Osteoarthritis: Symptoms, Exercise and Treatment Options

Osteoarthritis (OA) is a common cause of joint pain, stiffness and reduced mobility, most often in the knees, hips, hands, feet and spine. It is more than “wear and tear”: it involves the whole joint, including cartilage, bone, synovium, ligaments and muscles (Loeser et al., 2012). OA does not automatically mean surgery; many people manage well with education, exercise, physiotherapy, weight management and carefully chosen medication (Hunter & Bierma-Zeinstra, 2019; NICE guidance).

The featured image and supporting patient illustrations are AI-generated and do not depict actual patients.

What Is Osteoarthritis?

OA is a long-term condition with structural and functional joint changes: cartilage alters, bone may thicken, the joint lining becomes irritated and muscles weaken. This can cause pain, stiffness, swelling, tenderness, reduced movement and difficulty with daily activities. Severity varies widely; some people have marked changes with mild symptoms, others significant disability (Hunter & Bierma-Zeinstra, 2019; Loeser et al., 2012).

How Osteoarthritis Affects the Joint

• Articular cartilage: changes alter joint mechanics.
• Subchondral bone: may thicken and form osteophytes.
• Synovium: irritation causes inflammation and swelling.
• Capsule and ligaments: cause stiffness and altered stability.
• Muscles: weaken with pain and inactivity.

Treatment should therefore address pain, mobility, strength and function, not cartilage alone (NICE guidance).

Primary vs Secondary Osteoarthritis

Primary OA has no single identifiable cause; age, genetics, weight, biomechanics, muscle strength and repetitive loading combine. Secondary OA follows an identifiable cause: injury, fracture, ligament or meniscal damage, instability, surgery, congenital or developmental abnormality, inflammatory or metabolic disease, or occupational loading (Blagojevic et al., 2010; Hunter & Bierma-Zeinstra, 2019; Silverwood et al., 2015).

What Causes Osteoarthritis?

• Age: risk rises, but ageing alone does not guarantee OA (Hunter & Bierma-Zeinstra, 2019).
• Previous joint injury: ACL or meniscal injury, fracture, dislocation; OA may appear years later (Silverwood et al., 2015).
• Excess body weight: loads knees and hips; weight loss improves pain and function (Blagojevic et al., 2010; Messier et al., 2013).
• Genetics: especially some hand OA (Hunter & Bierma-Zeinstra, 2019).
• Muscle weakness: reduces control of joint loading (Roos & Arden, 2016).
• Joint alignment: alters force distribution.
• Repetitive loading: some jobs and sports; normal activity is beneficial.
• Previous surgery: may raise long-term risk.
• Other joint conditions: inflammatory, metabolic, developmental, structural.

Osteoarthritis Risk Factors

Age, family history, joint injury, overweight, muscle weakness, malalignment, occupational loading, sports injuries, joint surgery, and metabolic or inflammatory conditions. A risk factor does not make OA certain (Blagojevic et al., 2010; Silverwood et al., 2015).

Osteoarthritis Symptoms

Pain, stiffness, swelling, tenderness, reduced movement, weakness, crepitus, difficulty walking, climbing stairs or gripping, instability and reduced activity. Symptoms fluctuate, with periodic flare-ups (Hunter & Bierma-Zeinstra, 2019; NICE guidance).

Osteoarthritis Pain

OA pain is linked to activity and loading (knee pain walking, hip pain standing, hand pain gripping) and can follow inactivity. It does not always match X-ray findings (Bedson & Croft, 2008), so treatment should rest on the whole clinical picture.

Where Does Osteoarthritis Occur?

• Knee: pain, stiffness, swelling, trouble with stairs, rising and squatting.
• Hip: groin, front hip, buttock or thigh pain; trouble walking, putting on shoes, entering cars.
• Hand: finger and thumb pain, swelling, weak grip, difficulty opening jars or writing.
• Spine: neck or back pain and stiffness; not all spinal pain is OA.
• Foot: pain walking, stiffness, difficulty with some shoes (Hunter & Bierma-Zeinstra, 2019; Kolasinski et al., 2020).

Stiffness, Swelling and Crepitus

Stiffness follows sitting, inactivity or flares; in typical OA morning stiffness is brief, and prolonged stiffness with multiple swollen joints suggests inflammatory disease. Swelling reflects synovial irritation and fluid; persistent, hot or rapid swelling needs review. Crepitus (clicking, grinding) does not necessarily mean significant damage (NICE guidance).

How Osteoarthritis Affects Daily Life

OA can limit walking, stairs, sleeping, dressing, bathing, cooking, driving, work, sport and social life. This often matters more than the X-ray, so treatment aims at quality of life and independence (Hunter & Bierma-Zeinstra, 2019).

How Is Osteoarthritis Diagnosed?

Usually clinically, from history, examination, movement, strength, function and risk factors; imaging is not always needed (NICE guidance).

When Are X-rays Needed?

When symptoms are unusual, another diagnosis is suspected, trauma was significant, diagnosis is uncertain, surgery is planned or response is poor. They may show joint-space narrowing, osteophytes and bone changes, but never in isolation (Bedson & Croft, 2008; NICE guidance).

Is MRI Needed?

Not routinely; only when another condition is suspected or for a specific decision (NICE guidance).

Osteoarthritis vs Rheumatoid Arthritis

Sources: Hunter & Bierma-Zeinstra ; NICE .

Prescribed Drugs for Osteoarthritis Pain Relief

Medication eases symptoms and supports rehabilitation, alongside non-drug care. Choice depends on age, other conditions, kidney, liver, heart and gut health, other medicines and pregnancy (Kolasinski et al., 2020; NICE guidance).

• Topical NSAIDs: good for localized, especially knee, pain with less systemic exposure (Kolasinski et al., 2020).
• Oral NSAIDs (ibuprofen, naproxen, diclofenac): if topical fails; risks include ulcers, GI bleeding, kidney and cardiovascular problems and interactions, so clinician guidance is needed (Da Costa et al., 2017; Kolasinski et al., 2020).
• Paracetamol: modest long-term value; never exceed the dose (liver injury) (Da Costa et al., 2017; Machado et al., 2015).
• Corticosteroid injections: short-term relief for selected patients (Jüni et al., 2015).
• Other medications: occasionally, individualized.
• Opioids: not routine, because of dependence, falls, sedation and reduced function (Da Costa et al., 2014).
• Glucosamine and supplements: inconsistent evidence, not guideline-recommended; beware “cure” claims (Bannuru et al., 2019; Towheed et al., 2005).

Physiotherapy for Osteoarthritis

Physiotherapy is a core part of OA care. A physiotherapist assesses pain, mobility, strength, balance, walking, function and goals, then progresses a program that reduces pain, improves strength, balance, walking and confidence, restores daily activities, supports weight management and improves quality of life (Kolasinski et al., 2020; NICE guidance).

Therapeutic Exercise

Exercise is among the most important OA treatments, tailored to the individual: strengthening, mobility, flexibility, aerobic, balance, functional and neuromuscular work (Fransen et al., 2014, 2015; Kolasinski et al., 2020).

Strengthening: for knees, quadriceps, hamstrings, glutes, calves and hip stabilizers; for hips, abductors, extensors, glutes and core; for hands, grip strength (Østerås et al., 2017).

Flexibility and mobility: gentle range-of-motion and stretching, done regularly. Aerobic: walking, cycling, swimming or water exercise, ideally enjoyable and sustainable (Bartels et al., 2016; Fransen et al., 2015).

Balance and functional training: sit-to-stand, stairs, step-ups, walking, turning.

Manual Therapy

Joint mobilization and soft-tissue techniques can reduce symptoms but should accompany exercise, not replace it (Abbott et al., 2013; NICE guidance).

Structural Diagnosis and Management (SDM)

SDM is the assessment-led framework ASPC uses, combining history, joint motion, muscle length and strength and neurological examination to reach a structural diagnosis (Haque et al., 2020). It has not been published specifically for OA; applied here it means structural examination, differential diagnosis (referring if atypical), a diagnosis-led plan combining manual therapy with exercise and education, and regular reassessment.

Evidence: no OA trial of SDM exists. In 64 adults with plantar heel pain, SDM improved pain, function and ankle motion (Akter et al., 2024), which may not apply to OA. In 206 adults with hip or knee OA, manual physiotherapy added to usual care helped for a year, though adding exercise gave no extra benefit (Abbott et al., 2013). Guidelines make exercise central and manual therapy an adjunct (Kolasinski et al., 2020).

Osteoarthritis Exercises

Knee: straight-leg raise, sit-to-stand, mini squats, step-ups, calf raises, walking or cycling. Hip: glute bridges, hip abduction and extension, core work, gentle mobility, walking, cycling, aquatic exercise. Hand: finger and thumb mobility, gentle gripping, functional and resisted strengthening, avoiding excessive force when irritated. Select by pain, strength and function, and progress gradually (Fransen et al., 2014, 2015; Østerås et al., 2017).

Should You Exercise During Pain?

Usually yes. Mild temporary discomfort is expected, but severe or worsening pain should not be ignored; a physiotherapist can set resistance, repetitions, frequency and progression (NICE guidance).

Weight, Nutrition and Lifestyle

Weight management reduces joint load and improves pain, function and exercise ease in knee and hip OA; even modest loss helps, without extreme diets (Christensen et al., 2007; Messier et al., 2013). Nutrition: no food cures OA, but vegetables, fruit, whole grains, legumes, fish, eggs, lean protein, nuts and healthy fats support weight control; limit processed food and added sugar. Lifestyle: stay active, avoid prolonged inactivity, build strength, sleep well, manage stress, wear suitable footwear and follow a home program (NICE guidance).

Managing an Osteoarthritis Flare-Up

• Temporarily reduce aggravating activity.
• Avoid complete immobilization.
• Keep moving gently.
• Follow your pain plan.
• Return gradually to normal activity.
• Seek advice if severe or persistent (NICE guidance).

Prevention, Reversal and Non-Surgical Care

Prevention: not always possible, but healthy weight, activity, muscle strength, avoiding and properly rehabilitating injuries, and managing occupational loads lower risk (Roos & Arden, 2016; Silverwood et al., 2015). After injury, rehabilitation should restore motion, strength, balance, stability and function, with graded return to sport or work. Reversal: established OA cannot reliably be reversed, but symptoms and function often improve substantially (Hunter & Bierma-Zeinstra, 2019). Without surgery: yes; education, exercise, physiotherapy, weight and lifestyle measures, medication, injections and assistive devices help many people, and surgery is for severe symptoms despite conservative care .

When to See a Physiotherapist or Doctor

Physiotherapist: persistent pain, increasing stiffness, difficulty walking, weakness, trouble with daily tasks, avoiding exercise, or wanting a structured plan.

Doctor: sudden severe pain, a hot swollen joint, fever, major trauma, severe deformity, rapid progression, unexplained weight loss, neurological symptoms, or anything atypical (NICE guidance).

Injections and Joint Replacement

Injections suit selected patients with significant pain or exercise difficulty when other treatments fail; corticosteroids give temporary relief within a broader plan (Jüni et al., 2015). Joint replacement (total or partial knee, total hip) is considered for severe pain, restricted function and advanced disease unresponsive to non-surgical care (Hunter & Bierma-Zeinstra, 2019). Prehabilitation (strength, mobility, walking, education) eases recovery; post-surgery rehabilitation restores motion, strength, walking, balance, stairs and independence.

Long-Term Management

Continue exercise, strength training, healthy weight, mobility work, symptom monitoring, early flare management and periodic reassessment. Consistency beats occasional intensity (Kolasinski et al., 2020; NICE guidance).

For OA treatment in Dhaka, ASPC offers an assessment-focused, rehabilitation-based approach: manual therapy, therapeutic exercise, strengthening, mobility training and functional rehabilitation tailored to each patient.

Final Takeaway

OA involves the whole joint, can affect the knee, hip, hand, spine and foot, and should be treated by the individual, not the X-ray. The non-surgical foundation is education, therapeutic exercise, physiotherapy, activity, weight management and appropriate pain control. NSAIDs and injections help selected patients; joint replacement is considered when severe disability persists.

Osteoarthritis does not mean you have to stop moving.

Knee osteoarthritis: cracking, runner’s knee and exercise preparation

Cracking or crepitus alone does not show how severe arthritis is and can occur without pain. Knee osteoarthritis usually causes a pattern of activity-related pain, stiffness and functional change. Runner’s knee, or patellofemoral pain, is a different clinical presentation that often causes pain around or behind the kneecap during loaded bending. Symptoms can overlap, so treatment should follow the clinical assessment.

A gradual warm-up prepares the person for the exercise session: begin with easy walking or cycling and move into comfortable joint motion and the planned strengthening tasks. Adjust the dose after a flare-up rather than abandoning activity completely. For someone living with overweight or obesity, supported weight management can improve knee or hip symptoms and make activity easier; extreme diets are unnecessary.

NICE: osteoarthritis assessment and non-surgical treatment.

PRP, alternative treatments and food claims

Platelet-rich plasma (PRP) injections are discussed for knee osteoarthritis, but uncertainty remains about which preparation, dose and patient group may benefit. They should not be described as reliably regrowing cartilage or curing arthritis. NICE’s procedure guidance calls for special arrangements for clinical governance, consent and audit or research because efficacy evidence is limited in quality. Discuss cost, uncertainty, alternatives and potential harms with a qualified specialist.

Complementary approaches need an individual assessment of benefits and risks. They should support an agreed management plan and should not replace exercise, appropriate medical review or indicated surgery. No single food, including broccoli, is an established osteoarthritis treatment. A balanced diet may support weight and general health; laboratory findings about a food compound do not prove clinical benefit in people with knee arthritis.

NICE: PRP injections for knee osteoarthritis; NICE: osteoarthritis management.