Osteoarthritis (OA) is the most common form of arthritis, affecting an estimated 302 million people worldwide, and is a leading cause of disability among older adults. The knees, and hips, are the most commonly affected joints. OA leads to pain, stiffness, swelling, and loss of normal joint function (article). 

X-Ray has showed severe osteoarthritis in my knee / hip. What should I do? 

Do not panic. Imagings quite often show some abnormalities, but  it doesn’t mean that those findings are the cause of your pain. Let’s have a look at the poor correlation between knee pain and imagings, for example.

Knee X-ray and Pain

Radiographs have long been considered as the reference standard for the assessment of OA, for more than four decades. To date, the majority of studies have reported that radiographic OA (ROA) is poorly correlated with knee symptoms, and most risk factors for ROA are not strong predictors of knee pain. Pain perception is complex, however, and knee pain is frequently associated with non-OA variables, such as psychosocial factors, education, economic status as well as local pathology (article).

Knee MRI and cartilage damage

Arthritic change within knee joints is very common even in those without pain, for example a study from Geurmazi et al. 2012, found 69% of people with no pain had evidence of cartilage damage on MRI.


Now, you know that you shouldn’t completely believe to your imaging findings, because there are people with asymptomatic knee osteoarthritis and other people with symptomatic knee osteoarthritis. If you are part of the second group, there are two things you can start doing:

Exercise and Weight loss

The Key Factor  is to listen to your knee. You know what type of exercises your knee likes and doesn’t like to do. It is important that you keep the intensity of the pain below 5/10 (0= no pain; 10 = the worst pain), to avoid flare ups.

Exercises: Tai Chi, Yoga, Walking, Cycling, Balance Training, Running?

Running does not increase symptoms or structural progression in people with knee osteoarthritis – Grace H. et al. 2018

Key points from the article:

  • Running doesn’t appear to increase the risk of developing hip or knee arthritis;
  • Running with knee OA doesn’t seem to speed up disease progression or worsen symptoms over a period of time.

Avoid: TENS (transcutaneous electrical nerve stimulation), Modified Shoes, Wedged Insoles, Massage, Manual Therapy, Pulsed Vibration Therapy. The scientific evidence behind these treatments and tools is weak.



Bear in mind that it is crucial to exercise and keep your weight under control. These are the only two tools we can use to slow down osteoarthritis progression. The last but not the least, don’t be too worried about your X-ray findings. Remember, there is poor correlation between joint pain and imagings.




2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee;

Radiographic Knee Osteoarthritisand Knee Pain: Cross-sectionalstudy from Five Diferent Racial/Ethnic Populations 2018;

Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative. Clin Rheumatol. 2018;

Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study), Guermazi et al. 2012.


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