Joint pain and osteoarthritis

What usually happens

Using the joint does not wear it out faster. This is the belief that does the most harm: resting to protect the joint weakens the muscle around it, and weaker muscle means more pain, which encourages more rest. Movement is treatment.

Exercise is the most effective thing available, and that is not a consolation prize. Strengthening the muscles around the joint reliably reduces pain — often by more than tablets — and it is the one thing that keeps working.

What the X-ray shows and how much it hurts often disagree. Badly worn joints can be comfortable and mildly worn ones can be miserable, which is why we do not treat the picture.

Surgery is for later, and for a minority. Most people manage well for years without it, and being offered other things first is not being fobbed off.

At your appointment

We will ask which joints, what makes it better or worse, and — most usefully — what it stops you doing. That last one steers the plan more than the pain score.

We will examine the joint, and often decide against an X-ray: it rarely changes what we would do, and a worrying-looking report can make people move less rather than more.

Most people leave with a movement and strengthening plan, something for pain to make that possible, and a review point. Referral to physiotherapy is common and is treatment, not a holding pattern.

Worth asking

• —What exercise specifically, how often, and how do I start without flaring it?
• —How much pain is acceptable while I am exercising?
• —What can I take, and what does it realistically do?
• —At what point would we talk about a specialist or surgery?