Should I Exercise with Bone-On-Bone Knee Pain? Your Questions Answered!

Bone-on-Bone Knee Pain

Have you been told your knee(s) are bone-on-bone causing knee pain and there’s nothing you can do to fix it?


I’ve heard that before.  Bone-on-bone knee pain is common and scary.  

Recently, a patient clicked on our Facebook ad for looking for treatment for her knee pain. It has been going on for years now and she’s sick of it. She went to the ortho doc who took some x-rays and told her her knee is bone-on-bone and there is nothing she can do to help her knee and knee replacement will be her only option.

In fact, he said, “Come back when your knee pain is so bad you can’t take it anymore.

She wasn’t ready for that yet. She’s still young in her late 50’s and she doesn’t want to go through that yet, especially if it means she may have to get another one in her 70’s if this one wears out like they do every 15-20 years.

But she also didn’t want “Physical Therapy”. “I’ve tried that already and there is nothing exercise can do for me.” She said when we told her we are a physical therapy clinic.  

Let’s talk about why she’s right AND why she’s absolutely wrong.

We’re going to answer these 3 questions:

  1. What does bone-on-bone knee pain mean?
  2. What are the symptoms of someone with bone-on-bone knee pain?
  3. What treatments work best, according to science, for bone-on-bone knee pain? 

What does bone-on-bone knee pain mean?

Bone-on-bone is a term used to describe how much the cartilage in your joint has worn down.  You see, at the end of bones as they make contact with another bone to form a joint, they have special cartilage to cushion the bones.

Over time this cartilage can wear down, like the tread on tires. Cartilage wears down normally over the years and this condition is called osteoarthritis, or arthritis for short. This is common, I’m getting older, joint stiffness and arthritis. Describing the joint as bone-on-bone is a way to say “your arthritis is bad”.  

What are the symptoms of someone with bone-on-bone knee pain?

Symptoms of bone-on-bone knee pain are similar to an arthritic knee. They include:

  • Stiffness and pain in the morning and sometimes throughout the day. 
  • Difficulty walking 10-30 minutes
  • Joint Swelling
  • Leg weakness, even feeling like your knee is going to give out
  • In severe cases, pain at night as you’re laying down trying to sleep

Arthritis is tricky to treat because some days might be good and other days it can feel sore and achy. Usually, patients will find the more they do, the busier they are, and the more achy and painful their knees are. This is why many patients are hesitant to do any exercises for their knees.  

In the image below you can see one knee with space between the bones of the knee. Space is the dark color between the white of the bone. In the image on the right with the red arrows, you can’t see much space between the bones like you can with the image on the left with blue arrows


X-ray bone-on-bone vs normal knee

What are the best treatments for bone-on-bone knee pain, according to science?

Best non-surgical Treatment for Knee Arthritis

  1. Exercise: The best non-surgical treatment for bone-on-bone knees is exercise, according to this study from 2019.  Specifically, a resistance training exercise program for the legs was cited as the most helpful in combating the effects of knee arthritis.  This came from a systematic review and meta-analysis which are the highest level of scientific evidence.  Click here or here for some of our favorite exercises for knee pain
  2. Weight Loss: A very close second is weight management.  For every 1 pound of body weight lost, 4 pounds of pressure is taken off the knee as found in this popular studyAnother study suggested that a 10-pound weight loss can provide as much as a 40% reduction in knee pain.  Having excess weight has a compounding effect on worsening arthritis over time.  The best way to slow down the progression of knee bone-on-bone pain is to get thin and stay thin.  Though weight loss is not easy, it is very beneficial for immediate relief and avoiding early joint replacement.
  3. Pharmaceutical: Acetaminophen is effective in helping reduce bone-on-bone knee pain.  Dosing and side effects should be monitored by a physician 
  4. Pulsed Electromagnetic Field Mats: more research is emerging about the best practices for these mats that have proven to be helpful in aiding the use of exercise as a treatment for knee arthritis.  
  5. Supplements: This will include natural supplements like Tumeric and fish oil and include glucosamine and chondroitin.  None of these supplements show any sustained benefit with large sample sizes when measured over the past 6 months.  Some showed benefits within 6 months but they were marginal.  This means it would be appropriate to try some out for yourself to see if they give you any relief.  
  6. Injections: These include platelet-rich plasma, hyaluronic acid, and corticosteroids are the most common injectable medicines to treat arthritic knees.  None of them prove to have any improved benefit past 6 months when compared to patients who didn’t get an injection.  Additionally, corticosteroid use is now proving to be harmful to joint surfaces and has the potential to speed up the arthritic process resulting in total knee replacement.


Let’s go back to the patient on the phone wanting to avoid exercise as the treatment for her bone-on-bone and review why she is correct and where she was way off. She was correct in thinking that exercise can be problematic, especially if her progress is not monitored and her exercises are not dosed in a pain-free way.

Sadly, this is missing in so many regular physical therapy clinics (we hear this all the time).

She is incorrect in understanding her bone-on-bone knees can improve!

Stiffness and muscle weakness can improve with hands-on treatment and personalized exercises performed by specialist physical therapy clinicians like us. When you combine hands-on mobilizations and stretches to loosen stiff joints and then perform specific exercises to stabilize muscles around the joint (going into the glutes and ankles) you can achieve very different results. And that is what she was looking for! She was looking for different results!

Of course, there is no guarantee your case will respond. In fact, we guarantee we won’t cure you of your arthritis. But in the end, if you are able to push off knee replacement a few years and then get it done with as healthy a knee joint as possible, I do guarantee you’ll have the best chance at an active healthy life.

Getting specialty care for knee arthritis that improves your movement and strength is the best treatment. When you pair that with a successful weight loss program, PEMF, and supplementation you can say you’ve done everything you can fight the effects of arthritis and live a mobile and joyful life. 


Nick Hunter, PT, DPT

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