Osteoarthritis: The Complete Guide to Pain Relief, Exercise and Joint Care

Osteoarthritis affects more than 500 million people worldwide, and many of them have been told the same discouraging thing: it is just wear and tear, and you will have to live with it. That message is out of date. Osteoarthritis is common, but it is also one of the most treatable causes of long-term pain, and the most powerful treatments cost little or nothing.

This guide explains what osteoarthritis really is, how it is diagnosed, what actually reduces pain, how to exercise safely, when injections and surgery make sense, and how to protect your joints for years to come.

What is osteoarthritis?

Osteoarthritis (OA) is a long-term condition that affects the whole joint, not only the cartilage. Cartilage is the smooth, rubbery tissue that covers the ends of bones and lets them glide over each other. In osteoarthritis, cartilage gradually becomes thinner and rougher. The bone underneath reacts by thickening and forming small bony growths called osteophytes, or bone spurs. The joint lining (synovium) can become inflamed, the ligaments and capsule may thicken, and the muscles around the joint often weaken.

For many years, osteoarthritis was described as simple “wear and tear”, as if joints wore out like car tyres. Researchers now see it as an active process in which the joint is constantly trying to repair itself. Sometimes repair keeps up and symptoms stay mild. Sometimes it does not, and pain and stiffness build. This is important because it means what you do, especially how you move and load your joints, can influence how the condition behaves.

How common is it?

The Global Burden of Disease study estimated that around 595 million people were living with osteoarthritis in 2020, roughly 7.6 percent of the world’s population, and numbers are expected to rise sharply by 2050 as populations age and obesity becomes more common. It is one of the leading causes of disability in older adults worldwide. The knee is the most commonly affected joint, followed by the hand and hip. Women are affected more often than men, particularly after menopause.

Which joints are affected?

• Knees: the most common site. Pain is often felt at the front or inner side of the knee, especially on stairs, after sitting or when kneeling.
• Hips: pain is usually felt in the groin or buttock, sometimes spreading down the front of the thigh to the knee. Putting on socks and shoes may become difficult.
• Hands: commonly the joints at the base of the thumb and the end and middle joints of the fingers. Bony lumps called Heberden’s nodes (end joints) and Bouchard’s nodes (middle joints) may appear.
• Feet: especially the joint at the base of the big toe.
• Spine: the small facet joints of the neck and lower back.

Osteoarthritis rarely affects the shoulders, elbows, wrists or ankles unless there has been a previous injury.

Symptoms

• Joint pain that is worse with activity or at the end of the day and eases with rest
• Stiffness after rest or first thing in the morning that usually lasts less than 30 minutes
• Reduced range of movement, such as difficulty bending the knee or rotating the hip
• Grating, creaking or crackling sensations (crepitus)
• Swelling, which may be bony and hard or soft from fluid
• A feeling that the joint is unstable or might give way
• Muscle weakness around the joint
• Pain at night in more advanced cases

Symptoms often come and go in flares. A flare may follow a busy day, a change in activity or for no obvious reason, and usually settles over days to weeks.

Who is at risk?

• Age: osteoarthritis becomes more common after 45, although it is not an inevitable part of ageing.
• Sex: women are more likely to develop it, particularly in the knees and hands.
• Weight: excess weight increases the load on knees and hips, and fat tissue produces inflammatory substances that may affect joints throughout the body, including the hands.
• Previous joint injury: a torn ligament, meniscus injury or fracture into a joint increases the risk, sometimes decades later.
• Occupation: jobs involving repeated kneeling, squatting or heavy lifting.
• Genetics: osteoarthritis, especially of the hands, often runs in families.
• Joint shape: conditions such as hip dysplasia or knock knees and bow legs change how load passes through a joint.
• Muscle weakness: weak thigh muscles are linked to knee osteoarthritis.

Osteoarthritis or rheumatoid arthritis?

These are very different conditions. Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the joint lining. It usually affects many small joints on both sides of the body, causes morning stiffness lasting longer than an hour, swollen, warm, tender joints, and often tiredness and feeling generally unwell. It needs early treatment with disease-modifying medicines. Osteoarthritis typically causes shorter stiffness, affects fewer joints, and is driven by mechanical and local factors. If your joints are hot, swollen and very stiff in the morning, see a healthcare provider promptly.

How osteoarthritis is diagnosed

For most people, osteoarthritis can be diagnosed without any scans. Guidelines from the National Institute for Health and Care Excellence (NICE) say a clinical diagnosis can be made if you are 45 or over, have activity-related joint pain, and have either no morning stiffness or stiffness lasting no longer than 30 minutes.

A nurse, physiotherapist or other healthcare provider will ask about your symptoms and examine the joint, looking at movement, swelling, tenderness and muscle strength. Blood tests are not needed to diagnose osteoarthritis but may be used to rule out other conditions such as rheumatoid arthritis or gout.

Do I need an X-ray?

Often not. X-rays show joint space narrowing and bone spurs, but the picture correlates poorly with pain. Some people with severe X-ray changes have little pain, and others with mild changes have a great deal. X-rays may be useful if symptoms are unusual, worsening rapidly, or if surgery is being considered. MRI scans are rarely needed for osteoarthritis and can show changes that are normal for your age, which may cause unnecessary worry.

The three core treatments that everyone should get

International guidelines, including those from NICE, the Osteoarthritis Research Society International (OARSI) and the American College of Rheumatology, agree on three core treatments for everyone with osteoarthritis, whatever their age or X-ray findings:

1. Education: understanding the condition, knowing that movement is safe and that pain does not mean damage.
2. Exercise: both strengthening and general aerobic activity.
3. Weight management: for people who are overweight, particularly with knee or hip osteoarthritis.

These are not “extras” to try before real treatment. They are the real treatment, and the evidence for them is stronger than for many medicines.

Why exercise is medicine for osteoarthritis

Exercise reduces pain and improves function in knee and hip osteoarthritis by a similar amount to anti-inflammatory painkillers, with far fewer side effects. It strengthens the muscles that absorb shock and stabilise the joint, nourishes cartilage (which gets its nutrients from joint fluid moved around by loading), helps with weight, improves mood and sleep, and reduces the risk of heart disease and diabetes.

Structured programmes such as GLA:D (Good Life with osteoArthritis in Denmark), now delivered in many countries, combine education with supervised exercise and have shown reductions in pain of around a quarter to a third, less use of painkillers, and fewer people wanting surgery.

Strengthening exercises for knee osteoarthritis

• Sit to stand: stand up from a chair without using your hands, then sit down slowly. Start with 8 to 10 repetitions.
• Straight leg raise: lying on your back with one knee bent, tighten the thigh of the straight leg and lift it to the height of the other knee. Hold for five seconds and lower slowly.
• Step-ups: step up onto the bottom stair with your sore leg, then step down. Hold the banister for balance.
• Mini squats: holding a support, bend your knees slightly, keeping your heels down, then straighten.
• Bridge: lying on your back with knees bent, lift your hips off the floor, squeezing your buttocks.

Exercises for hip osteoarthritis

• Side-lying leg lift: lying on your side, lift your top leg slowly and lower it, keeping it in line with your body.
• Standing hip extension: holding a chair, move one leg backwards keeping your back straight.
• Clam: lying on your side with knees bent, keep your feet together and lift your top knee.
• Hip flexor stretch and gentle range-of-movement exercises to maintain flexibility.

Hand osteoarthritis

Gentle range-of-movement exercises, such as making a loose fist then straightening the fingers, touching each fingertip to the thumb, and strengthening grip with a soft ball, can reduce stiffness. Warm water often helps before exercise. A hand therapist can advise on splints for the thumb base and on gadgets that make daily tasks easier.

How much exercise, and what about pain?

Aim to build up to strengthening exercises two or three times a week and around 150 minutes of moderate aerobic activity a week, such as walking, cycling, swimming or water aerobics. It is normal to feel some discomfort during and after exercise. A useful guide is the traffic light approach: pain up to about 2 out of 10 is acceptable, up to 5 out of 10 is acceptable if it settles within 24 hours, and pain above that or lasting longer means you should reduce the amount and build up more gradually. Pain during exercise does not mean you are damaging the joint.

Low-impact activities are often easiest to start with. Swimming and exercise in water reduce load on joints. Cycling, on a static bike or outdoors, is excellent for knee osteoarthritis. Walking is free and effective; start with short, regular walks and increase gradually. Tai chi and yoga can improve strength, balance and pain, particularly in knee osteoarthritis.

Weight and osteoarthritis

Every kilogram of body weight adds roughly three to four kilograms of force through the knee with each step when walking. Losing weight reduces this load and also reduces inflammation. Studies show that losing around 5 to 10 percent of body weight, combined with exercise, can significantly reduce knee pain and improve function. Losing more brings greater benefit. Even if weight loss is difficult, avoiding further weight gain helps.

Newer weight-loss medicines such as semaglutide have been shown in a trial of people with obesity and knee osteoarthritis to reduce weight and knee pain. They are not suitable or available for everyone, and they work best alongside exercise. Ask your healthcare provider whether you might be eligible.

Pain relief: what works and what does not

Topical anti-inflammatories

Anti-inflammatory gels and creams, such as diclofenac or ibuprofen gel, are recommended as a first choice for knee and hand osteoarthritis. They work nearly as well as tablets for these joints, with far fewer side effects because little reaches the bloodstream.

Anti-inflammatory tablets

Oral non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen or celecoxib, can be effective for short periods during flares. They can cause stomach ulcers, bleeding, kidney problems and raise blood pressure and the risk of heart attack and stroke, especially in older people. Use the lowest effective dose for the shortest time, and check with a pharmacist or healthcare provider first, particularly if you have heart, kidney or stomach problems or take blood thinners. A stomach-protecting medicine is often prescribed alongside.

Paracetamol

Paracetamol (acetaminophen) was once recommended as the first medicine for osteoarthritis, but research shows it provides little benefit for most people. Some may still find it helpful for short periods, but it is no longer routinely recommended as a long-term treatment.

Opioids

Strong opioid painkillers such as morphine and oxycodone are not recommended for osteoarthritis. They provide little long-term benefit and carry risks of dependence, falls, constipation and drowsiness. Weak opioids such as codeine and tramadol have similar problems.

Other options

• Capsaicin cream: made from chilli peppers, it may help knee and hand pain when used regularly for several weeks. It can sting at first.
• Duloxetine: an antidepressant that also affects pain processing; it is used in some countries for persistent knee osteoarthritis pain.
• Heat and cold: a warm pack can ease stiffness and a cold pack can help with swelling after activity.
• TENS: a small device that delivers gentle electrical pulses; some people find it useful, though evidence is mixed.

Supplements

Glucosamine and chondroitin are widely sold, but large, high-quality studies have not shown consistent benefits, and NICE does not recommend them. Turmeric and fish oils have limited evidence. If you choose to try a supplement, give it about three months and stop if there is no benefit, and check for interactions with your other medicines.

Injections

Corticosteroid (steroid) injections into the knee or hip can reduce pain during a flare, usually for a few weeks. They are not a long-term solution, and repeated injections may speed up cartilage loss, so most guidelines suggest limiting them to a few times a year and using them alongside exercise.

Hyaluronic acid injections, sometimes called “joint lubricant” injections, have shown small effects in studies and are not recommended by NICE. Platelet-rich plasma (PRP) and stem cell injections are heavily marketed and often expensive, but high-quality trials have not shown convincing benefits. Be cautious about paying for treatments that promise to regrow cartilage.

Aids, footwear and supports

• Supportive, cushioned shoes with a low heel
• A walking stick held in the hand opposite the painful knee or hip, which can reduce joint load significantly
• Knee braces for some people with instability or pain on one side of the joint
• Thumb splints for thumb base osteoarthritis
• Raised toilet seats, chair raisers, long-handled shoe horns and grab rails
• Kitchen gadgets with thick handles, jar openers and lever taps for hand osteoarthritis

An occupational therapist can assess your home and suggest practical changes to make daily tasks easier and safer.

Surgery: when is it time?

Most people with osteoarthritis never need surgery. Joint replacement is considered when pain and stiffness severely affect quality of life, sleep or independence despite at least several months of core treatment. Age, weight and X-ray findings alone should not decide whether you are offered a referral.

Joint replacement

Hip and knee replacements are among the most successful operations in medicine. Most people experience major pain relief and improved movement, and modern implants often last 20 years or more. Recovery involves several months of rehabilitation exercises. Risks include infection, blood clots, stiffness, ongoing pain in a minority of knee replacements, and the need for revision surgery in the future. Getting fitter and stronger before surgery (prehabilitation) improves recovery.

Knee arthroscopy

Keyhole “washouts” or “clean-ups” of the knee for osteoarthritis have been shown in multiple trials to be no better than sham surgery or exercise, and are not recommended unless the knee is mechanically locking.

Other operations

Osteotomy, which realigns the bones, may help younger, active people with osteoarthritis on one side of the knee. Joint fusion is sometimes used for small joints of the hands, feet or spine.

Living well with osteoarthritis

Pacing

Pacing means balancing activity and rest so you can do more over the week without big flares. Break big tasks into smaller ones, alternate heavy and light jobs, and plan rests before you need them. On good days, resist the urge to do everything at once.

Managing flares

• Reduce but do not stop activity; keep the joint moving gently
• Use topical anti-inflammatory gel or heat or cold packs
• Use a stick temporarily if walking is painful
• Return to your normal exercise gradually as pain settles
• Seek advice if the flare does not settle within a few weeks or the joint becomes hot and very swollen

Sleep and mood

Persistent pain and poor sleep feed each other. Good sleep habits, regular exercise and treating pain help. Low mood and anxiety are common in people with long-term pain and are worth discussing, because treating them can also improve pain.

Work

Many people with osteoarthritis continue working. Adjustments such as a supportive chair, reducing kneeling, using lifting aids, or changing tasks or hours can help. In many countries, employers must make reasonable adjustments for long-term conditions.

Can osteoarthritis be prevented?

• Stay active and keep the muscles around your joints strong throughout life
• Maintain a healthy weight
• Protect joints from injury; warm up before sport and use injury prevention programmes for sports such as football and netball, which reduce knee ligament injuries
• Get proper rehabilitation after a joint injury
• Avoid long periods of kneeling or heavy lifting at work where possible

When to seek help urgently

• A joint becomes hot, red and very swollen, especially with fever (this could be infection)
• Sudden severe pain after a fall or injury
• You cannot bear weight on the leg
• The knee locks and you cannot straighten it
• New pain with unexplained weight loss, night sweats or feeling unwell
• Calf pain and swelling after joint surgery

Common myths about osteoarthritis

• Myth: It is just old age. Fact: Many older people have no joint pain, and osteoarthritis can affect people in their 40s, especially after injury.
• Myth: Exercise will wear the joint out faster. Fact: Appropriate exercise reduces pain and is a core treatment.
• Myth: The X-ray shows how bad it will be. Fact: X-ray changes and pain often do not match.
• Myth: It always gets worse. Fact: Many people stay stable for years, and symptoms often improve with treatment.
• Myth: Eventually everyone needs a joint replacement. Fact: Most people never do.
• Myth: Cracking joints mean arthritis. Fact: Painless clicking is common and usually harmless.

A sample week for knee osteoarthritis

• Monday: 20-minute walk plus strengthening exercises
• Tuesday: 30 minutes on an exercise bike or swimming
• Wednesday: strengthening exercises and gentle stretching
• Thursday: 25-minute walk
• Friday: strengthening exercises plus tai chi or a balance class
• Weekend: an active day out or gardening, paced with rests

Adjust to your fitness and pain, and increase gradually over weeks. Consistency matters more than intensity.

The nurse’s role

Nurses in primary care, rheumatology and orthopaedic services often lead osteoarthritis education, medication reviews, weight management support and preparation for surgery. Practice nurses can review painkillers, check blood pressure and kidney function in people taking anti-inflammatories, and signpost to physiotherapy and exercise programmes. Orthopaedic nurses support people before and after joint replacement, from pre-assessment to wound care and rehabilitation.

Frequently asked questions

Is walking good for knee osteoarthritis?

Yes. Regular walking improves strength, fitness and pain for most people. Start with short distances, wear supportive shoes and build up gradually.

Can cartilage grow back?

Adult cartilage has limited ability to regrow, and no injection or supplement has been proven to rebuild it. However, symptoms can improve a great deal without cartilage changing.

Does weather affect osteoarthritis?

Many people report more pain in cold or damp weather. Research is mixed, but keeping warm and active can help.

Should I rest a painful joint?

Short rest during a flare is fine, but long rest weakens muscles and usually makes pain worse. Keep moving within comfort.

Is running bad for my knees?

Recreational running does not appear to increase the risk of knee osteoarthritis in people without previous knee injury and may even be protective. If you already have osteoarthritis, some people can continue running with adjustments; others do better with cycling or swimming.

Will a knee replacement get rid of all my pain?

Most people have major pain relief, but around one in ten to one in five people continue to have some pain after knee replacement. Hip replacements tend to have even better results.

But I have tried exercise and it hurt. Why should I try again?

Because the right exercise, at the right dose, built up gradually, is different from simply doing more. Many people start too hard, flare, and give up. Others are given vague advice without a plan. A physiotherapist or structured programme can tailor exercises to your joint and pain level, and most people notice improvement within six to eight weeks. It is the single most effective thing you can do for osteoarthritis, and it is never too late to start.

Related: Knee pain: causes and what helps · Hip pain · Osteoarthritis vs rheumatoid arthritis · Strength training for beginners

Sources: National Institute for Health and Care Excellence (NG226, Osteoarthritis in over 16s), Osteoarthritis Research Society International guidelines, American College of Rheumatology/Arthritis Foundation guideline, Global Burden of Disease Osteoarthritis Collaborators (The Lancet Rheumatology, 2023), World Health Organization, GLA:D programme.