Osteoarthritis is the most common form of arthritis in Canada, affecting millions of people and becoming more common with each decade of life. For many, the diagnosis arrives with a sense of inevitability: the joint is worn out, it will only get worse, and eventually it will need replacing. Often the advice that comes with it is to take it easy.
That picture is outdated, and in some ways it is the opposite of the truth. This article explains what osteoarthritis really is, why exercise is the recommended first treatment, how to exercise when your joints hurt, and where other treatments, including surgery, fit in.
Not just wear and tear
The phrase 'wear and tear' implies a joint that is gradually ground down by use, like a tyre. That is not how living tissue behaves. Osteoarthritis involves the whole joint — cartilage, the bone beneath it, the joint lining, ligaments and the surrounding muscles — and reflects an imbalance between the stresses on the joint and its ability to repair and adapt.
Joint tissues respond to load. Cartilage is nourished by movement and compression. Muscles that support the joint grow stronger with exercise and absorb forces that would otherwise reach the joint surfaces. Inactivity weakens all of these. That is why people who stay active with osteoarthritis generally do better than those who rest, and why exercise does not 'use up' a joint.
Common symptoms
Osteoarthritis typically develops gradually and affects weight-bearing joints such as the knees and hips, as well as the hands and spine.
- Pain with activity, especially weight-bearing such as walking, stairs or standing.
- Stiffness after rest, typically lasting less than about 30 minutes in the morning.
- Reduced range of movement — difficulty bending the knee fully or putting on socks with hip arthritis.
- Swelling, especially after more activity than usual.
- Crunching or creaking sounds, which are common and not in themselves harmful.
- Pain that fluctuates, with good and bad days or weeks.
The X-ray is not the whole story
Many people are told their X-ray shows 'bone on bone' and assume exercise cannot help. In reality, there is a weak relationship between X-ray findings and how much pain or difficulty someone has. Some people with severe-looking X-rays have little pain, while others with mild changes have significant symptoms. Many people over 50 without any knee pain show osteoarthritis changes on imaging.
Pain in osteoarthritis is influenced by muscle strength, activity levels, sleep, mood, general health and how sensitive the nervous system has become — all of which can change. That is why two people with identical X-rays can have very different experiences and why exercise helps even when imaging looks advanced. Guidelines recommend diagnosing osteoarthritis clinically, without imaging, in people over 45 with typical symptoms.
Why exercise comes first
Every major international guideline for knee and hip osteoarthritis recommends exercise and education as core treatment for everyone, regardless of age, severity or other conditions. Strengthening, aerobic and neuromuscular exercise reduce pain and improve function. The size of the benefit is comparable to that of common painkillers, and it comes with improvements in heart health, blood sugar, mood and sleep rather than side effects.
In Canada, the GLA:D programme — Good Life with osteoArthritis: Denmark — delivers structured education and neuromuscular exercise for knee and hip osteoarthritis. Participants typically report reduced pain and improved function, and some people who expected to need surgery find they no longer do.
| Treatment | Role |
|---|---|
| Education and exercise | First-line for everyone |
| Weight management | First-line where relevant |
| Walking aid, footwear, bracing | Helpful adjuncts for some |
| Topical anti-inflammatory gels | Useful for knee and hand pain |
| Oral medication | Short-term, with physician guidance |
| Steroid injection | Short-term relief for a flare |
| Joint replacement | When symptoms remain severe despite the above |
What a good programme includes
An effective osteoarthritis programme combines several elements and is matched to your goals and current ability.
- Strength training for the muscles around the joint — the quadriceps and hip muscles for knee osteoarthritis, the gluteals and thigh muscles for the hip.
- Aerobic exercise such as walking, cycling, swimming or water exercise, building toward 150 minutes a week.
- Neuromuscular exercise that improves control and alignment during functional movements like squatting and stepping.
- Range-of-motion work to maintain flexibility.
- Balance training, which also reduces falls risk.
- Education on pain, pacing and managing flares.
Exercising when it hurts
It is natural to worry that pain during exercise means damage. With osteoarthritis, that is not usually the case. A widely used approach is the pain monitoring model: rate your pain from zero to ten during exercise. Pain up to about five out of ten is acceptable, provided it settles back to your usual level within 24 hours and does not progressively increase from week to week.
If pain goes above five, or is worse the next day, reduce the intensity or volume of the exercise rather than stopping completely. Over weeks, as strength builds, most people find they can do more with less pain. Starting with low-impact options like cycling or water exercise can help on bad days.
Weight, sleep and the rest of the picture
For knee osteoarthritis in particular, weight has a large effect. Each kilogram of body weight adds several kilograms of force through the knee with each step, so even a modest loss of five to ten percent of body weight can noticeably reduce pain and improve function. Weight also affects inflammation in the body more broadly.
Sleep, stress and mood matter because they influence pain sensitivity. Poor sleep makes pain worse, and pain makes sleep worse; breaking that cycle helps. Staying socially active and continuing activities you enjoy, even in modified form, is part of treatment rather than an extra.
When to consider surgery
Joint replacement is an excellent operation for the right person at the right time. It is generally considered when pain and loss of function remain severe despite a genuine trial of exercise, education, weight management and appropriate medication, and when they significantly limit daily life.
Exercise before surgery — sometimes called prehabilitation — improves recovery afterwards, so it is worthwhile even for people already on a surgical waiting list. Arthroscopic 'clean-out' surgery for knee osteoarthritis is not recommended, as trials have shown it is no more effective than non-surgical care.
Managing a flare
Even with a good programme, osteoarthritis tends to have flares — a few days or weeks when the joint is more painful and swollen, often after an unusually busy day, a long trip or a change in routine. Flares are a normal part of the condition, not a sign that the joint has suddenly deteriorated or that exercise has failed.
During a flare, reduce rather than stop activity. Swap long walks for shorter, more frequent ones, choose cycling or water exercise over impact, and lower the weights or repetitions in your strength programme for a week or so. Ice or heat, whichever you find more comfortable, a topical anti-inflammatory gel for the knee and gentle range-of-motion exercise help settle things. Most flares ease within days to a couple of weeks. If one lasts longer, or the joint becomes hot, red and very swollen, see your physician.
Supplements, shoes and gadgets
People with osteoarthritis are offered an endless stream of products. Glucosamine and chondroitin have been studied extensively and show little benefit over placebo for most people, so major guidelines do not recommend them. Wedged insoles are no longer recommended for knee osteoarthritis, though comfortable, supportive footwear helps many people walk further. A walking pole or cane used in the hand opposite the painful hip or knee meaningfully reduces load on the joint and is an underused, inexpensive aid. Knee braces can help some people with particular patterns of knee arthritis and are worth discussing as part of an assessment rather than buying blind.
Arthritis physiotherapy in Woodbridge
At Med Wellness in Woodbridge, our physiotherapists assess knee and hip osteoarthritis and build a structured programme of education, strengthening, aerobic and neuromuscular exercise around your goals. We help you manage flares, adjust activities rather than abandon them, and prepare for surgery if and when that becomes the right choice.
No referral is needed in Ontario, and physiotherapy is covered by most extended health plans. Call +1 (905) 605-8889 to book an assessment.
References
Written by Sandip Dhameliya, Registered Physiotherapist · Clinically reviewed by Paramjeet Kaur Bassi · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
