Is bone-on-bone knee pain a drag on your active lifestyle?
Whether it’s the result of an old knee injury (e.g ligament tear or knee sprain), or knee osteoarthritis (OA) from weak knee mechanics over a long time, let’s explore the therapies you should know about to move forward – with or without surgery.
What happens if your knee is bone on bone
When the cartilage in your knee joint deteriorates, inflammation, pain, and stiffness set in. This is because there’s no longer a smooth surface for the bones to glide over each other without friction.
This means you have osteoarthritis – the most common form of arthritis. The degenerative form is most common in older people, especially in the knee (it’s the largest joint in your body).
The ends of your leg bones start to rub at the level beneath the cartilage – hence the term “bone-on-bone.” The joint space gets narrower, so the meniscus shock absorber can inflame too.
How it’s diagnosed
Bone on bone is most commonly diagnosed through a physical examination and x-ray. The doctor will ask about your medical history and past injuries. They may also order a bone scan or blood tests to help confirm the diagnosis.
Check which doctor to see for knee pain here.
It’s important to rule out other conditions like rheumatoid arthritis – an autoimmune condition that requires different treatments including sometimes, medication.
Note: “Bone on bone” can be misleading and might not be the best way to visualize your knee issue, unless you are truly at end-stage cartilage degeneration – and on the way to a likely knee replacement.
A CT scan or MRI is recommended to show your exact type of degenerative joint disease.
In the meantime, let’s crack on with some ways to get those pain nerves settled with better movement and strength, even if you might need surgery in the future.
6 Options to address Knee Arthritis
1. Physical Therapy
A good starting point for addressing bone-on-bone knee pain is to see a physical therapist.
They will help you to identify which daily activities are causing you pain – and demonstrate how to modify them for less pain. This can often be the key to successful long-term management of your condition.
Your PT will work with you to improve the range of motion in your knee joint with soft tissue work, and show you how to strengthen the muscles around it. This can help to take some of the load off your painful joint and reduce the risk of further cartilage damage.
2. Corticosteroid Injections
If physical therapy alone doesn’t provide enough pain relief, your doctor may recommend corticosteroid injections.
Cortisone is a powerful anti-inflammatory medication that can be injected directly into the knee joint to provide temporary pain relief. It’s usually only recommended once or twice – and for short-term use.
3. Hyaluronic Acid Injections
Hyaluronic acid injections seek to replace your body’s own joint fluid. This synthetic form with brand names like Euflexxa, Gel-One, and Hyalgan  can provide lubrication and cushioning to the knee joint, to reduce pain and stiffness.
They’re usually given once a week for 3-5 weeks – and may need to be repeated every few months to maintain the pain-reducing effect.
4. Stem Cell Injections
Another cutting-edge option for treating knee arthritis is stem cell therapy. This involves taking stem cells from another part of your body – usually from your hip bone – and injecting them into your knee joint.
Do Stem cells work for knee arthritis?
Due to their natural genetic profile, stem cells have the potential to repair and regenerate damaged cartilage. It may not however work for everyone, and cartilage re-growth is not guaranteed.
A new technique of reprogramming adult stem cells (e.g from your hip) to act more like embryonic stem cells holds a lot of promise.  I will be watching this space keenly!
Platelet-rich plasma – what is it?
A similar therapy using your body’s chemistry is PRP – platelet-rich plasma therapy. These are injections of your own blood plasma, which is rich in growth factors that can promote healing. Ask your healthcare provider about PRP for knee joint damage.
5. Weight Loss
Carrying excess weight puts additional pressure on your load-bearing joints – like your hips, spine, and knees.
Every extra kilogram of weight adds extra force to your knees with each step. So, it’s not surprising that losing weight is one of the most effective ways to reduce the pain and disability associated with knee osteoarthritis.
6. Supports and Orthotics, braces
You may find knee arthritis relief from using a shoe insert support or orthotic device, especially if you have uneven wear on your knee joint.
Some people turn to compression socks and boots, to help with venous return of blood and cellular debris, which can help with the muscle soreness that comes with knee OA.
Have more pain on the inside of your knee? Orthotics could help to unload the joint in a way to even up pressure. Talk to your sports medicine doctor or podiatrist– it could be a game-changer!
Flat shoes? Understand how they can cause knee pain here.
Braces for bone on bone
Braces can be helpful for knee osteoarthritis. The most important factor in choosing a knee brace is to make sure that it fits properly. A poorly fitting brace will not provide the support that you need and could actually make your condition worse.
One type is a hinged knee brace. This type of brace has two hinges on either side of the knee joint. The hinges allow the brace to move with your knee as it bends. This provides support and stability to the knee joint and helps to prevent further damage to the joint.
Another is the patellar tendon-bearing knee brace. This type of brace attaches to the kneecap and provides support to the patellar tendon, stabilizing the kneecap. This can give you a feeling of stability and relieve pressure at the top part of your shin bone.
Ice baths for arthritis
Ice baths reduce the pain and inflammation associated with arthritis by constricting blood vessels and numbing the area. This promotes a flush of “new” blood back to the degenerated joint.
They are rising in popularity for people with arthritis pain and other conditions.
The science says ice baths are good for reducing muscle damage post-exercise, however, this report from Healthline suggests more research is needed about the benefits to inflammation.
What I find interesting about cold water immersion is the potential positive impacts on the central nervous system, including benefits for sleep and mental resilience.
If you’re interested in trying this, make sure to talk to your doctor first. And be sure to take care when getting in and out of the bath – as you may be more vulnerable to slips and falls.
Pulsed electromagnetic field therapy
Pulsed electromagnetic field therapy (PEMF) is a type of alternative therapy that uses magnetic fields to relieve pain and promote healing.
PEMF may be effective in treating arthritis. One study found that people with arthritis who underwent PEMF therapy had significantly less pain and stiffness than those who didn’t. 
Acupuncture or dry needling for arthritis
Acupuncture is a Chinese medicine technique that involves inserting thin needles into the skin at specific ‘meridian’ points on the body. While science is lacking on how, or if it works, many have reported its benefits for bone on bone knee pain.
Dry needling uses the same thin needles, but it’s aimed at muscle knots or ‘trigger points’. A physical therapist will target this to the muscles and soft tissues around your inflamed knee joint, to reduce tightness and bring about positive chemical changes.
Bone-on-bone knee exercises to avoid
1. High-Impact Cardio: Running, jumping, or any other high-impact cardio exercise is going to put additional stress on your already painful joints. If possible, avoid these exercises or at least scale back the intensity.
2. Twisting movements: Activities like tennis, soccer, and dancing create torsion at the knee, inflaming your cartilage even more, and causing increased pain.
The hinge joint of your knee works best in flexion and extension (bending and straightening) which is why walking and basic leg exercises are better.
3. Excessive Knee Bending: You should skip deep lunges or squats, which can be detrimental to your cartilage health, depending on your stage of OA.
Focus on building muscle strength and knee joint flexibility in a more limited range of motion first. Do exercises that work other parts of your legs, like your hip stabilizers (glutes) and hamstrings.
Below are some examples of hip strength exercises for knee arthritis. (Check with your medical Doctor and exercise physiologist first, before trying any new moves).
Ultimately I like to see my clients return to deeper ranges of motion, like flexing the knee more.
This exposes more of the cartilage left in your knee to the benefits of movement, so joint fluid is stimulated (a good thing for your cartilage!).
Bone on Bone Knees: FAQ
Is walking good for bone on bone knee pain?
Walking is a great exercise for people with arthritis because it’s low-impact and doesn’t put too much stress on the joints. However, if you’re in a lot of pain, you may want to start with shorter walks and gradually build up to longer distances.
Try to include slight hills in your walks! Building leg strength should be your priority with knee osteoarthritis – not just cardio fitness.
Do I need surgery for my bone on bone knee?
Not necessarily. Surgery is typically only recommended if other methods of pain relief, such as medication and exercise, have failed. If you have reached this point of severe, unyielding pain, speak to a good orthopedic surgeon about how they can help you.
These days your pain has to be severe and constant to be considered for total knee replacement, so there are lots of alternative therapies to try first.
Should I get a cortisone injection for knee pain?
Cortisone injections can help relieve pain from arthritis by stopping inflammation occurring. Hence, you should ask about cortisone in the case of chronic bone on bone pain.
They are effective when targeted to a specific region. The steroid liquid will give you roughly 1 month of relief, while you build strength and movement in your knee.
You can’t use cortisone repeatedly because steroid medication has a weakening effect on your body’s tissues.
Is heat or cold better for knee arthritis?
Both heat and cold can be helpful in relieving pain from arthritis. The use of heat is generally more beneficial when applied over muscles to loosen them and prepare for movement. Or, taking a warm bath regularly.
Ice is best used in acute attacks of arthritis pain or new injuries such as a sprain or tear.
What is the best way to sleep with knee osteoarthritis?
- Sleeping on your side with a pillow between your knees takes some pressure off your joints and reduces pain.
- Consider investing in an orthopedic mattress topper to make sleeping more comfortable.
- Place pillows under your knees if back-sleeping.
- Use a knee sleeve for slight pressure which can reduce pain feedback to the brain.
Total Knee Replacement
Total knee replacement surgery is a major operation that can be very effective in relieving pain and restoring function in people with severe knee OA. The procedure involves removing the damaged articular cartilage and replacing it with a metal and plastic joint.
The surgery is usually done under general anesthesia, and the hospital stay is typically three to five days. Recovery from total knee replacement surgery can take several months.
Most people report significant improvements in pain and function after surgery, but as with any procedure there is some risk of complication, such as infection or blood clot.
For most people, though, total knee replacement surgery is a successful procedure that can greatly improve quality of life, and aid the return to an active lifestyle.
What stage of knee arthritis are you experiencing? Have you tried any of the options listed above in this comprehensive guide? Let us know below.
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Mayo Clinic: https://www.mayoclinic.org/drugs-supplements/hyaluronic-acid-injection-route/description/drg-20074557
Mayo Clinic: https://www.mayoclinic.org/tests-procedures/bone-marrow-transplant/in-depth/stem-cells/art-20048117
Bagnato, Gian Luca, et al. “Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial.” Rheumatology 55.4 (2016): 755-762.