Osteoarthritis

Osteoarthritis is progressive loss of the cartilage surface of a joint, most commonly the knee and hip. Pain is typically worse with activity and better with rest, stiffness after sitting lasts a few minutes rather than half an hour, and the joint may be swollen but is not usually hot.

That pattern distinguishes it from inflammatory arthritis, and the distinction changes the treatment entirely.

For knee and hip osteoarthritis, structured exercise reduces pain and improves function more reliably than any passive treatment. This is well established and it is consistently the intervention patients are least often offered first.

Strengthening the muscles around the joint reduces the load the joint surface has to absorb. Weight management, where relevant, changes joint load directly. Together these can defer or avoid joint replacement.

Progressive strengthening, range of movement work, hydrotherapy where land-based exercise is too painful to start with, gait retraining, and advice on load management for daily activities. Physical agents — laser, shockwave, TECAR — are used to reduce pain enough to allow the exercise, not as the treatment itself.

If the joint is beyond conservative management we say so. Rehabilitation before surgery still improves outcomes afterwards, and that is a legitimate goal in itself.

Which joints are involved and how the load is distributed, because knee pain that comes from a stiff hip is treated at the hip. Muscle strength around the joint, measured rather than estimated. How far you can walk before pain stops you, timed. And what specifically you cannot do — stairs, getting out of a car, kneeling — because those are the outcomes the programme is aimed at.

We also look at what else limits exercise: cardiac and respiratory capacity, other painful joints, and medication that affects balance. A programme built without those is a programme that gets abandoned in the second week.

Pain, walking distance, strength and confidence on stairs improve for most people who complete a structured programme. These are the outcomes worth committing to.

The cartilage does not regrow. No exercise, injection, supplement or device regenerates a worn joint surface, and anyone who tells you otherwise is selling something. What changes is how much load the joint has to absorb and how well the muscles around it protect it — which is enough to change daily life substantially, but it is a different claim.

When pain persists at rest and at night despite a genuine course of rehabilitation, when walking distance has collapsed, and when the joint is structurally beyond what load management can compensate for. At that point continuing conservative treatment is not caution, it is delay.

Rehabilitation is not wasted in that case. Going into surgery with stronger muscles and better movement produces a faster and more complete recovery afterwards, and that is a legitimate goal in its own right.

Strength gained through training is lost over a comparable period if training stops. This is the single most common reason a good result does not last.

You leave with a written programme, the load it should be done at, and a schedule for progressing it. Where a gym or pool is available at home we build the programme around that rather than around equipment you will not have.