One of the most common things I hear in the clinic is, “It’s just my arthritis playing up again.”
Osteoarthritis (OA) is a common condition, particularly as we get older or following previous joint injuries. But having OA doesn’t mean every episode of pain is necessarily coming from the arthritis itself. You can have mild, moderate or severe changes visible on imaging, but those findings don’t always reflect how much pain you’re experiencing or how well you can move.
More importantly, having OA doesn’t mean there aren’t other things we can improve.
When someone presents with OA, one of the first things I want to understand is their injury and loading history. OA develops through a combination of biological and mechanical factors, and previous joint injury is one recognised risk factor. Have they previously injured that joint? Have they lost strength or mobility? Are there particular positions or movements they repeatedly load?
I often use the analogy of a circle with four pulleys pulling in different directions. Imagine one or two pulleys doing significantly more work than the others. The forces acting on that circle will change.
Our muscles work together in a similar way to influence how a joint moves and tolerates load. This doesn’t mean every muscle needs to be equally strong, but it gives us a useful starting point for investigating strength deficits, movement strategies and areas that may be working harder than necessary.
This leads into one of our core clinical principles at By Design: Comprehensive Rehabilitation. We don’t just assess the painful joint in isolation. We look at the strength of the muscles surrounding it, the capacity of the joints above and below, and whether there are meaningful differences between the left and right sides.
We assess range of motion, coordination, balance and proprioception, which is your body’s ability to recognise where it is in space. We also consider the role of muscles in supporting joints where ligaments have previously been injured or become less effective. These assessments help us identify what someone can currently do, what they’re struggling with and which physical capacities might benefit from improvement.
But rehabilitation shouldn’t stop at isolated muscle strength. I also want to know whether that joint can tolerate the demands of everyday life.
Can you squat, hinge, push, pull, walk or climb stairs comfortably?
Can you repeat those movements without symptoms becoming increasingly limiting?
Depending on your goals, we might also assess endurance, running, jumping, acceleration, deceleration or changing direction. Not everyone with OA needs plyometric training. Someone wanting to return to tennis has very different physical requirements from someone wanting to walk comfortably around their garden and stop themselves from tripping over. The goal is to progressively develop the physical capacity needed for the activities that matter to you.
A recent client presented with thumb pain that she immediately attributed to her existing OA. She’d spent much of the weekend working on her sprinkler system, repeatedly gripping and manipulating equipment.
During our assessment, we identified symptoms consistent with irritation and overload of the muscles and tendons around her thumb. Rather than putting the whole flare-up down to her arthritis, we treated those structures and the movement limitations we found. She still has osteoarthritis. But this flare-up appeared to have another contributing factor, and that was something we could work on.
Ultimately, osteoarthritis does involve changes in the joint, but your scan is only one part of the clinical picture. We can’t necessarily reverse established joint changes, and not every episode of pain has a separate, identifiable cause.
What we can do is investigate the factors that may be contributing to your symptoms and limitations. Sometimes that means improving muscle strength, restoring useful movement, building endurance or changing how you approach certain activities. Sometimes it means managing the osteoarthritis itself.
Either way, I don’t want someone leaving an appointment believing their only option is to tolerate pain because an X-ray showed arthritis. There’s often more worth assessing, and rehabilitation should be directed towards helping you feel better, do more and maintain the activities you enjoy.
If you’re living with osteoarthritis and unsure what’s contributing to your pain, book an assessment with the By Design Physiotherapy team.
We’ll assess your movement, strength and functional capacity to identify opportunities for improving how you move and manage your symptoms.
This is general information only. If you’re managing pain or an injury, speak with your physio about what’s right for you.
About this article
Written by Marissa Seeley, Physiotherapist, By Design Physiotherapy & Strength
Published 30 October 2026
Framework note: Comprehensive Rehabilitation is a By Design clinical principle used to guide assessment, rehabilitation and clinical reasoning. The pulley analogy is a simplified educational model, not a validated measure of joint loading or muscle balance.
References:
Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskelet Disord. 2008;9:116.
Duong V, et al. Risk factors for the development of knee osteoarthritis across the lifespan: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2025;33(10):1162–1179.
Hunter DJ, Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393(10182):1745–1759.
