If you’ve been told your knee pain is “just wear and tear”, or that you have “bone on bone” and there’s nothing you can do except wait for surgery, this article is for you.
Knee osteoarthritis (OA) is one of the most common reasons people come to see us at Pottsville & Cabarita Physiotherapy. More than two million Australians live with osteoarthritis, and the knee is the joint most often affected. The good news is that our understanding of knee OA has changed dramatically over the past two decades and the message from the research is far more hopeful than many people expect.
What is knee osteoarthritis, really?
For years, OA was described as cartilage simply “wearing out” like the tread on a tyre. We now know that’s not the full picture.
Osteoarthritis is a whole-joint condition. It involves the cartilage, but also the bone underneath, the joint lining (synovium), the ligaments, and the muscles that support the knee. The joint is constantly trying to repair and adapt. OA happens when the repair processes can’t quite keep up with the load the joint is under.
That’s an important shift, because it means joints respond to what we do with them. Cartilage is nourished by movement and loading, it doesn’t have its own blood supply, so it relies on the compression and release of activity to stay healthy. Rest doesn’t protect an arthritic knee; the right kind of movement does.
Common signs of knee OA
- Pain that comes on with activity (walking, stairs, getting up from a chair) and eases with rest
- Morning stiffness that settles within about 30 minutes
- Stiffness after sitting for a while (“gelling”)
- Swelling or a sense of fullness in the knee
- Clicking or grinding (crepitus) is common, and usually not a sign of harm
- Reduced confidence on stairs, slopes or uneven ground like sand
- Feeling that the leg is weaker than it used to be
Symptoms often fluctuate. Many people have good weeks and bad weeks, and a “flare” doesn’t necessarily mean the joint is getting worse.
Do I need an X-ray or MRI?
Often, no. Australia’s Osteoarthritis of the Knee Clinical Care Standard (updated in 2024) recommends that knee OA be diagnosed clinically based on your history and a physical examination rather than with imaging.
For people over 45 with activity-related knee pain and morning stiffness of 30 minutes or less, a confident diagnosis can usually be made without a scan. Imaging is useful when something else is suspected, or symptoms don’t fit the usual picture.
Here’s why this matters: X-ray findings match symptoms surprisingly poorly. Some people with significant changes on X-ray have very little pain, while others with mild changes have a lot. A scan that says “severe” can make people fearful of moving and fear of movement is one of the biggest drivers of disability in knee OA.
“Bone on bone” what does it mean?
It’s a phrase that sticks in people’s minds, and it can be frightening. It usually describes narrowing of the joint space on X-ray. It doesn’t mean your knee is damaged beyond help, and it doesn’t mean exercise will make it worse. Plenty of people with “bone on bone” knees improve their pain and function significantly with a well-structured program.
What the evidence says works
Every major international and Australian guideline agrees on the core treatments for knee OA:
1. Education and self-management Understanding your condition reduces fear and helps you make good decisions about activity. Knowing that “hurt doesn’t always mean harm” is often a turning point.
2. Exercise as the foundation of care Exercise therapy is the first-line treatment for knee OA at every stage. Research consistently shows it reduces pain and improves function, with effects similar to or greater than common pain medications, and without the side effects. The best type of exercise is the one you’ll keep doing, but programs usually include:
- Strengthening, particularly the quadriceps (front of thigh) and hip muscles
- Neuromuscular training, balance, control and alignment during functional movements like squatting, stepping and lunging
- Aerobic activity, walking, cycling, swimming or aqua exercise
Structured programs like GLA:D® (Good Life with osteoArthritis: Denmark), which combines education with supervised neuromuscular exercise, have shown average pain reductions of around a quarter to a third, along with improved function and reduced use of pain medication. We offer this program at Pottsville and Cabarita Physio
3. Weight management (where relevant) For people carrying extra weight, losing even 5–10% of body weight can meaningfully reduce knee pain and improve function. Every kilogram lost takes several kilograms of load off the knee with each step.
4. Supportive strategies Appropriate footwear, a walking pole or stick when needed, heat for stiffness, and pacing strategies can all help you stay active.
What isn’t recommended
The 2024 Clinical Care Standard is also clear about what to avoid:
- Arthroscopy (“knee clean-out”) is not recommended for knee OA. High-quality trials show it is no more effective than placebo surgery or exercise therapy for degenerative knee pain.
- Opioids are not recommended for managing knee OA, as the risks outweigh the small benefits.
- Rest as a treatment: prolonged rest leads to weaker muscles, stiffer joints and more pain over time.
Joint replacement surgery can be an excellent option for some people with advanced OA who haven’t improved with a good trial of non-surgical care. But exercise and education should come first and if surgery is needed, being stronger beforehand leads to better recovery.
How physiotherapy helps
At our Pottsville and Cabarita Beach clinics, a knee OA assessment includes:
- A thorough history and examination to confirm the diagnosis and rule out other causes
- Measuring strength, range of motion, balance and function (such as how easily you rise from a chair or climb stairs)
- Explaining what’s going on in plain language
- Building a progressive, individualised exercise program
- Setting goals that matter to you: walking the dog on the beach, getting back to golf, or keeping up with the grandkids
- Strategies to manage flare-ups so you can keep moving
We also offer supervised exercise and Clinical Pilates through LOFT Pilates, which many people find a supportive way to build strength and confidence.
Living well with knee OA on the Tweed Coast
We’re lucky on the Tweed Coast to have so many ways to stay active: beach walks, the Creek paths, ocean swimming, and plenty of flat cycling routes. Knee OA doesn’t have to take these away. With the right plan, most people can stay active and keep doing what they love.
Questions & Answers
Q: Is walking bad for knee arthritis? A: No. Walking is one of the best activities for knee OA. It loads the joint in a healthy way and supports cartilage nutrition. If walking is painful, we can adjust the distance, pace or surface (firm sand near the water is easier than soft sand) and build up gradually.
Q: Will exercise make my knee OA worse? A: Research shows appropriately dosed exercise does not speed up OA and generally improves pain and function. Some discomfort during or after exercise is normal and acceptable as a guide, pain up to around 5 out of 10 that settles within 24 hours is usually fine.
Q: Does running cause knee arthritis? A: For recreational runners, the evidence suggests running doesn’t increase — and may even reduce — the risk of knee OA compared with being sedentary. Previous knee injuries, genetics and body weight are bigger risk factors.
Q: Do I need an X-ray to know I have knee OA? A: Usually not. For most people over 45 with typical symptoms, a physiotherapist or GP can diagnose knee OA from your history and examination. Imaging is used when other conditions are suspected.
Q: How long does it take for exercise to help? A: Many people notice changes within 6–8 weeks of consistent exercise, with continued gains over 3 months and beyond. Consistency matters more than intensity.
Q: Should I have a knee arthroscopy? A: Arthroscopy is not recommended for knee osteoarthritis under Australian guidelines, as it hasn’t been shown to improve outcomes more than non-surgical care.
Q: Do I need a referral to see a physio? A: No referral is needed to see a physiotherapist. If you have a GP Chronic Condition Management Plan, you may be eligible for Medicare rebates on some sessions — ask your GP.
Take-Home Tips
- Motion is lotion — gentle daily movement helps keep your knee joint nourished and less stiff.
- Strong thighs, happier knees — quadriceps and hip strength are key to reducing knee load.
- Don’t fear the flare — a sore day isn’t damage. Ease back, keep moving, and build up again.
- Pain-monitor your exercise — pain up to about 5/10 that settles within 24 hours is generally okay.
- Skip the scan (usually) — knee OA is diagnosed by how your knee behaves, not how it looks on an X-ray.
- Get a plan — a tailored, progressive program is more effective than random exercises.
Ready to take the next step? Book a knee assessment with our physiotherapists at Pottsville or Cabarita Beach. No referral needed.
Author: Melissa Macdonald, Physiotherapist. This article is general information only and does not replace individual assessment and advice from a qualified health professional.