Friction: “Bone on Bone Arthritis” Doesn’t Tell you the Whole Story about Knee Pain

By Christina Nowak  MScPT, CSCS, PhD (s)

A common complaint that I hear in the gym is that “I can’t squat because of my knees, I have bone-on-bone arthritis”. As we get older and we use and abuse our bodies, our joints wear down and deteriorate. Over time, the wear causes a degeneration of the cartilage in the knees and you have a decrease in the amount of space between the bones in your knee joint. This is also known as the evil arthritis

But does this mean that you’re going to have pain in your knees and that you can’t squat?


A systematic review published in 2008 showed that 85% of persons that have ZERO knee pain show signs of osteoarthritis on X-ray (1). For persons who don’t have arthritis, up to 90% of people with no arthritis or knee pain show some sort of abnormality on MRI (2). What this means is that knee osteoarthritis (OA) on Xray isn’t a very good indicator of knee pain! It likely ISN’T the cause of your knee pain!IMG_1588

So what do I do about it?

Arthritis doesn’t go away and the cartilage does not grow back. The best way to combat the pain and disability of knee OA is to exercise! A study that got released this month in the Clinical Journal of Sports Medicine compared leg strengthening (quads, hamstrings and calves) to hip strengthening using a theraband (3). What they found is that a 12 week program where strengthening exercises were performing 3-5x/week significantly reduced the pain and increased function of persons who had knee OA. It didn’t matter if the exercises were targeting the lower body or the hip.

[convertkit form=4883992]

The conclusion:

Just because you have arthritis in your knees does NOT mean you should stop exercising. It is actually the opposite – you SHOULD be exercising to reduce the pain and discomfort from arthritis.


1. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Dis. 2008. 9:116-27.

2.   Guermazi A, Niu J, Hayashi D, Englund M, Neogi T,  Aliabadi P, McLennan CE, Felson       DT. Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham osteoarthritis study). BMJ. 2012. 245: 1-13.

3. Lun V, Marsh A, Bray R, Lindsay D, Wiley P. Efficacy of hip strengthening exercises compared with knee strengthening exercises on knee pain, function, and quality of life in patients with knee osteoarthritis. Clin J Spor Med. 2015. [ePub ahead of print].

Posted in

Christina Prevett

Reader Interactions

Leave a Reply