at the Wellington Branch.

Janika

Physiotherapist & Practice Owner