What Is Osteoarthritis and Why Do My Joints Hurt?

Key Takeaways

• Osteoarthritis affects the whole joint, not just cartilage, and the familiar ’wear and tear’ description is misleading.
• Scan findings often do not match how much a joint hurts, which is why imaging is not routinely used to diagnose it in Australia.
• Movement, strength work and weight support sit at the front of the care pathway, and nine out of 10 people with knee osteoarthritis manage without a joint replacement.
• Current national guidance advises against opioids, arthroscopy for uncomplicated knee osteoarthritis and several heavily marketed injections and supplements.

The first few steps each morning feel stiff. Getting out of the car takes longer than it used to. Stairs have become something you think about. When joints start speaking up like this, the question is usually the same. What is osteoarthritis, and why do my joints hurt?

Osteoarthritis is a long-term condition affecting the synovial joints, where bones move against one another. It involves the whole joint rather than the cartilage alone. In 2022, an estimated 2.1 million Australians were living with osteoarthritis.

The knee is often the joint people notice first, because it carries you through almost every movement of an ordinary day. Australian care standards now treat knee osteoarthritis as a condition to be actively managed rather than quietly endured.

Osteoarthritis is not an inevitable part of getting older. It does not always worsen with time, and much of what shapes your day-to-day symptoms is within your influence.

What Is Osteoarthritis, Exactly?

Osteoarthritis is often described as cartilage wearing away, which makes it sound like a tyre losing tread. That picture is incomplete, and it pushes people into moving less exactly when movement helps most. The condition is broader than cartilage alone:

Whole-Joint Involvement

Osteoarthritis involves the cartilage covering the ends of the bones, the bone underneath it, the joint lining and fluid, the capsule holding everything together, and the muscles, tendons and ligaments. Low-grade inflammation is also part of the process.

Joints are living tissue that respond to what you ask of them. They adapt to load, recover and rebuild. Osteoarthritis develops when the balance between the demands on a joint and its capacity to recover tips the wrong way over time.

Commonly Affected Joints

Knees, hands and hips account for most cases in Australia. The spine, ankles, feet and shoulders can be involved too, although less commonly.

Knee symptoms usually show up as pain with walking, climbing stairs, rising from a chair or getting in and out of a car. Hand osteoarthritis often appears as stiffness with bony enlargement around the finger joints. Hip symptoms are frequently felt in the groin rather than over the hip itself.

Other Arthritis Types

Arthritis is an umbrella term covering more than 100 conditions. Osteoarthritis is by far the most common, accounting for around 57% of Australians living with arthritis, excluding gout.

Rheumatoid arthritis is an autoimmune condition in which the immune system attacks joint tissue, usually affecting joints on both sides of the body and often producing prolonged morning stiffness. Gout is driven by uric acid crystals and arrives suddenly, frequently in the big toe. The distinction matters, because the treatments are not interchangeable.

Australian Prevalence

Prevalence climbs sharply from age 45 and reaches about 30% among people aged 75 and over. It is more common in women (10%) than in men (6.1%).

Aboriginal and Torres Strait Islander peoples are around 1.5 times more likely to have osteoarthritis, and it appears to develop at a younger age.

Why Your Joints Hurt

Pain is the reason most people book an appointment, and the part that makes the least sense. Some days feel fine. Others do not, with no obvious explanation. Several things feed into what you feel:

Changes Inside the Joint

As cartilage thins and the bone underneath adapts, the joint can become more sensitive to load.

The joint lining may become inflamed, producing swelling, warmth and a dull ache that lingers after activity. Fluid can build up, creating tightness or fullness.

Weakness in the Surrounding Muscles

Muscles act as shock absorbers. When the quadriceps, glutes and calf muscles lose strength, more force travels through the joint surfaces with every step.

Pain encourages you to move less, which weakens those muscles further, which increases the load on the joint again. Interrupting that loop is one of the more dependable ways to change how a joint feels, and much of what physiotherapy and exercise physiology do.

Swings in Activity Levels

Joints tolerate what they are accustomed to. A sudden increase, such as a full weekend in the garden after a quiet fortnight, can leave a joint sore for days. A sudden drop is unhelpful, because tissue loses capacity when it is not used.

Activity that builds gradually is better tolerated than bursts followed by long rests. Recognising this pattern often explains flare-ups that otherwise feel random.

Effects of Sleep, Stress and Mood

Pain is produced by the nervous system rather than transmitted from a joint. Broken sleep, sustained stress and low mood all lower the threshold at which pain registers.

None of that means the pain is imagined. It means the volume dial has more than one input. Many people notice their joints feel worse through a demanding stretch at work or after a run of poor sleep, and improving those factors can change symptoms.

What Makes Osteoarthritis More Likely

No single cause explains osteoarthritis. It develops through a combination of factors, some fixed and some open to change. Knowing which is which helps you focus your effort:

Age and Sex

Risk rises with age, and women are affected more often than men, particularly after menopause.

Neither factor is a reason to accept symptoms as permanent. They raise the likelihood of developing osteoarthritis, but they do not decide how well you function while living with it.

Body Weight and Metabolic Health

People carrying excess weight have roughly double the risk of developing knee osteoarthritis, and the risk is around fourfold for people living with obesity. Load through the joint is only part of the reason.

Excess adipose tissue also contributes to systemic inflammation, which affects joints throughout the body, and that second mechanism helps explain why osteoarthritis also turns up in hands, which carry no body weight.

Injury and Rehabilitation History

A significant knee injury, such as a ligament rupture, a meniscal tear or a fracture, raises the risk of osteoarthritis developing in that joint years later. This is part of why osteoarthritis is not solely an older person’s condition, and why some people meet it in their 30s or 40s.

Rehabilitating an injury thoroughly, rather than stopping the moment the pain settles, may reduce that later risk.

Occupation and Repetitive Loading

Occupations involving prolonged kneeling, squatting, climbing and heavy lifting are associated with higher rates of knee osteoarthritis. Tradespeople, cleaners, farmers and nurses are among those affected more often.

The issue is usually high repetition paired with limited recovery, rather than physical work. Building strength and varying tasks where the job allows can help.

Joint Alignment and Family History

Joint alignment, such as a pronounced bow-legged or knock-kneed position, changes how load distributes across a joint surface. Genetics also play a role, particularly in hand osteoarthritis.

These factors are largely fixed, but they influence risk rather than dictate the outcome. Strength, activity levels and weight remain open to change whatever your starting point.

How Osteoarthritis Is Diagnosed in Australia

Diagnosis in Australia follows the national care standard for knee osteoarthritis, revised in 2024 by the Australian Commission on Safety and Quality in Health Care. The process leans more on conversation than on technology:

Taking a Detailed History

Your practitioner will ask how the pain behaves, when it started, what settles it, what stirs it up and how long morning stiffness lasts. They will also ask about other health conditions and any previous injuries to the joint.

They should also ask what your symptoms are stopping you from doing, and how that is affecting your sleep, mood and social life. Osteoarthritis is assessed as something happening to a person, not only to a joint.

Examining the Joint and Your Movement

A physical examination typically covers range of motion, tenderness along the joint line, swelling, alignment, bony enlargement and any grating sensation through movement. Your walking pattern and your ability to rise from a chair may also be assessed.

Where the clinical picture is typical, a diagnosis can be made confidently without further tests.

Understanding the Limited Role of Imaging

Imaging is not routinely used to diagnose osteoarthritis in Australia. Where a scan is clinically warranted, a standing X-ray is the first-line choice. Magnetic resonance imaging (MRI), computerised tomography (CT) and ultrasound are not considered appropriate investigations for diagnosing knee osteoarthritis.

Imaging findings also correlate poorly with symptoms. Some people show substantial changes on X-ray and have few symptoms, while others show minimal changes and live with considerable pain. Cartilage thinning and meniscal changes are common in knees with osteoarthritis, whether or not the person has any symptoms.

Scans rarely change initial treatment, which is guided by your function rather than your imaging. A scan report is not a verdict on your future.

Ruling Out Other Explanations

Certain features prompt a closer look. A recent injury, a hot and swollen joint, rapidly worsening symptoms, prolonged morning stiffness or a relevant medical history may warrant further investigation.

Pain can also be referred from elsewhere. Knee symptoms sometimes originate at the hip or lower back, and inner knee pain has several possible causes beyond osteoarthritis.

What Helps Manage Osteoarthritis

There is no cure for osteoarthritis, and no treatment works the same way for everyone. Australian and international guidelines agree on a core set of approaches that help most people move and feel better:

Physical Activity and Movement

Being active is the first-line recommendation for osteoarthritis, and it is safe for the joint even when symptoms are severe. Feeling some discomfort during exercise does not mean damage is occurring.

Physical activity covers incidental movement through the day, structured exercise, muscle strengthening and sport. Walking, cycling, swimming and water-based classes are commonly well tolerated.

Even a modest amount is better than none. Goals that build gradually from where you are today outlast ambitious plans abandoned in week two.

Strength and Neuromuscular Training

Strengthening the muscles around an affected joint reduces the force travelling through the joint surfaces and improves stability and confidence. For the knee, that usually means the quadriceps, hamstrings, glutes and calves.

Neuromuscular training adds control and balance work, teaching the joint to handle real-world demands such as stairs, uneven ground and getting up from a low chair.

Programs delivered one to one, in small groups or at home have all been shown to help, so the format can follow your preference. Exercise physiology programs can be matched to your current capacity and the activities you want back.

Weight Management and Nutrition

For people living with excess weight, losing 5% to 10% or more of body weight over roughly 20 weeks is associated with reduced pain and improved quality of life. Weight loss may also improve outcomes if surgery is eventually needed.

Nutrition matters beyond the number on the scales. Adequate protein supports the muscle you are working to build, and a balanced diet supports bone health and recovery.

These figures are a general guide only and the right approach depends on your circumstances. An Accredited Practising Dietitian can help you build something sustainable.

Medicines and Pain Relief

Medicines exist to reduce pain enough for you to keep moving. They are not a replacement for activity, strength work or weight management.

Australian guidance points to topical non-steroidal anti-inflammatory drugs (NSAIDs) or capsaicin as a short-term option, with oral NSAIDs as first-line treatment after a risk assessment. Paracetamol is less effective but may suit people at risk of harm from NSAIDs. Corticosteroid injections may be offered as a short-term adjunct, although repeated injections are not supported by current evidence.

Opioid analgesics are not recommended for knee osteoarthritis, because the risk of harm outweighs the benefit for most people. Any decision about medicines belongs with your general practitioner (GP) or pharmacist, who can weigh up your other conditions and prescriptions.

Low-Value Treatments and Supplements

Several widely marketed options are not recommended in current Australian guidance for knee osteoarthritis, either because the evidence shows no meaningful benefit or because the cost and risk outweigh what they offer:

• Platelet-rich plasma (PRP) injections
• Hyaluronan injections
• Stem cell and adipocyte cell treatments
• Medicinal cannabis, gabapentin and pregabalin medicines
• Glucosamine, chondroitin and fish oil supplements

Passive treatments such as therapeutic ultrasound and electrotherapy also play little role. This list reflects current national guidance and may change as evidence develops, so it is worth discussing anything you are considering with your treating practitioner.

When Surgery Is Part of the Picture

Surgery has a genuine place for some people. It sits later in the pathway than many expect:

Completing Non-Surgical Care

Australian guidance describes optimal non-surgical management as including around 12 weeks of appropriate physical activity and exercise. Referral for surgical assessment follows worsening symptoms and severe functional impairment that persist despite that work.

This step is skipped more often than it should be. A New South Wales program found that nearly 70% of participants on a knee replacement waiting list had received no non-surgical management beyond medication.

Considering Joint Replacement

Knee and hip replacements are well-established procedures in Australia. In 2021-22, around 53,500 knee replacements and 35,500 hip replacements were performed for osteoarthritis.

Even so, nine out of 10 people with knee osteoarthritis manage without needing a joint replacement. Staying active and managing weight beforehand also improves recovery for those who go ahead, so the work you do now is rarely wasted.

Avoiding Unnecessary Arthroscopy

Knee arthroscopy, the keyhole procedure used to trim or tidy tissue inside the joint, is not recommended for uncomplicated knee osteoarthritis. The evidence shows little or no clinically meaningful benefit for pain or function.

Australian practice has shifted accordingly. Medicare claims for knee arthroscopy in people aged 45 and over fell 47% between 2015 and 2022, from 404 to 216 services per 100,000 people.

Getting the Right Support in Australia

Osteoarthritis is a long-term condition, and care works better when it is coordinated rather than pieced together appointment by appointment. Australia has a defined pathway for this:

Starting With Your GP

Your GP is usually the first point of contact. They can assess and diagnose, discuss medicines and refer you to allied health services or to a non-GP specialist when appropriate.

Planned reviews at agreed intervals form part of good care, giving you a regular point at which the plan can be adjusted as your symptoms, function and goals shift.

Claiming Through Medicare

From 1 July 2025, GP Management Plans and Team Care Arrangements were replaced by a single GP Chronic Condition Management Plan (GPCCMP). Where you are eligible, this can provide Medicare rebates for up to five allied health services per calendar year. Aboriginal and Torres Strait Islander patients who have had a health assessment can claim a further 10 services under a separate arrangement.

Referrals no longer require a set form and can be made by letter, and you can choose which eligible provider you see. Rebates do not always cover the full fee, so it is worth asking about any gap when you book.

Eligibility is determined by your GP, based on your circumstances.

Working With a Wider Team

Osteoarthritis care often draws on several professions. Physiotherapists and accredited exercise physiologists build and progress exercise programs. Dietitians support weight and nutrition goals. Psychologists can help where pain, sleep and mood have become tangled together.

Where symptoms remain severe despite thorough non-surgical care, your GP may refer you to a rheumatologist, an orthopaedic surgeon or a sport and exercise physician for an opinion. Being referred is not a sign that anything has failed. It is one more step in a plan you remain in charge of.

Stiff Mornings Are Not a Forecast

Knowing what is happening inside your joints changes how the next few months feel. The stiffness that seemed like a warning becomes information you can work with, and what happens next stops feeling like something taken out of your hands.

Joints respond to what you give them, and they keep responding for years. Wanting your walks back, your garden back and your Saturday mornings back is a reasonable place to start.

MTP Health can assess your joints and build a program around the activities you want to return to. Your GP is also a sound starting point if you would prefer a referral or a management plan first.

Frequently Asked Questions (FAQs)

1. Is osteoarthritis the same thing as arthritis?

No. Arthritis is the umbrella term for more than 100 joint conditions, and osteoarthritis is one of them. Rheumatoid arthritis, gout and juvenile arthritis are separate conditions with different causes and different treatments.

2. Can exercise damage a joint that already has osteoarthritis?

No. Australian guidance is clear that exercise does not damage a joint with osteoarthritis, at any severity.

Where symptoms flare persistently, the usual answer is to adjust the type, amount or intensity of the exercise rather than stop. A physiotherapist or accredited exercise physiologist can help you find that adjustment.

3. Do I need a scan to know whether I have osteoarthritis?

Most people do not. Where the history and physical examination are typical, a diagnosis can be made without imaging.

An X-ray may be requested where symptoms are unusual, where another diagnosis is suspected or where surgery is being considered.

4. Does osteoarthritis always get worse over time?

Not necessarily. Osteoarthritis is not always progressive, and many people find their symptoms settle with the right combination of activity, strength work and weight management. Symptoms can also fluctuate, with better and worse stretches that do not reflect a permanent change in the joint.

5. How long before exercise starts helping my joint pain?

Many people notice some change within six to 12 weeks of consistent exercise, although this varies considerably between individuals.

Progress often shows up in function first, such as stairs feeling more manageable, before pain levels change. Timeframes here are a general guide and depend on your starting point and other health factors.

6. Should I see a physiotherapist or an exercise physiologist?

Both are university-qualified practitioners who use exercise to manage musculoskeletal conditions. Physiotherapists are registered with the Australian Health Practitioner Regulation Agency (Ahpra) and combine assessment, hands-on treatment and exercise. Accredited Exercise Physiologists are accredited through Exercise and Sports Science Australia and specialise in exercise prescription for injury and chronic conditions.

For osteoarthritis, either is a sound starting point. Clinics such as MTP Health work across both, so you can move between them as your needs change.

7. Can I claim physiotherapy or exercise physiology for osteoarthritis on Medicare?

Yes, where your GP prepares a GPCCMP and you meet the eligibility criteria. Private health insurance extras cover may also apply, depending on your policy.

This article provides general information only. It does not take your individual health, circumstances or goals into account, and it is not a substitute for personalised medical advice. Joint pain can have several causes, and management that suits one person may not suit another. Speak with your GP, physiotherapist, exercise physiologist or another qualified health practitioner before making decisions about your care or starting a new exercise program.