"Bone on Bone": Why This Phrase Does More Harm Than Good for Knee and Hip OA

Reframing the Way We Talk About Osteoarthritis

 You’ve just been told your knee is “bone on bone.” Instantly, you picture grinding joints, damage, and an inevitable path to surgery. That phrase sticks in your mind—and can leave you feeling helpless.

 At Exercise Matters, we help clients reframe osteoarthritis (OA) with empowering, evidence-based language. This blog explores why “bone on bone” is misleading, and how structured exercise—like the GLA:D program—can bring real relief, even in advanced stages.

Why the Phrase "Bone on Bone" Is Problematic

It creates fear and hopelessness

Hearing “bone on bone” suggests irreversible damage and that movement will only make things worse. But research shows that pain and function don't always correlate with joint images.

It discourages people from exercising

Many people stop moving after hearing this phrase—when in reality, movement is exactly what helps.

It oversimplifies a complex condition

Osteoarthritis is more than just cartilage loss. It involves the whole joint:

• Cartilage

• Bone

• Synovial fluid

• Muscles and ligaments

• Neurological perception of pain

  
  

Evidence: Studies have shown that even people with radiographic “severe OA” can experience significant pain reduction and functional improvement through exercise (Bennell et al., 2015).

What Does "Bone on Bone" Actually Mean?

It usually refers to:

• Reduced joint space on imaging

• Thinning cartilage

But it does not mean your bones are literally grinding. Even with reduced cartilage, the joint remains functional and modifiable.

Key Point: Imaging often shows “bone on bone” changes in people who don’t have pain—and vice versa.

How Exercise Helps—Even in Severe OA

1. Strengthens the muscles that support the joint

Stronger quadriceps and glutes reduce load on the knee joint.

2. Improves joint alignment and control

Targeted movement patterns help distribute forces more evenly across the joint.

3. Reduces inflammation and pain perception

Regular exercise improves joint lubrication and desensitises pain pathways.

4. Boosts confidence and function

As you move more and feel stronger, confidence returns—and so does your ability to do daily tasks.

GLA:D Results: The GLA:D program has shown a 30–40% reduction in pain and improvement in function, even among participants with advanced OA (Skou et al., 2018).

Case Study: Denise, 70, Diagnosed with "Bone on Bone" OA

Denise was told by her doctor that her knee was “bone on bone” and that surgery was the only option. Instead, she joined our GLA:D program:

• Started with sit-to-stand and glute activation

• Progressed to step-ups, balance work, and walking drills

After 10 weeks:

• Reported a 50% reduction in pain

• Improved walking distance and stair tolerance

• Delayed surgery and resumed recreational hiking

What to Say Instead of "Bone on Bone"

• "There are some changes in your knee, but it’s strong and can adapt."

• "Exercise can help reduce your pain and improve your movement."

• "Many people with knees like yours improve without surgery."

Frequently Asked Questions

1. Is surgery inevitable with “bone on bone” OA?

Not necessarily. Many people avoid or delay surgery through structured rehabilitation like GLA:D.

2. Can I make the joint grow new cartilage?

Not exactly—but you can improve function and reduce pain with stronger muscles and better movement patterns.

3. Will I make it worse by exercising?

No. Exercise done right is protective. The key is progressive, guided loading—not overdoing it.

4. What if I’ve had pain for years?

It’s never too late to start. We’ve helped people regain function after years of inactivity.

Don’t Let Words Define Your Future

The term “bone on bone” doesn’t define your outcome. With the right exercise, education, and support, you can regain control of your knees—and your life.

📞 Book a GLA:D Assessment: (07) 5448 3532 🌐 www.exercisematters.healthcare

References:

• Skou ST et al. (2018). GLA:D program results in pain and function improvements in knee OA. BMJ Open.

• Bennell KL et al. (2015). Exercise for osteoarthritis: clinical evidence and practical application. Br J Sports Med.

• Deyle GD et al. (2020). Physical therapy vs glucocorticoid injection for knee OA. NEJM.