Six Things Everyone With Knee Arthritis Should Know

Dr Adam Walker (PhD) — Director and Head of Rehabilitation, Gold Coast Knee Group

Understanding your knee is a treatment. Not a nice extra alongside the real treatment — one of the three things that actually changes how an arthritic knee feels and functions.

That sounds like something a physiotherapist would say to fill in an appointment. So let me be specific about the mechanism.

Knowledge stops an ache becoming a pain, which is what leads to a scan and sometimes to an operation. And it stops a worry becoming a fear, which is what leads to avoiding the knee, losing condition, and ending up in more pain than you started with.

Both of those paths begin with not knowing what is happening. Both are avoidable.

Here are the six things worth understanding, and then a method for actually learning them — because being handed information is not the same as understanding it.

Why Understanding Your Knee Reduces Your Pain

The Neuro Orthopaedic Institute has led the world in pain education for a long time. After Explain Pain, the way clinicians think about persistent pain changed substantially. They started with chronic back pain and have since turned their attention to knees, producing The Knee Osteoarthritis Handbook1 — the resource we use with our own patients.

The aim is simple to state and hard to do. Help you understand every sensation in your knee. With understanding come solutions.

The flow-on effects reach further than people expect. Understanding your condition:

• Improves your problem-solving and your goal-setting

• Lets you choose the activities that suit you rather than guessing

• Reduces your body’s stress response

• Helps you tell good advice from bad, and there is a great deal of bad advice about knees

• Puts you in charge of your own arthritis

• Improves the other two ingredients — your activity and your inflammation

The three reinforce each other, which is covered in more detail in the three critical ingredients of knee arthritis management.

1. What Knee Osteoarthritis Actually Is

The old story is that osteoarthritis is cartilage wearing out through age, injury and overuse, that nothing much changes it, that exercise only helps in the early stages, and that you will eventually need surgery.

The current view is close to the opposite. Osteoarthritis is a mild whole-body inflammatory process that can show up in any joint. Many things feed into it — what is happening in your knee, your gut, your thoughts and your life. Its course can be changed. Exercise helps at every stage. Symptoms can improve. Surgery can often be avoided.

If you take nothing else from this article, take that. The old story has one logical response, which is to wait. The current one has several, and all of them are things you can start.

2. The Three Critical Ingredients

Knowledge, physical activity and inflammation.

They are not called critical for nothing. Each one improves the other two, which is why one on its own produces modest results and all three together produce the ones that surprise people.

We have written separately on activity and exercise and on inflammation. This article is the third one.

3. How Pain Actually Works

Pain physiology is genuinely complex, and it is the part most worth understanding. Here are the points that matter:

• Everything you feel, think, say or do about your knee can influence your pain. Not “affect how you cope with it” — influence the pain itself.

• Thoughts, beliefs and feelings interact. They are interconnected in the brain and they feed into each other.

• Small things add up. Individually minor thoughts, beliefs and actions combine, and the total makes a large difference.

• The brain is bioplastic. You can change your pain by changing your thoughts, feelings and actions. Slowly, over time, with practice, the helpful patterns get stronger.

• Your brain weighs up danger and safety messages from everywhere in your body and responds with protection — which might be pain, muscle spasm, stiffness in the knee, or more inflammation.

• The key tactic is to reduce danger messages and increase safety messages. Almost everything useful in managing an arthritic knee is a version of that.

This is the framework that makes sense of everything else on this list. Once you understand that your brain is producing a protective response based on the total picture, a great many confusing things about knees stop being confusing.

4. What Your Scan Does and Does Not Mean

Scan results may be the single most misunderstood thing in knee arthritis. They come wrapped in misinformation, and they rob a lot of people of hope they had every right to keep.

Two facts.

Around 50% of people with X-ray findings of knee osteoarthritis have no pain at all. Half. If the changes on the film caused the pain directly, that number would be close to zero.

The relationship between how much change shows on a scan and how much pain someone has is highly variable. Severe changes with minimal symptoms, mild changes with severe symptoms — both are common.

So a painful knee has to be rethought. There are many contributors to the pain, which means there are many possible solutions. A scan showing arthritis is a description of one part of the picture, not a prediction of your future.

5. Noisy Knees are Normal

You can sometimes hear a person coming down the corridor. Cracks, pops and clicks. Should you be worried?

Generally, no. Knees with and without arthritis make noise.

• Clicks are usually tendons moving over bone. Harmless.

• Pops are usually air bubbles in the joint fluid forming with movement. Harmless.

• Grinding and grating is the one that worries people most. It typically relates to roughened cartilage surfaces moving over each other.

Arthritic knees can be noisier, and there is a reason for it — inflammation thins the fluid in the joint, so the noises become more pronounced. Settle the inflammation and the noise reduces. It is a satisfying thing to watch happen.

The rule of thumb: if the noise is not accompanied by consistent pain, it is not something to worry about. If it is, that is worth getting looked at.

6. Why Your Knee Pain Varies So Much

Some days your knee is severe. Other days it is barely there. Nothing about the joint itself changed overnight.

It comes down to context — where you are, who you are with, what you believe, what you value and what you understand. Your pain may vary with the weather, with an afternoon among friends, or with a bad day at work.

All your senses are taking in information, and the result is a different level of perceived threat on different days. Different threat, different pain, same knee.

Understanding this gives people real confidence. It lets you deliberately build more of the situations that carry safety messages, and it lets you recognise the days when your brain is reading more danger than is actually there — without concluding that your knee has deteriorated.

We have gone into this in much more depth in why knee pain changes day to day.

How to Actually Learn This

Reading a list once does very little. Understanding it well enough to change what you do takes a bit of method.

1. One topic at a time. Health information is overwhelming when it arrives all at once. Treat it like a curriculum and build week by week.

2. Use a resource you can work through at your own pace. Somewhere quiet, on your own terms, with a clear plan and enough information but not too much.

3. Use the SALAD approach. As you work through something, note what Surprised you, what Annoyed you, where you got Lost, what Applied to you, and what you Disagreed with.

4. Discuss it. Take your SALAD back to whoever is helping you and talk through what you learned and how it made you feel. This is where most of the value is.

5. Do some of it alongside other people. Sharing what has worked and what has not may be the most valuable part of the whole thing.

That fifth point is why our program runs in groups rather than only one to one. Hearing from someone eight weeks ahead of you does something that no amount of explanation from me achieves.

The Bottom Line

Knee osteoarthritis is not what most people were told it was. It is not simple wear and tear, your scan is not your destiny, your noisy knee is usually fine, and your pain varying wildly from day to day is normal rather than a sign of deterioration.

None of that is wishful thinking. It is where the evidence sits.

And understanding it is not a consolation prize for people who cannot be fixed. It is a treatment in its own right, and it makes the other two treatments work better.

Knowledge is what turns you from someone waiting on their knee into someone managing it.

Want to work through this properly?

Our Healthy Knee Program is built around all three ingredients, and the education runs through it week by week rather than arriving as a handout on day one. It starts with a full knee assessment so the program matches your knee rather than a template.

We see patients across the Gold Coast at Robina, Currumbin and Benowa. You can get in touch with our team or phone 0408 051 943.

FAQs About Understanding Knee Osteoarthritis

🎯 Does my X-ray showing arthritis mean I will have pain?

No. Around half of people with X-ray findings of knee osteoarthritis have no pain at all.

The relationship between how much change shows on a scan and how much pain someone experiences is highly variable in both directions. The image describes one part of the picture.

🎯 Are noisy knees a sign of damage?

Usually not. Knees with and without arthritis make noise. Clicks are typically tendons moving over bone and pops are usually air bubbles in the joint fluid — both harmless.

Grinding relates to roughened cartilage surfaces moving over each other. If it is not accompanied by consistent pain, it is not something to worry about.

🎯 Why is my knee noisier than it used to be?

Arthritic knees often are, and inflammation is a large part of why. It thins the fluid in the joint, which makes the noises more pronounced.

Bring the inflammation down and the noise usually reduces with it.

🎯 Why is my knee pain worse on some days than others?

Because pain is produced in context, and the context changes daily even when the knee does not. Weather, stress, sleep, who you are with and what you believe about your knee all feed in.

Your brain weighs up danger and safety messages from your whole body and responds with protection. Different inputs, different output, same joint.

🎯 Can changing how I think about my knee actually change the pain?

Yes. Everything you feel, think, say or do about your knee can influence your pain — not just how well you cope with it.

The brain is bioplastic, which means it changes with practice. It happens slowly and it needs repetition, but the helpful patterns do get stronger over time.

🎯 What is the SALAD approach?

It is a way of reading actively rather than passively. As you work through information about your knee, note what Surprised you, Annoyed you, where you got Lost, what Applied to you, and what you Disagreed with.

Then talk it through with whoever is helping you. The discussion is where most of the learning happens — a handout on its own rarely changes anything.

🎯 Should I get a scan of my knee?

Often it changes nothing about your management, and it can leave you more worried than before. That said, whether imaging is appropriate is a clinical decision for your GP based on your particular presentation.

We have written specifically about imaging and meniscus tears in meniscus tears in the older knee.

🎯 Is understanding my condition really a treatment?

It is one of the three things that make the difference, alongside activity and inflammation, and it improves both of the others.

Practically, it does two jobs. It stops an ache turning into a pain that ends up scanned and sometimes operated on. And it stops a worry turning into a fear that stops you using the knee, which is how people lose condition and end up worse.

🎯 Where can I learn more about knee osteoarthritis?

The Knee Osteoarthritis Handbook, written by Moseley, Butler and Stanton, is the resource we use with our own patients. It was written specifically to translate the science into language that is actually usable.

Work through it a topic at a time rather than in one sitting, and use the SALAD method as you go.

References

1 Moseley GL, Butler DS, Stanton TR. The Knee Osteoarthritis Handbook. Noigroup Publications, 2023. https://www.noigroup.com/product/knee-osteoarthritis-handbook/