“Bone-on-bone” knee pain is a term used to describe a condition where the cartilage in the knee joint has significantly worn down, leading to the bones rubbing against each other during movement. This condition is typically associated with osteoarthritis, which is the most common form of arthritis.

Osteoarthritis is a degenerative joint disease that can develop over time due to age, repetitive knee joint stress, previous injuries, genetics, or obesity. As the cartilage wears away, the joint loses its ability to cushion and protect the bones, leading to pain, stiffness, and decreased range of motion in the knee.

There are four stages to Osteoarthritis:

  • Stage 1- Symptoms in this stage are mild, involving minor bone spur pain in the knee. This stage is usually remedied with over the counter (OTC) medications used to relieve discomfort and pain.
  • Stage 2- At this stage, minor pain is experienced after walking or running, with joint stiffness and tenderness in the knee area. Knee cartilage remains a healthy size, and the bones are not rubbing or scraping against each other.
  • Stage 3- During this moderate stage, the cartilage in the knee begins to narrow, causing discomfort during everyday activities. Pain may be more extreme after running, walking, kneeling or bending. After long periods of sitting, your knee may be stiff upon standing, and it may be difficult to bend or straighten the knee.
  • Stage 4- The most severe stage of osteoarthritis, the cartilage in the knee has been significantly reduced or dissipated completely, leaving the joint stiff and likely immobile. The bone-on-bone pain causes great pain when moving the knee joint.

It is important to note that diagnostic imaging may appear to show bone on bone, but this is typically not the case.  True bone on bone is very rare and often misdiagnosed.  When it comes to treating acute or chronic knee pain, knee surgery tends to be a daunting prospect to patients.  With many alternatives available, relief can be found without surgical intervention. 


Treatment options for bone-on-bone knee pain may include:

1. Pain Management: Corticosteroid injections or hyaluronic acid injections may be used to reduce inflammation and provide temporary relief.

2. Physical Therapy: A physical therapist can recommend exercises to strengthen the muscles around the knee, improving joint stability and function.

3. Occupational Therapy: The goal of occupational therapy is to help individuals maintain independence, improve their ability to perform daily activities, and enhance their overall quality of life.

4. Regenerative Medicine: Regenerative Medicine is an innovative field that focuses on using the body’s natural healing processes to repair and regenerate damaged tissues, including those affected by bone-on-bone knee pain due to osteoarthritis. There are several regenerative medicine treatments that may be considered for managing knee pain caused by osteoarthritis.

5. Activity Modification: The therapist can help you modify your daily activities to reduce joint stress while still maintaining an active lifestyle. They may suggest alternative ways of performing tasks to protect the knee joint.

6. Weight Management: Maintaining a healthy weight can reduce the stress on the knee joint and slow down the progression of osteoarthritis.

7. Assistive Devices: Using a cane or brace can help support the knee and reduce pressure on the joint. 

If you are experiencing bone-on-bone knee pain or suspect you may have osteoarthritis, it is crucial to seek medical advice from a qualified healthcare professional. We can properly diagnose the condition through physical examination, imaging tests (such as X-rays or MRI), and consider your medical history. Give us a call today to discuss your options for bone-on-bone knee pain, 908-756-2424.


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