Is it really your osteoarthritis that's causing you pain?

You've been diagnosed with osteoarthritis and now you're worried. Will it get worse? Will you lose your mobility? Perhaps you're afraid to move, fearing it might make things worse. These concerns are understandable, but the reality is often more encouraging than you might imagine.

L’exercice adapté fait partie des premiers traitements de l’arthrose de la hanche et du genou. Le guide de physiothérapie de 2020 associe les exercices à des conseils dans ses quatre profils de soins.¹ Un programme régulier, adapté à vos besoins, peut réduire la douleur et faciliter les activités. Une gêne peut augmenter au début; le professionnel ajuste les exercices avec vous².

Osteoarthritis visible on an X-ray does not always cause pain. Conversely, knee pain can occur without visible osteoarthritis. Therefore, the X-ray and your symptoms must be interpreted together. ³ However, changes in the joint can contribute to pain, and more advanced signs are more often associated with symptoms. ⁴

What Science Tells Us About Osteoarthritis and Pain:

• Signs of osteoarthritis may be visible on medical images, such as X-rays, even in the absence of pain ³
• Osteoarthritis usually progresses slowly. However, one review describes rapid progression in at least one in seven people who developed knee osteoarthritis in the studies examined. The affected knees progressed from no or minimal signs to an advanced stage on X-rays in less than four years, often in less than twelve months. ⁵ This figure does not apply to all people who already have osteoarthritis.
• Appropriate exercise can improve symptoms. A review of studies found no evidence that therapeutic exercises damage the structure or quality of knee cartilage, the tissue that covers the ends of the bones. ⁶ The program is tailored to your condition. Our article also addresses the question: Does running cause osteoarthritis?
• Exercises, advice, and other treatments can help manage pain and resume activities. You can choose a plan based on your needs.

The example of the hip illustrates this difference. One study looked at 978 adults aged 50 and older living in Framingham, in the United States. After adjusting the estimates for age, 19.6% showed signs of hip osteoarthritis on X-rays. The proportion was 4.2% for those who had both these signs and pain in the same hip on most days. ⁷

This guide helps you understand the true relationship between osteoarthritis and pain. To learn more about different forms of osteoarthritis, consult our guide on knee osteoarthritis.

Can osteoarthritis develop overnight?

Osteoarthritis generally develops over several years and does not usually occur overnight. However, some forms of knee osteoarthritis progress more rapidly, as indicated in the review described above. ⁵ Sudden pain alone is therefore not a reliable indicator of the rate of change in your joint.

Une poussée d’arthrose correspond à une augmentation temporaire des symptômes, comme la douleur, la raideur ou l’enflure². Une nouvelle douleur peut aussi avoir une autre cause, notamment une blessure. Votre récit et l’examen aident à l’évaluer⁸. La douleur peut être liée à l’arthrose sans refléter exactement les changements visibles sur une radiographie.⁴

Certain changes in the knee become more common with age and are also seen in adults who have no pain or history of injury. A review of magnetic resonance imaging (MRI) scans—a test that shows the tissues—confirms this. ⁹ This does not mean that all osteoarthritis is simply a normal change or that the tissues never contribute to the pain.

L’arthrose peut s’accompagner de douleur ou rester sans douleur. Elle ne s’aggrave pas nécessairement de façon continue. Les soins peuvent réduire les symptômes et améliorer les activités, même si aucun traitement ne fait disparaître l’arthrose¹⁰.

The X-ray alone isn't enough to explain all your pain.

To improve your comfort, the treatment plan takes into account the joint and other factors that influence pain. Pain intensity does not directly reflect the condition of the tissues. Nerves and the brain play a role in the experience of pain. Sleep, stress, fatigue, and expectations can also influence pain; in turn, pain can disrupt sleep and affect mood. These connections do not mean that the pain is imaginary or that you are to blame for it. The same severity shown on an X-ray does not necessarily result in the same symptoms in two different people. ^{114, 113}

How Can Physical Therapy Help With Painful Osteoarthritis?

Physical therapy helps manage osteoarthritis pain and resume daily activities through tailored exercises and guidance. ¹ The physical therapist assesses your symptoms, your range of motion, and the activities you find difficult. The treatment plan may include:

• A schedule that balances strenuous tasks, leisure activities, and sports, with breaks or adjusted exertion levels.
• Exercises to strengthen muscles and maintain the ability to walk or engage in other activities.
• Adjustments to your posture or movements to make tasks that are difficult for you easier.
• Selon vos besoins, de la Manual therapy, comme des mouvements de l’articulation guidés avec les mains, en complément des exercices².

The 2020 guidelines place education and exercise at the center of care for hip or knee osteoarthritis. ¹ A review of twelve studies on manual therapy for the knee reports improvements in functional abilities as assessed by questionnaires, compared to no treatment or when these techniques are added to another treatment. Some pain-related results are also favorable. The quality of the studies varied, and the data do not allow for conclusions regarding functional abilities measured by physical tests. ¹²

What symptoms can osteoarthritis cause?

L’arthrose peut causer une Joint pain, de la raideur, une difficulté à bouger et parfois de l’enflure¹⁰. Des craquements peuvent aussi survenir. Pour reconnaître une arthrose du genou, le professionnel combine plusieurs éléments du récit et de l’examen; aucun bruit ni symptôme isolé ne suffit.^{13, 14}

• L’absence de raideur au réveil, ou une raideur de moins de trente minutes, est compatible avec l’arthrose. Une raideur plus longue mérite une évaluation¹⁰. Ce repère complète les autres symptômes.¹³
• Cracking or creaking sounds in the joint when you move—known as crepitus—are common, even in people who aren't experiencing pain ¹⁵. These sounds alone are not enough to conclude that tissue is tearing. They may be associated with signs of osteoarthritis on medical imaging, but the certainty of the evidence is low to very low. They must be interpreted in conjunction with other symptoms.
• Une enflure peut accompagner l’arthrose, mais elle peut aussi avoir une autre cause. Si elle s’aggrave, revient souvent ou persiste, faites-la évaluer⁸.

Treatment is tailored to your symptoms and the activities you wish to resume. Improvement is still possible even if changes are visible on the images; the response to treatment varies from person to person.

Education includes information about osteoarthritis, advice on adjusting activities, and support for managing symptoms on a daily basis. ¹

Votre âge ou votre radiographie ne résument pas vos possibilités. Pour l’arthrose de la hanche ou du genou, une douleur qui limite encore beaucoup votre vie malgré des soins adaptés justifie une nouvelle évaluation. Vous pouvez alors discuter d’autres options, parfois d’une chirurgie².

When should you seek immediate medical attention?

Une articulation douloureuse dont la peau est gonflée et chaude demande un avis médical urgent. Une Joint pain avec malaise général, forte fièvre, sensations de chaud ou de froid, ou frissons demande aussi un avis urgent⁸.

Allez à l’urgence si vous ne pouvez plus marcher ou prendre appui, ou si l’articulation paraît déplacée, même sans blessure. Après une chute ou une blessure, une Joint pain très forte, des picotements ou une perte de sensibilité demandent aussi des soins immédiats. Appelez le 911 si vous avez besoin d’une ambulance⁸. Ces situations ne doivent pas être attribuées automatiquement à l’arthrose.

Depending on the affected joint, our detailed guides go into greater depth: hip osteoarthritis, lumbar osteoarthritis, and cervical osteoarthritis.

To learn more 

The podcast “Parle-moi de santé,” hosted by physical therapist Alexis Gougeon, dedicates its 15th episode to osteoarthritis with Anthony Teoli.

Écouter l'épisode 15 de Parle-moi de santé sur l'arthrose, sur YouTube

The link above takes you to the video episode.

Sources

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2. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management. NICE guideline NG226. 2022.↩ Back to text: 1st, 2nd, 3rd, 4th mentions
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7. Kim C, Linsenmeyer KD, Vlad SC, Guermazi A, Clancy MM, Niu J, et al. Prevalence of radiographic and symptomatic hip osteoarthritis in an urban United States community: the Framingham osteoarthritis study. Arthritis Rheumatol. 2014;66(11):3013-7.↩ Back to text
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Nos physiothérapeutes ont défini la stratégie de recherche, le plan et le contenu clinique de cet article. Un outil d’IA a soutenu la recherche documentaire et la révision du texte pour assurer une cohérence du contenu et du style d’écriture.