Knee Osteoarthritis

Arthritis is not a death sentence for your knee

Knee osteoarthritis is one of the most common reasons people slow down, give up activities they love, and start accepting limitations they don't need to accept. The typical story I hear is: "I was told I have bone-on-bone arthritis and I need a knee replacement." That may eventually be true, but there is usually a lot we can do between that X-ray and the operating room.

Arthritis is a spectrum. Mild cartilage wear is nearly universal after age 50 and often causes no symptoms at all. Moderate arthritis can be well managed with the right approach. Even advanced arthritis responds to treatment that addresses the whole kinetic chain, not just the joint.

What's actually happening in the knee

Osteoarthritis is the gradual breakdown of the articular cartilage that covers the ends of the bones in your knee. As that cartilage thins, the joint space narrows, the bone underneath remodels, and the surrounding soft tissue becomes inflamed. But the pain you feel doesn't always correlate with the imaging.

Some people with terrible-looking X-rays walk around comfortably. Others with mild imaging findings are in significant pain. The difference often comes down to the biomechanics — how the knee is being loaded, how the muscles around it are functioning, and what's happening at the hip, ankle, and foot.

How we approach it

I look at the knee in context. If your hip is weak, your knee absorbs more medial load. If your ankle is stiff, your knee compensates with abnormal rotation. If your quad is inhibited from swelling or pain, the joint loses its primary shock absorber. Addressing these factors often produces more relief than treating the knee in isolation.

OMM addresses the pelvic, hip, and ankle restrictions that alter knee mechanics. Restoring normal motion above and below the knee reduces the abnormal forces driving pain and wear.

Ultrasound-guided injections let us target the joint precisely. Options include corticosteroid injections for acute flares, hyaluronic acid (viscosupplementation) for lubrication and cushioning, and PRP when we want to promote tissue healing.

Motion analysis helps us identify the movement patterns that are overloading your knee. Sometimes the fix is surprisingly simple — a change in gait pattern, footwear modification, or targeted strengthening.

Exercise is the single most evidence-based treatment for knee osteoarthritis. Strengthening the quadriceps, hamstrings, and hip abductors reduces pain and improves function as effectively as many medications — without the side effects.

What about imaging?

I'll get X-rays when I need to stage the arthritis, plan treatment, or rule out other causes. But I try not to let imaging drive the conversation more than the exam does. Your knee doesn't know what the X-ray looks like. What matters is how it moves, how strong it is, and how it's being loaded.

When surgery makes sense

Joint replacement is an excellent operation for the right patient at the right time. That time is when you've exhausted conservative options and the arthritis is limiting your quality of life in a way you're not willing to accept. It's not when the X-ray looks bad. Many patients can delay or avoid surgery entirely with a good conservative program.

What you can do right now

Walk. It sounds counterintuitive, but moderate walking is protective for arthritic knees. The cartilage in your knee needs cyclical loading to stay healthy — it's how it gets its nutrition. Avoiding activity leads to deconditioning, which leads to more pain, which leads to less activity. Break the cycle.

Strengthen your quads. A strong quadriceps muscle is the single best thing you can have for an arthritic knee. Straight leg raises, wall sits, and step-ups are simple and effective.

Lose weight if you're carrying extra. Every pound of body weight translates to roughly four pounds of force across the knee joint with each step. Even a modest reduction makes a meaningful difference.