Have You Been Told You’re “Bone on Bone” or That You Need Surgery Now?

Have you been told you’re bone on bone, and that you need a hip replacement, knee replacement or that there’s nothing you can do about it? Today, we will tell you exactly what it means when someone tells you you’re bone on bone, what you need to do about it, and why it doesn’t mean you’re destined for a hip replacement.

Bone on bone isn’t as bad as it sounds. It’s actually normal! As we age, for example, if you’re 30, 40, 50, 60, even 20, if you are in pain and were told to get an X-ray, someone might tell you that you’re bone on bone. They might also tell you that you have so much arthritis, and that it is the worst joint they have ever seen. Arthritis is also a normal part of the aging process, and is like wrinkles on the inside.

This might sound scary, but there is hope!

When you’re bone on bone, it just means there’s a little bit less space in the joint, but it is normal because arthritis is just like wrinkles on the inside of your body.

I’m in my 40’s and I have wrinkles on the outside, and I probably have wrinkles on the inside too! I’ve seen patients for the last 20 years, probably dozens of patients a year who were told that they were  bone on bone, and that it’s the worst they’ve ever seen. They weren’t able to play with their kids, run, or walk without pain. We worked together to improve their mobility and strength, and they were able to get back to walking, running and playing with their kids. Meanwhile, their imaging results never changed, and they still had arthritis.

Pain and imaging don’t necessarily always match up. That’s the thing. There could be a lot of different reasons for your pain, and all the X-ray does is look at your bone and your joint, but it ignores all your soft tissue, all your muscle. It is also a picture of when your body is still, not when it is moving. Most people that walk into our clinic have pain only when they move. This is why an X-ray or MRI is not the most accurate way to find out WHY you are in pain.

For example, we’ll have people come in and they tell me, “I am bone on bone and my knee hurts”.

I’ll touch their quadricep muscle, the thigh muscle that crosses the knee, and they will say, “Yes, that’s exactly where it hurts”. That’s nowhere close to where the joint is, and what’s happening inside the joint because of a little arthritis doesn’t change. I’ve worked with people who have so much arthritis where their shoulder doesn’t move at all, but they had no pain at all. I’ve also had a patient come in who was told he needed knee surgery. We worked on his knee, loosened it up, created more space in the joint, and he was back to running and playing basketball within about two months.

One major point is that it’s good if someone says, “Oh, you’re bone on bone”. It means you don’t have something more serious going on, like a tumor at the end of the bone or in the cartilage. That’s going to be a big problem because if you have a tumor in the bone in your leg, it’s usually a sign that you’ve got tumor somewhere else. The big reason to get an MRI or x-ray,is to confirm that you do not have fractures, tumors, or a spinal cord compression. But, even a spinal cord compression or a tumor will show signs on the outside that don’t seem congruent. Basically, if it smells like a duck and it walks like a duck, but it looks like an egg, something’s fishy, right? We will know.

So if the pain isn’t coming from the arthritis, where does the pain come from?

Usually the cause of the pain is from a joint above or below. Meaning, usually your hip or your ankle not moving well. If you’ve  been told that you’re bone on bone, but no one’s looked at your hips, ankle or even back, then you need to have someone look at those areas because the pain you’re experiencing in your knee may be coming from there.

We’ve had people who have been told that they have bone on bone, then they get the joint replacement and it doesn’t work and turns out that they were looking at the wrong joint. They had a hip problem, not a knee problem. So we worked on the hip and they got back to playing soccer just fine.

If you’re reading this and you’ve already had a hip or knee replacement, great.

You know, and it’s not a bad decision because you may have needed it. I’ve seen people come in after replacement surgery, they feel better, but they’re not back to their activity level. And what we specialize in is helping people get back to their high level of activity. There are people that race professional bikes, or people that have run marathons. After I worked with a patient, she ran three or four marathons, even after having a hip replacement and after knee replacement. So you can play basketball and you can run and you can squat and reach your goals after a joint replacement.

If you have pain in your knees and someone’s told you you’re bone on bone or it’s the worst they’ve ever seen and you’re concerned that the arthritis is going to get worse and not better, give us a call! We offer what is called a total body diagnostic, where we don’t just look at where the problem is. We look above and below and your whole body. It’s a free visit. It takes about 20 minutes and at the end of that time we’ll know exactly where the problem is and you’ll know exactly what to do about it and how we can help.  I’m pretty sure that we can help, especially if everyone said, “Oh, you need surgery.” Is surgery the real thing that you need? Not always. Sometimes it is, but we’ll even let you know if we think you do.

If that’s something that sounds interesting to you, all you have to do is contact us or call us to apply for one of these visits, so we can help you reach your goals, without letting arthritis hold you back!

About The Author

Dr. Kaitlin Herzog

Dr. Herzog attended the University of Pittsburgh, where she earned her bachelor’s degree in Exercise Science. She went on to earn her Doctor of Physical Therapy degree at Wheeling Jesuit University. Kaitlin has been an athlete for most of her life and was introduced to physical therapy when she had several sports-related injuries. She decided to become a physical therapist to help others maintain an active lifestyle while staying pain free. Kaitlin uses a hands-on approach to help people of all backgrounds optimize their movement and performance. Dr. Herzog is a record-holding competitive powerlifter, and you can find her training or competing in her spare time. She also enjoys Olympic weightlifting, CrossFit, yoga, sports, hiking, baking, crafts, traveling, and exploring Greensboro with friends.​

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