Bone-on-Bone Knee Pain: Best Treatments, According to Physical Therapists

Learn about bone-on-bone knee pain as well as the best treatments and relief options, including physical therapy.

Published Date: Aug 7, 2023

If you’ve been struggling with knee pain and your doctor has used the phrase “bone on bone” to describe your ailment, you might be pretty alarmed. You might assume it means you’re destined to live in pain or that surgery is inevitable. If so, it might be time to think again. “This is rarely the case,” says Dylan Peterson, PT, DPT, a physical therapist and product consultant at Hinge Health.

When a healthcare provider refers to knee arthritis as “bone on bone,” it usually means you have arthritis that is pretty advanced and that the cartilage that should cushion the joint has run pretty thin, says Dr. Peterson. But significant arthritis in a joint doesn’t necessarily translate to how you feel, nor should it deter you from engaging in movement that can improve your comfort and mobility over time.

Here, learn more about bone-on-bone knee pain and find out how to feel better with tips from our Hinge Health physical therapists.

Our Hinge Health Experts

Dylan Peterson, PT, DPT
Physical Therapist and Clinical Reviewer
Dr. Peterson is a Hinge Health physical therapist who focuses on developing clinical exercise therapy programs and member education.
Jonathan Lee, MD, MBA
Orthopedic Surgeon and Medical Reviewer
Dr. Lee is a board-certified orthopedic surgeon and an Associate Medical Director at Hinge Health.

Osteoarthritis: A Common Cause of Knee Pain

Knee pain is very complex and can be related to a number of different factors. One of the more common contributors to knee pain is osteoarthritis (OA), a condition characterized by pain, stiffness, and inflammation of a joint. OA occurs, in part, when cartilage — a slippery, shock-absorbing tissue — gets thinner. But the entire joint and surrounding tissues may also be impacted. That includes the bone itself as well as nearby ligaments, fat, and the synovium (lining of the joint).

Any changes to the joint may lead to pain and changes in mobility. However, not everyone with knee OA has pain, and some don’t even know that they have osteoarthritis. In fact, research shows that more than half of those who show signs of knee OA on imaging (e.g., X-ray, MRI) have no pain, says Dr. Peterson.

Knee osteoarthritis can range from mild to moderate or severe. People with severe knee OA may have very little cartilage, which means there’s less space between the bones in the knee. This is where the notion of “bone on bone” comes from, but Dr. Peterson advises against dwelling on it. How you feel and function is more important than what your X-rays show, he says. And what your scans say isn’t a reliable indicator of how you feel in your everyday life. 

“Bone-on-Bone” Knee Pain: A Hinge Health Perspective

As a general rule, Hinge Health physical therapists try to avoid describing knee OA or any type of OA as “bone on bone” because patients tend to find this language scary and discouraging. “It can keep them from taking action to change how they feel,” says Dr. Peterson.

Dylan Peterson, PT, DPT
You might not be able to change how your knee looks on a scan, but you can absolutely change how you feel with movement, exercise, and other measures.

Dr. Peterson notes that his father has what doctors have described as bone-on-bone OA in his left knee, but that his dad has taken steps to strengthen the surrounding muscles, reduce extra tension on the knee, and bring more blood flow to the area so that the joint fluid is refreshed often. The result: “Most days his pain is a one or two out of 10, but it doesn’t keep him from going to the gym, hiking, or working in his yard. And sometimes he goes for days without any pain at all.”

Dr. Peterson adds that because “bone on bone” sounds scary, it can make some people more anxious about their condition. Stress and fear contribute to additional inflammation, in addition to influencing their behavior. Hinge Health therapists work to counter such notions and focus on improving function so patients can feel their best. “The goal is getting you back to doing the things you want to do in life,” says Dr. Peterson.

Can You Exercise With Bone-on-Bone Knee Osteoarthritis?

In a word, yes. Many people with advanced knee osteoarthritis are afraid to exercise, even as part of a physical therapy (PT) program, because they think that they’re going to make the problem worse. That’s a mistake, says Dr. Peterson. “Exercise can cause temporary inflammation, and it may cause some increased fatigue and tension, but that’s not a bad thing,” he explains. He notes that even people who are perfectly healthy often have some temporary inflammation and fatigue after exercising. In the long-run, however, activity almost always pays off.

The key, of course, is to find out which exercises are safe for you, and there isn’t any one-size-fits-all “prescription” when it comes to exercising with knee osteoarthritis. While low-impact exercises like walking and swimming may be ideal for beginners and those who are currently sedentary, others with knee OA have no problem engaging in higher-intensity exercise. And if you do better starting with lower-impact activities, you can gradually work up to higher-impact options if that’s something you want to do. “It’s really all about your current level of fitness and what your knee is ready to do at the moment, and then building from there,” says Dr. Peterson.

How Physical Therapy Helps

When it comes to bone-on-bone knee pain relief, physical therapy can be hugely helpful and get you back to the activities you want to do with less pain. No matter how active (or inactive) you are at the moment, working with a physical therapist can help relieve knee pain and increase your mobility.

During an initial appointment, your therapist will rule out any rare but more serious issues that could be causing knee pain (instead of OA). They’ll also assess your strength, flexibility, and range of motion. Next, they’ll likely ask you about your lifestyle and the kind of activities you like to do so they can tailor your care plan to best suit you. 

Your PT exercises will then be designed to address your personal needs. In addition to learning about the right exercises for you, you should also expect your PT to discuss lifestyle and habit changes that can improve your pain and function, says Dr. Peterson. For instance, if you’re currently having a knee flare-up and you love to play pickleball, your PT might advise you to play doubles instead of singles so you can stay active while still scaling back to give your body what it needs. 

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Exercises to Ease Knee Osteoarthritis Pain

Whether you’ve been told that you are “bone on bone” or simply have knee pain, these  exercises recommended by Hinge Health physical therapists can help alleviate knee pain and increase function. Plus, they can help prevent future pain flares. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Find Your Movement ‘Sweet Spot’ 

Pain with movement can be scary. But a little pain during exercise (and for a limited time afterward) is perfectly normal, says Dr. Peterson. This balance between too much and too little is what we refer to as your movement sweet spot and is an important tool in managing your pain day to day. 

“We talk about nudging into your pain,” says Dr. Peterson. “It’s okay to have some discomfort, though how much you can tolerate is subjective.” If you find that your pain has increased so much that it’s impacting your ability to sleep well or move around the next day, you may need to cut back a little until you get stronger. 

Your movement sweet spot can change over time as you get stronger and more mobile, which is part of the reason why finding your sweet spot can be challenging. If you’re not sure whether you’re doing too much or too little, your physical therapist can help guide you, says Dr. Peterson.

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.  

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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  1. Arthritis Treatment. (n.d.). Body Logic. Retrieved from https://bodylogic.physio/conditions/arthritis-treatment/

  2. Osteoarthritis. (n.d.). Arthritis Foundation. Retrieved from https://www.arthritis.org/diseases/osteoarthritis

  3. Bedson, J., & Croft, P. R. (2008). The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskeletal Disorders, 9(1). doi:10.1186/1471-2474-9-116