Knee and hip pain is one of the most common musculoskeletal complaints, especially in middle age and beyond. It is often associated with the idea of “wear and tear”, as if it were an inevitable and unsolvable process.
However, scientific evidence shows that pain and structural changes are not always directly related.
Pain does not equal image
Studies show that changes consistent with osteoarthritis are often identified in imaging tests of people without pain. This means that the presence of ‘wear and tear’ on an X-ray or MRI does not, in itself, explain the symptoms.
Pain is a complex experience, influenced by physical and biological factors, as well as by the individual context. It does not depend exclusively on the structural state of the joint.
What is osteoarthritis?
Osteoarthritis is a condition characterised by progressive changes in the cartilage and other joint structures. It can affect the knee, hip and other joints.
International recommendations are consistent: first-line treatment should include therapeutic exercise, education and promotion of physical activity. Prolonged rest is not recommended as a primary strategy.
Why does pain persist?
Pain can persist when there is:
- decreased muscle strength
- reduced physical activity due to fear
- loss of joint tolerance to load
Completely avoiding movement tends to further reduce this tolerance. The joint needs adequate load to maintain function.
The role of physiotherapy
At Physioclem, intervention begins with a detailed functional assessment, which includes analysis of gait, climbing and descending stairs, hip and knee strength, and movement patterns.
The approach is based primarily on:
Progressive therapeutic exercise
Exercise is considered a first-line intervention in the main international recommendations for knee and hip osteoarthritis.
Education
Understanding that pain does not necessarily mean structural deterioration helps to reduce fear and promote safe movement.
Load management
Temporarily adjusting certain activities allows movement to be maintained without aggravating symptoms.
In conclusion
Knee and hip pain should not automatically be viewed as a sentence of irreversible wear and tear.
With proper assessment and evidence-based intervention, it is possible to reduce pain, improve function, and maintain an active lifestyle.
At Physioclem, the approach is individualised, progressive, and focused on functional recovery — because safe movement is an essential part of care.
References
Culvenor AG, Oiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on MRI in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268–1278. doi:10.1136/bjsports-2018-099257.
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976–1982. doi:10.1097/j.pain.0000000000001939.
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578–1589. doi:10.1016/j.joca.2019.06.011.
