KNEE BONE ON BONE: Pain Management & treatment Options


KNEE BONE ON BONE: Pain Management & treatment Options

A healthy knee has cartilage, which is a soft, pliable substance that lies in the space between the bones. Hyaline and articular cartilage are the two forms of cartilage. Your meniscus is composed of the first. Both the right and left sides of your knees have this tissue, which serves as a natural shock absorber. The surface of the bones is covered in articular cartilage. Its smoothness and viscosity enable the joint’s surfaces to slip past one another with little resistance.

“Bone on Bone” refers to the growing severity of osteoarthritis (OA) in a joint. Osteoarthritis is an inflammation of the bones within a joint brought on by a loss of cartilage. In a healthy joint, cartilage aids in the alignment of movement of the joint between the two bones.


Your doctor has informed you that bone on bone pressure within the joint is the cause of your knee discomfort. What does this mean? We must first comprehend the anatomy of a healthy knee before we can examine the reasons for bone-on-bone knee discomfort.

The knee’s ability to absorb stress is reduced as a result of cartilage loss, and each movement increases internal friction. The main cause of degenerative joint disease is osteoarthritis). Inflammatory processes intensify and pressure is put more directly on the bones as your joint tissue deteriorates. Simple movements like standing up from a chair or walking become more painful.

Common knee bone on bone signs and symptoms

  • Localized joint pain, stiffness, lack of flexibility, a grinding sensation, swelling, feeling weaker, and touch sensitivity are common symptoms. Localized joint pain, stiffness, lack of flexibility, a grinding sensation, swelling, feeling weaker, and touch sensitivity are common symptoms.
  • A physical examination and imaging procedures (often x-rays) are used to make a clinical diagnosis. Any one or all the knee’s three compartments can develop knee OA (inside, outside, between kneecap and thigh bone).
  • A crucial point to remember when using imaging is that the x-ray doesn’t always match symptoms completely. Both major joint changes and little discomfort may be present, as well as modest joint changes and severe pain.

How Does Pain in the Bone-on-Bone Knee Feel?

Depending on how severe it is, bone-on-bone knee discomfort brought on by advanced arthritis can differ from person to person. Typically, it will feel like a dull, aching discomfort. However, some people experience a strong ache that alternates between those two characteristics.

For most patients, the area of pain corresponds with the site of bone-on-bone contact. This disorder can develop when the cartilage in a joint is worn away and the bones begin to rub against one another.

It is important to remember that arthritic pain is usually localized. Normally, it doesn’t radiate. Unlike other joint problems, which might affect numerous body parts, knee pain only hurts in the affected knee. As an illustration of radiating pain, consider lower back pain that radiates to the lower leg or foot.

What Leads to Osteoarthritis in the Knee?

Age is the primary factor in knee osteoarthritis. Osteoarthritis will eventually affect almost everyone in some way. However, several factors raise the chance of severe arthritis occurring earlier in life.

  • Age: As a person ages, cartilage loses some of its healing capacity.
  • Weight: Weight puts more strain on every joint, but especially the knees. Your knees will carry an additional 3 to 4 pounds for every pound you acquire in weight.
  • Heredity: This includes genetic changes that could increase a person’s risk of developing knee osteoarthritis. It might also be brought on by genetic deviations in the structure of the bones that are around the knee joint.
  • Gender: Osteoarthritis of the knee is more common in women than in males between the ages of 55 and 80.
  • Damage caused by repeated stress: These are frequently a result of the kind of job that a someone has. Because of the constant strain on the joint, those who work in specific industries that require a lot of kneeling, crouching, or moving heavy objects (55 pounds or more) are more likely to develop osteoarthritis of the knee.
  • Athletics: Long-distance runners, tennis players, and soccer players may have an increased chance of getting knee osteoarthritis. That implies that players should exercise caution to prevent harm. It’s crucial to remember that consistent, moderate exercise helps to strengthen joints and can lower the risk of osteoarthritis. Osteoarthritis can be brought on by weak knee-area muscles.
  • Other diseases: Osteoarthritis is more likely to develop in those with rheumatoid arthritis, the second most prevalent kind of arthritis. Osteoarthritis is also more common in people with specific metabolic problems, such as iron overload or excess growth hormones.

What Can You Do to Relieve Pain from Bone-on-Bone Knees?

Although there is no cure, the discomfort can be managed. Acetaminophen, nonsteroidal anti-inflammatory drugs (such aspirin, ibuprofen, or naproxen), or even opioids, may be recommended by your doctor. But for some patients, continued use of these medications might cause substantial negative effects.

Steroid injections are also given to certain people to treat their symptoms. But when used for too long, they develop adverse effects.

Total replacement of the knee joint is a final resort when medicine and physical treatment are insufficient to provide you with enough relief. However, not everyone should do this. Some individuals shouldn’t undergo this procedure due to their age or other health issues.

To treat osteoarthritis of the knee, researchers are exploring novel therapies. They are experimenting with the following techniques, among others.

Treatment of Knee Bone-on-Bone/ Osteoarthritis:

Relieving pain and restoring mobility are the main objectives of treatment for osteoarthritis of the knee. Typically, the treatment program will combine several the following:

  • Loss of weight: If necessary, even a small amount of weight loss can considerably lessen osteoarthritis-related knee pain.
  • Exercise: Knee stability and discomfort are improved by strengthening the muscles around the knee. Exercises that stretch the muscles around the knees maintain them flexible and fluid.
  • Pain relievers and anti-inflammatory medications: For example, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen sodium, which are available without a prescription (Aleve). Without first seeing your doctor, don’t take over-the-counter drugs for longer than 10 days. The likelihood of side effects increases with continued use. Your doctor might prescribe an anti-inflammatory pill or another medication to aid with the pain if over-the-counter remedies don’t work.
  • Injections of hyaluronic acid or corticosteroids into the knee: Strong anti-inflammatory medicines include steroids. In joints, hyaluronic acid often exists as a lubricating fluid.
  • Substitute treatments: Topical creams containing capsaicin, acupuncture, or dietary supplements like glucosamine and chondroitin or SAMe are some alternative therapies that may be useful.
  • Using tools like braces: There are two different kinds of braces: “unloader” braces, which shift weight away from the side of the knee affected by arthritis, and “support” braces, which offer overall knee support.
  • Occupational and physical therapy: Physical or occupational therapy can help if you’re having problems with daily tasks. You can learn from physical therapists how to make your muscles stronger and your joints more flexible. Occupational therapists can show you how to carry out common, everyday tasks—like housework—less painfully.
  • Surgery: Surgery is a good alternative if other therapies don’t work.

Is Surgery Used to Treat Knee Osteoarthritis?

1- Arthroscopic Lavage and Debridement?

  • Cartilage Repair Techniques
  • Bone Marrow Stimulating Techniques
  • Osteochondral Transplantation Techniques
  • Autologous Chondrocyte Implantation (ACI)

2- Osteotomies around the Knee

  • Joint Arthroplasty
  • Total Knee Arthroplasty (TKA)
  • Minimal Invasive Surgery (MIS)
  • Biomechanics and Anatomic Improvements in Implant Design
  • Implant Fixation
  • Intraoperative Control 


According to study, increasing hip and knee muscular strength and doing joint mobilizations can lessen knee pain caused by osteoarthritis. Unlike machines, people are not as simple as they are. We are a lot more. Of course, everyone is a little different. As a result, what may be effective for one individual might not be for another. My responsibility as a physical therapist is to determine what suits you the best! My favorite. My day is more varied because of it, and I face numerous interesting problems. Finally, “bone on bone” does not mean the game is over. Game on!

Frequently asked questions ( KNEE BONE ON BONE )

If you have bone on bone, do you need a knee replacement?

The knee becomes increasingly looser and more unstable as knee arthritis worsens. Sometimes, this is a minor issue. In some instances, it is significant enough to make the patient trip and fall. Bone-on-bone arthritis sufferers who are starting to fall should urgently consider surgery

Is Walking Effective for Treating Bone-on-Bone Knee Pain?

Walking has advantages and disadvantages. In general, it’s beneficial to continue doing some form of weight-bearing exercise for your bones, muscles, and cardiovascular system. But occasionally, walking might aggravate an arthritic knee’s pain.
While there are no specific activities that patients with bone-on-bone knees are prohibited from doing, they should pay attention to their bodies and choose activities that are less taxing on the knee joints.

What Could Happen If You Put Off Seeing a Specialist for Bone-on-Bone Knee Pain Relief Too Long?

It is uncommon for a patient to reach the stage of bone-on-bone contact when the tibial plateau or the femoral condyle are beginning to crumble. In most cases, reconstructing a knee won’t be possible after it’s too late.
However, delaying bone-on-bone knee pain treatment for a long time can exacerbate existing medical comorbidities like age or weight. You can also need surgery due to cardiac problems you may have acquired later in life.