“It’s bone on bone” -Every Patient with OA

113%, quite the impressive number, but it does not mean much without proper context. Unfortunately, it is monumental in an unfavorable way. As found by the World Health Organization, 113% represents the increase in osteoarthritis (OA) that has occurred in the general population from 1990-2019³. Inevitably, this is a condition that all practitioners will encounter on a professional or personal basis. This may strike many as disheartening, but there is most definitely light at the end of the tunnel. As physical therapists, we represent the stepping stones helping to guide patients to the end of their tunnel making each stride less painful. In this week’s newsletter we will explore the ins and outs of OA while giving you new steps to help guide your patients forward successfully. 

The Roots of the Issue

‘Bone on bone’ is a loaded term that we tend to hear second hand from patients that are scared straight by their physicians. After looking at their radiographs it is clear why this is the go to phrase to explain the condition concisely, but why did it come to this in the first place?

Osteoarthritis is a natural physiological process that develops over time due to the cumulative wear and tear our bodies experience with age and activity. However, this process is accelerated when we introduce a consistent increased load to our joints and chronic inflammation that are both driven by modifiable risk factors. Obesity and diabetes are the dynamic duo that are leading the cause against healthy, happy, and mobile joints. When we consider that 43% of adults over 18 are overweight and 8.9% of the US population is diabetic it makes sense to see a 113% increase in OA, it was inevitable^4,5. Additionally, arthritis and its contributing factors often create a vicious cycle in which pain leads to reduced activity, reduced activity contributes to weight gain and diabetes, and these inflammatory conditions further worsen arthritic symptoms. While non-modifiable risk factors like age (55 and older), female sex, and a history of injury (such as orthopedic trauma or repetitive motion) play a role in osteoarthritis prevalence, the most effective approach is early prevention by addressing modifiable risk factors.

There’s a Storm Coming?

While osteoarthritis is a debilitating condition, you may have been exposed to patients that embrace their pain in a more comedic light. By this we are referring to the age-old conversation that one may be able to tell that a ‘storm is brewing’ just by how their knee feels. As a quick detour from the gravitas of OA, it’s time to see if this myth has any credibility.

Published in 2023, a meta-analysis/systematic review was conducted looking at 14 studies to find associations between weather conditions and OA pain. In short, they found that OA pain has positive correlations with barometric pressure and relative humidity, whereas temperature was a negative correlation. As for the strength of these correlations, temperature and barometric pressure were found with moderate strength while relative humidity was weak. From a physiological perspective, there is in fact a basis for these correlations. In mice models it was found that proteins coined as ‘Thermo-TRPs’ (Thermosensitive Transient Receptor Potential channels) exist and lead to mice demonstrating mechanical pain sensitivity at 50℉ as well as having interactions with other meteorological factors². As for a clear objective scale to associate OA pain and weather conditions, these studies found limitations in producing valid and reliable metrics due to the subjective nature of pain rating and the relatively small database to pull from to accumulate similar testing conditions.

So while your patient's achy knee might not replace your local weather app just yet, it turns out their joints may actually be better meteorologists than we thought.

Differential Diagnosis-Is OA Really What You’re Dealing With?

Sadly, reports of ‘joint pain’ are not a sure fire way to differentially diagnose osteoarthritis. If that were the case, then physician diagnoses and our doctoral degree in physical therapy would carry much less weight. While making a medical diagnosis isn’t within our scope, recognizing when something more serious may be going on helps us either refer for further evaluation in direct access settings or adjust our care to account for underlying systemic conditions. The chart below outlines similar conditions along with their key signs and symptoms to help distinguish them from osteoarthritis¹.

Current Treatment Recommendations

When it comes to osteoarthritis, we cannot turn back the clock or undo years of joint wear and tear, but we can support patients where they are and help them make meaningful progress. There is no magic bullet to fix for OA. Current clinical practice guidelines emphasize aerobic exercise, joint mobility, and strengthening the muscles around the joint, but the most powerful tools we have are education and collaboration. That might sound vague, so let us explain. As mentioned earlier, many people with OA fall into a cycle of inactivity that only makes their symptoms worse. What they truly need is consistent, manageable movement. This is where we play a key role, helping patients navigate the space between pain and function. By introducing low-impact options like aquatic therapy, cycling on a stationary bike, or teaching how to use assistive devices, we can help them start moving again in ways that feel safe and doable. When combined with functional training and clear, achievable goals, we set the stage for patients to get the most out of the conservative treatments we offer^6,7,8.

Parting Thoughts

Osteoarthritis is a chronic condition, but it doesn’t have to hold patients back. With a good understanding of the condition, a careful clinical eye, and strong communication, we can help people manage their symptoms and stay active. As clinicians, we are in a unique position to bring clarity and support as patients figure out what works best for them. When we educate and collaborate, we empower patients to take control of their health instead of feeling limited by their diagnosis. We may not be able to change the forecast, but we can definitely help them get through the storm.

What have you found most effective in getting your patients moving again? Are there particular strategies or tools you’ve seen make the biggest impact? We encourage you to share your knowledge from any encounters with OA that you have had to grow our body of knowledge in the fight against this chronic condition.

References:

1. Heick J, Lazaro R. Goodman and Snyder’s Differential Diagnosis for Physical Therapists: Screening for Referral. 7th ed. Elsevier; 2022.

2. Wang L, Xu Q, Chen Y, Zhu Z, Cao Y. Associations between weather conditions and osteoarthritis pain: a systematic review and meta-analysis. Ann Med. 55(1):2196439. doi:10.1080/07853890.2023.2196439

3. Osteoarthritis. Accessed May 21, 2025. https://www.who.int/news-room/fact-sheets/detail/osteoarthritis

4. Obesity and overweight. Accessed May 21, 2025. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

5. CDC. National Diabetes Statistics Report. Diabetes. July 23, 2024. Accessed May 21, 2025. https://www.cdc.gov/diabetes/php/data-research/index.html

6. Van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, Peter WF. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care. 2020;18(4):575-595. doi:10.1002/msc.1492

7. Teo PL, Hinman RS, Egerton T, Dziedzic KS, Bennell KL. Identifying and Prioritizing Clinical Guideline Recommendations Most Relevant to Physical Therapy Practice for Hip and/or Knee Osteoarthritis. Journal of Orthopaedic & Sports Physical Therapy. Published online June 30, 2019. doi:10.2519/jospt.2019.8676

8. Wang W, Niu Y, Jia Q. Physical therapy as a promising treatment for osteoarthritis: A narrative review. Front Physiol. 2022;13:1011407. doi:10.3389/fphys.2022.1011407

Disclaimer:

We are current Doctor of Physical Therapy (DPT) students sharing information based on our formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While we strive to provide accurate and up-to-date information, our knowledge is based on my current academic and clinical rotations and ongoing learning, not extensive clinical practice.