So You Have… Hip or Knee Osteoarthritis

Science & Research

Aug 5

Introduction to the “So You Have…” series

This series is designed to provide clear, practical guidance for common musculoskeletal concerns using strategies that are strongly supported by research. The goal is not to replace an individual assessment, but to help you understand what is happening, what tends to help most, and how to make day-to-day decisions with more confidence.

In this post, the focus is knee and hip osteoarthritis (OA), a very common cause of persistent joint pain and stiffness. The encouraging message is that many people can improve pain and function substantially with a structured approach, even if imaging shows arthritic change.

What is OA?

Osteoarthritis (or OA) is a condition that involves the whole joint, not only cartilage. Over time, there can be changes in cartilage, bone shape, the joint lining, and the supporting tissues around the joint. Importantly, OA is not best understood as a simple “wear-and-tear” problem where a joint inevitably deteriorates. Joints are living tissues that adapt to load. Symptoms often reflect how reactive or sensitive the joint system is at a given time, not just what an X-ray looks like.

A key point is that imaging findings and symptoms do not always align. Some people have clear arthritic features on scans with little pain, and others have substantial pain with comparatively modest imaging change. This means pain is influenced by joint tissue sensitivity, inflammation/irritation, muscle capacity, movement confidence, and overall health factors. OA is often manageable: many people build better tolerance for walking, stairs, and sport by improving strength, gradually increasing activity, and learning how to respond to flares.

What are common symptoms?

Knee and hip OA symptoms vary widely, but there are several common patterns. Many people notice pain with load, such as stairs, hills, squatting, rising from a chair, or longer walks. Stiffness is also common, particularly after sitting or on first getting up; it often eases after several minutes of gentle movement. Some people experience swelling or a sense of fullness (more common at the knee), and others describe aching that increases later in the day after higher activity.

Another hallmark is variability. OA symptoms frequently fluctuate—good weeks and more difficult weeks are both typical. A temporary increase in pain may occur after unusual activity, rapid increases in training, disrupted sleep, or prolonged standing. These “flares” can feel discouraging, but they often settle with appropriate management rather than requiring complete rest or suggesting permanent harm. This is one reason management focuses on consistent movement strategies rather than one-time fixes.

What are first-line treatments?

Across major guidelines, first-line care for knee and hip OA consistently emphasizes three foundations: education/self-management, exercise, and weight management when relevant and desired. These approaches are recommended because they address function and symptoms over the long term, and because they are generally low risk.

1) Education and a plan you can repeat
Understanding how OA behaves (including flares) helps people pace activity and reduce the “boom–bust” pattern of overdoing it on good days and crashing afterward. A useful plan sets a realistic baseline for walking and strengthening that you can repeat most days of the week.

2) Exercise: strengthening + general activity
Strengthening (hips, thighs, calves) improves how loads are shared through the joint, while aerobic activity improves overall capacity and often reduces pain. There is no perfect exercise program—consistency and gradual progression matter most.

3) Weight management (if applicable)
If weight loss is a goal that fits your preferences and context, it can meaningfully reduce symptoms—particularly in knee OA—by reducing cumulative joint load.

What are some other treatment options?

Not everyone gets adequate relief with first-line strategies alone. Some people have higher baseline pain, frequent flares, significant sleep disruption, or life constraints that make consistent exercise difficult. In those cases, additional options can be used to reduce symptoms enough to allow progress with activity and rehabilitation.

1) Anti-inflammatory medication (topical or oral)
Topical anti-inflammatories are strongly supported for knee OA in several guidelines and may be a reasonable early option for symptom control. Oral anti-inflammatories can also help, but suitability depends on health history and should be discussed with a physician.

2) Injections
Intra-articular corticosteroid injections can provide short-term relief for some people with knee or hip OA, often as a temporary tool to enable movement and exercise progression. This also should be discussed with your primary care physician.

3) Supports and load modifiers
A cane, walking poles, or a brace (particularly for some knee patterns) can reduce symptoms by modifying load and improving confidence during walking and stairs.

4) Supervised physiotherapy and coaching
Individualized progression, pacing, and graded exposure to meaningful activities (stairs, hiking, running) can be particularly helpful when you feel “stuck” or cautious with movement.

How to deal with flares

Flares are common in OA and are best approached as a period of increased sensitivity rather than an automatic sign of damage. The aim is to reduce irritability while maintaining safe movement, so the joint and surrounding muscles do not become deconditioned.

A key principle - activity modification not completely stopping activity. Reduce one or more of: total volume (steps/sets), intensity (load/speed), range (eg. depth of squats), or impact (swap running for cycling or pool walking). Maintain a baseline you can repeat for several days, then rebuild gradually. Many people do well using a “24-hour check”: mild to moderate symptom increase can be acceptable if it returns near baseline within about a day; if not, the dose was likely too high and should be adjusted.

Flares often settle over days to a couple of weeks when loads are reduced temporarily and then reintroduced in small increments. The long-term goal is a steady, sustainable pattern rather than large peaks and crashes.

Frequently Asked Questions

1) What is the relationship between scans and symptoms?

Imaging can identify features associated with OA (for example, joint space narrowing or osteophytes), but the relationship between scans and pain is often modest. Research shows substantial “discordance”: many people have radiographic OA without pain, and many people with knee pain have limited OA findings on plain X-ray. For this reason, scan results should not be used in isolation to predict your pain severity, your future, or what you can safely do.

Clinically, this means two helpful things. First, if your scan looks “worse than you expected,” it does not automatically imply the joint is fragile or that activity is unsafe. Second, if your scan is relatively mild, your symptoms still deserve care—pain can arise from multiple pain-sensitive tissues and sensitivity changes. A good plan is typically guided by symptoms, goals, and physical examination findings rather than imaging alone.

2) Does exercise or sport cause further damage?

For most people with knee or hip OA, appropriately dosed exercise is recommended and is not considered harmful. High-quality guidelines consistently place exercise and education at the center of OA care because they improve pain and function and support long-term activity.

Problems are more often linked to sudden spikes in load (a rapid increase in walking, hiking, sport, or gym volume) rather than steady training. If sport is important to you, the goal is usually to maintain participation while managing load: building strength, improving fitness, planning recovery days, and scaling intensity when symptoms rise. In other words, exercise is typically a treatment for OA—not a cause of deterioration—when progressed smartly.

3) Is it safe to run with OA?

Running can be appropriate for some people with OA, especially when introduced gradually and monitored by symptom response. The main clinical consideration is not whether running is “allowed,” but whether your current capacity supports it and whether your progression is paced. Many runners do well with a staged return: run–walk intervals, flatter routes, shorter durations, and strength work for hips, thighs, and calves.

Some practical tips. Keep early sessions easy, build frequency and duration slowly, and use symptom feedback over the next 24–48 hours to guide the next step. If symptoms escalate across multiple days, that usually indicates the overall dose is too high and should be reduced temporarily.

Guidelines emphasize exercise as core care; running is best considered a specific form of exercise that may or may not be the right choice at a given time, depending on the person.

4) Should I avoid pain when exercising?

Not always. For many people with OA, insisting on completely pain-free exercise can lead to under-loading and slower progress. A more useful goal is tolerable, time-limited discomfort that does not produce a prolonged flare. Many clinicians use a symptom-guided approach: mild to moderate discomfort during exercise can be acceptable if it remains stable and settles back toward baseline within about 24 hours.

This is not an invitation to “push through” severe pain. Warning signs to scale back include sharp or escalating pain, substantial swelling, night pain that is clearly worse after exercise, or a steady day-to-day upward trend in symptoms. In practice, exercise should feel challenging but safe, and your plan should allow recovery. Adjusting load is part of the process, not a sign that exercise is failing.

5) Are there supplements that help with OA?

Supplements are widely used, but evidence of meaningful benefit is inconsistent, and product quality varies. Several guidelines do not recommend routine use of certain popular supplements (for example, some explicitly advise against offering glucosamine).

If you are considering supplements, a cautious, structured trial is reasonable: select one product, use a reputable brand, define what improvement would look like (e.g., less morning stiffness, improved walking tolerance), and reassess after a set period (often 6–8 weeks). If there is no clear benefit, stopping is appropriate. It is also important to check medication interactions and surgical considerations with a pharmacist or clinician, particularly for products with potential effects on bleeding or blood pressure.

Overall, supplements—when used—are best viewed as adjuncts, not replacements for exercise and self-management.

6) What is the best exercise for OA?

There is no single “best” exercise, but there is a best framework: a program you can do consistently, progress gradually, and relate directly to your functional goals. Guidelines strongly support strengthening and aerobic activity as central components of care.

A balanced plan typically includes:

Strength (2–3x/week): sit-to-stand or squat variations, step-ups, hip hinging patterns (bridges or deadlift patterns), hip abduction strengthening, and calf raises.

Aerobic (2–5x/week): walking, cycling, swimming, or elliptical—selected based on tolerance and preference.

The most important programming variables are dosage and progression. Starting slightly easier than you think you need, repeating it reliably, and then increasing small amounts over time tends to outperform irregular bursts of intense effort. If you would like, I can provide a simple 2-week starter template for knee OA and for hip OA that fits common symptom patterns.