Around a five-minute read
Joint pain and stiffness can make familiar activities more difficult, from climbing stairs to opening a jar. If you have been told you have osteoarthritis, you may wonder what is happening inside your joints—and what you can do about it.
Osteoarthritis is the most common type of arthritis in the UK. Although it is a long-term condition, it does not inevitably become worse. Treatment and practical support can help you manage symptoms and remain active.
What is happening inside the joint?
Osteoarthritis involves changes to the tissues within a joint. These include cartilage—the smooth tissue covering the ends of bones—as well as the underlying bone and other structures around the joint. Small bony growths, called osteophytes, can also develop.
You may hear osteoarthritis described as “wear and tear”. However, this phrase does not tell the whole story. Osteoarthritis involves changes throughout the joint, rather than simply a surface wearing away through use.
It commonly affects the knees, hips and small joints of the hands. It becomes more common with age, but younger people can develop it too, particularly following a joint injury. Previous injury, family history and being overweight are among the factors associated with developing the condition.
It can be caused by a range of factors, such as obesity, joint injury, repetitive stress and overload. Family history, aging and biological sex. It can also be secondary to other medical conditions.
What does osteoarthritis feel like?
The main symptoms are joint pain and stiffness, but people experience them differently. Symptoms may come and go, or become more persistent and interfere with everyday activities.
You might notice:
- Pain when using the affected joint.
- Stiffness when getting up in the morning or moving after a rest.
- Difficulty bending or straightening the joint fully.
- Tenderness or swelling.
- A grating or crackling sensation during movement.
- A joint looking larger or more knobbly than before.
- Weakness in the surrounding muscles.
Morning stiffness associated with osteoarthritis usually settles within about 30 minutes. Pain may ease with rest, although some people with more advanced symptoms also experience pain at night.
The effects depend partly on which joint is involved. Knee symptoms may make walking or stairs difficult. Hand symptoms can make gripping objects harder. Hip osteoarthritis can cause pain in the groin, thigh or buttock, and sometimes pain is felt around the knee.
These symptoms are reasons to seek an assessment, rather than a checklist for diagnosing yourself.
Will you need an X-ray or blood test?
Often, osteoarthritis can be diagnosed without either.
A doctor will ask about your symptoms and examine your joints. NICE, the organisation that produces clinical guidance in England, recommends a clinical diagnosis without imaging when someone:
- Is aged 45 or over.
- Has joint pain related to activity.
- Has no morning stiffness, or stiffness lasting no longer than 30 minutes.
Being younger than 45 does not rule out osteoarthritis. It means that this particular diagnostic shortcut does not apply.
When further tests can help
If symptoms are unusual or another condition is suspected, a doctor or hospital specialist may arrange investigations. These can include:
- X-rays: These can show changes such as narrowing of the joint space and bony growths. Early changes may not appear on an X-ray.
- MRI scans: These provide more detail about soft tissues within and around a joint. They are not routinely needed to diagnose typical osteoarthritis.
- Blood tests: These do not confirm osteoarthritis, but can help investigate other possible causes of joint symptoms.
- Joint fluid tests: Sometimes fluid is removed from a joint to check for conditions such as gout or infection.
Not being offered a scan does not mean your symptoms are being dismissed. In a typical case, your history and examination may provide the information needed to begin care.
How can osteopathy fit into your care?
The useful question is what a treatment plan contains, and whether those elements are supported by evidence.
For osteoarthritis, exercise, information and support are central to care. Weight management is also recommended where appropriate.
Your osteopath can certainly assess your joints carefully to evaluate for signs of osteoarthritic changes. They can also communicate with your doctor for further investigations as appropriate and with your consent.
Hands-on treatment may have a supporting role
Osteopathy includes joint mobilisation and soft-tissue techniques. This comes under the umbrella of manual therapy.
NICE says manual therapy should only be considered for hip or knee osteoarthritis alongside therapeutic exercise. There is insufficient evidence to support using it alone. This is guidance about treatment methods; it is not proof that osteopathy as a whole is effective for every joint affected by osteoarthritis.
If hands-on treatment forms part of your osteopathic care, it should therefore sit within a broader plan that includes appropriate exercise. It should not be presented as a cure or a way to reverse joint damage.
Movement should remain part of the plan
It is understandable to feel cautious about exercise when a joint hurts. However, appropriately tailored exercise can help reduce pain and improve function. Strengthening exercises and activities that support general fitness are both important.
Some discomfort can occur when starting an exercise programme. The exercises should be adapted to your needs, with support to build a manageable routine. The aim is to help you continue, rather than leave you unsure about what is safe or achievable.
When discussing care, useful questions include: “What are we trying to improve?”, “What can I do between appointments?” and “How will we decide whether this is helping?”
What if symptoms still limit your life?
Osteoarthritis care can include more than one approach. Depending on your symptoms and health, your GP may discuss pain relief, physiotherapy, aids for everyday activities or specialist assessment. Surgery may be considered when symptoms seriously affect daily life and other treatment has not helped sufficiently.
You do not have to wait until you can no longer cope before asking for a review.
When should you seek medical advice?
Arrange a GP assessment if joint pain keeps returning, affects your sleep or normal activities, or if morning stiffness lasts longer than 30 minutes.
Seek an urgent GP appointment or contact NHS 111 if a painful joint is hot and swollen, or joint pain comes with a fever, shivering or feeling generally unwell. These symptoms should not simply be assumed to be osteoarthritis.
Understanding your symptoms is a useful first step. The next is a plan that helps you manage them, with clear goals and support for the activities that matter to you.
References
- NHS. Osteoarthritis: overview.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Osteoarthritis: overview, symptoms and causes. Reviewed September 2023.
- NHS. Osteoarthritis: symptoms.
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management, NG226—recommendations. Published 19 October 2022. Sections 1.1–1.3.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. Osteoarthritis: diagnosis, treatment and steps to take. Reviewed September 2023. Diagnostic information.
- NHS. Osteoarthritis: treatment and support.
- National Institute for Health and Care Excellence. NG226: rationale and impact—therapeutic exercise. Published 19 October 2022.
- NHS. Joint pain.
