Knee Osteoarthritis: Causes, Symptoms and How Chiropractic Care May Help

Knee osteoarthritis is common, manageable and does not follow the decline most people assume that it does. Symptoms will fluctuate. People with substantial changes on an X-ray walk comfortably for years and plenty with mild changes on a scan might find that they struggle. What can make things worse is the loss of muscle mass and confidence that follows when someone gets the diagnosis because they stop using their leg and knee for movement and exercise.

This page covers the osteoarthritic knee, it’s causes and symptoms and what chiropractic may be able to do to help it. Mechanical and injury-related knee problems have their own page on knee pain, and many others lower limb conditions are explained on my leg, knee, ankle and foot pain guide page.

“He has made a huge difference to us and our problems ”

“We both have various complex needs for our backs, spine and knees and since moving to Bournemouth have been looking to find a chiropractor. Our GP from the Westbourne Medical Centre recommended seeing Leslie… He has made a huge difference to us and our problems and is a kind, caring and knowledgeable person”

John & Di N

What is knee osteoarthritis?

Osteoarthritis is a condition of the whole joint rather than of cartilage alone. The cartilage thins, the underlying bone thickens, small spurs form at the edges, the joint lining can become irritated and the surrounding muscles usually weaken. All of that happens together, which is one reason the old description of simple wear and tear is unhelpful.

It also explains why scans and symptoms match poorly. Marked changes turn up on the X-rays of people with no pain at all, while others struggle with a knee that looks close to normal. “Bone on bone” sounds painful and but it describes a picture, not a prognosis and it says nothing about what you will be able to do as time goes on. Current UK guidance is that in someone over forty-five years old, with activity-related knee pain and morning stiffness lasting less than half an hour, a diagnosis can be made clinically without imaging.[1]

What causes osteoarthritis of the knee

Age is the largest single factor, but it does not make osteoarthritis an inevitable part of ageing. Previous injuries matter. A serious ligament tear, a meniscal injury or a fracture through the joint in your earlier years can raise the risk of post-traumatic osteoarthritis later in life, which is why so many of the knees I see belong to people who played a lot of sport in their youth.

Body weight matters because the load through the knee is a multiple of body weight. Work involving heavy lifting, kneeling or repeated squatting contributes as does weakness in the quadriceps and hip muscles and family medical history can also play a part. What does not cause it is ordinary walking and exercise, using the joint does not uses it up and wear it out.

Explore our leg, knee, ankle and foot guides

Leg, knee, ankle or foot pain: the main guide

Heel, ankle and foot

Knee, thigh and calf

Knee pain: runner’s knee, bursitis, clicking, locking and giving way
Knee osteoarthritis: wear and tear, bone on bone (you are here)
Muscle strains of the leg: pulled hamstring, quadriceps, calf and night cramps

Related guides

When leg pain starts in the back

When leg pain starts in the hip or pelvis

Staying active

Symptoms of knee osteoarthritis

The usual pattern is knee pain that comes on with activity and standing and it eases with rest and is at its worst on stairs, kneeling and getting out of a low chair. Stiffness after sitting still is typical and wears off within a few minutes of moving and morning stiffness is usually short. Many people notice creaking or grating and the knee may swell after a busy day. Some describe it giving way, which is more often quadriceps weakness than anything structural.

Two other patterns are worth separating out. Morning stiffness lasting well over half an hour, several joints involved or a hot puffy knee points towards inflammatory arthritis rather than osteoarthritis and you need to see your GP for blood tests. Sharp, catching pain with true locking is more suggestive of a mechanical problem, covered on the knee pain page. Pain felt at the knee with nothing to find in the knee itself when examined can be referred from the hip, so I examine that area too.

How chiropractic care may help

What chiropractic care can reasonably offer is help with the pain and stiffness, as an adjunct to the core treatment, which is exercise, strengthening, weight management where relevant and a patients understanding of the condition.[1] The exercise does the work. My role is to make exercise possible and to keep you doing it.

The evidence supports this. Land-based exercise produces worthwhile improvements in pain and function. The benefit is moderate and fades over the months if you stop.[2] A trial comparing hands-on treatment plus exercise against steroid injection found the hands-on and exercise group doing better at one year.[3] For people with a higher body weight, diet combined with exercise outperformed either alone.[4] In my clinic that means soft tissue work, mobilisation of the knee and of the hip, ankle and lower back where they are stiff and adding load and an achievable strengthening programme.

Chiropractic or any hands on therapy can not reverse osteoarthritis, regrow cartilage or straighten a joint. What chiropractic can do is help with associated symptoms and support exercise.

Knee replacement and rehabilitation

If a replacement is planned, going into surgery with stronger legs makes the months afterwards easier. Afterwards your surgical team’s protocol takes priority and I work around that. I do not treat a recently replaced knee directly without the surgeon’s agreement. Where I am useful is with everything that has been compensating: the other knee, the hip, the lower back and a walking pattern that has developed. Guidance is that rehabilitation should continue past the point where most people are discharged.[5]

For an arthritic knee I usually expect some change within four to six weeks and I review at that point. If nothing is changing or if the knee is at the stage where a surgical opinion is the sensible next step, I will tell you.

If arthritis in your knee is getting in the way of things you would rather be doing, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

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Red flags for an arthritic knee

Osteoarthritis itself is not dangerous, but a few things that happen to an arthritic knee need a doctor first. A hot, red, swollen knee with a fever needs same-day assessment, because joint infection is an emergency. Sudden severe swelling without an obvious cause needs assessing rather than treating.

Pain that has changed character, is now constant, wakes you at night and is unrelated to what you did that day, particularly alongside unexplained weight loss needs a GP appointment before anything else. A knee that has begun to lock or gives way often enough to cause falls, also needs review, since that may be mechanical rather than arthritic. After a fall, especially if you cannot put weight through the leg, go to A&E.

Your first visit to Bournemouth Chiropractic

At your first chiropractic visit I take a full medical history covering how long the knee has troubled you, what makes the pain worse, how far you can walk and what you have stopped doing. Then I examine the knee, measure its movement, test the muscles around it and check the hip, ankle and lower back. I will tell you what the pattern suggests, whether my medical chiropractic care alongside exercise is likely to help and what a realistic plan could look like, including the work you need to do at home.

Frequently Asked Questions

Can a chiropractor help with knee osteoarthritis?

Chiropractic care may help with the pain and stiffness of knee osteoarthritis as an adjunct to the core treatments which are exercise, strengthening and weight management. It is not a substitute for those core pieces of advice and chiropractic treatment or any other treatment can reverse arthritis or rebuild cartilage.

Will exercise wear my knee out faster?

Exercise usually does not wear out knees nor any joints on the body. Appropriate exercise improves pain and function in knee osteoarthritis.[2] Muscle that is not used weakens and a weaker leg leaves the knee joint less protected. The skill is choosing the right type and amount of exercise and then building it up gradually to restrengthen and keep the knee strong.

Do I need an X-ray? Will osteoarthritis show up on a scan?

Osteoarthritis, especially in the early stages in your knee will not usually show up on an X-ray. In someone over forty-five with activity-related knee pain and little morning stiffness, the diagnosis can be made from the history and examination alone.[1] Imaging is useful when the picture is unclear or something that suggests a different diagnosis or a surgical opinion is being considered.

Does bone on bone mean I need a knee replacement?

Not by itself, that terminology is misleading. Surgery is generally considered when knee pain substantially affects your quality of life and non-surgical treatment has been tried properly and is no longer working. That is a decision about how the pain is affecting your lifestyle, not about how the X-ray looks.

When should I see my GP rather than book with a chiropractor?

Go to your GP first if the knee is hot, swollen and painful and you have a fever, if the pain has become constant and wakes you at night or if you have several painful joints with morning stiffness lasting over half an hour. After a fall, if you cannot put weight through the leg, go to A&E instead.

Whatever is behind your knee pain or if knee osteoarthritis is causing you pain come and find out what helps

Have you been told your knee is worn, has wear and tear or has degenerative change. A lot of people take that to mean the use of their leg is over and there is nothing to do but wait for a knee replacement. That is not always the whole story and what a scan shows often matches the pain less closely than expected. At a first full chiropractic appointment I will take a full medical history, examine the knee and look at how you move through the hip, pelvis and lower back and then give you a picture of where things stand.

Osteoarthritic knees are a very common reason people come to see me here in Bournemouth, usually because the stairs, the garden or the walks they have always done have started to alter.

For knee osteoarthritis, the treatments with the strongest evidence behind them are exercise and where it applies, weight management and those stay at the centre of what I recommend. Hands-on care alongside that is a well-tolerated option worth considering for some people, aimed at keeping the joint moving and helping you manage the load, not at reversing the wear itself. I will tell you about what I think treatment can and cannot do in your case and if you are already on a surgical pathway I will support what your surgeon has planned preoperatively and post operatively

Book an appointment online and you can choose what suits you: a first appointment, which is the full chiropractic visit with a detailed history taking, examination and treatment where appropriate or a free 15 minute consultation, which is simply a no-obligation chat about your problem with no examination and no treatment. If you are not sure which you need, call the clinic.

Call or message, whatever is easiest and we will take it from there.

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