Why "wear and tear" is the wrong way to think about osteoarthritis
For decades, osteoarthritis was explained as joints simply wearing out — like brake pads on a car. That explanation isn't quite right, and it's also harmful.
If you've been told you have osteoarthritis, there's a good chance someone described it as "wear and tear" — the idea that your joints are simply wearing out with age and use. It's the most common way the condition gets explained, and it's also one of the most misleading.
The phrase paints a picture of joints as mechanical parts grinding down over time, with nothing to be done except wait for a replacement. The current evidence tells a very different — and far more hopeful — story.
What the old model got wrong
The "wear and tear" metaphor implies three things, and modern research challenges all of them:
- Joints have a fixed lifespan. They don't. Cartilage and the surrounding tissues are living, biological structures that respond and adapt to the loads placed on them.
- Using your joints causes damage. In fact, appropriate movement helps nourish joint tissue. Prolonged inactivity tends to be more harmful for osteoarthritis than staying active.
- Pain reflects the amount of damage. Pain is a complex experience shaped by many factors — not a simple gauge of how worn a joint is. Many people with notable changes on imaging report little or no pain, while others with mild changes experience more — which is why treatment focuses on how a joint feels and functions, not just how it looks on a scan.
What osteoarthritis actually is
Osteoarthritis is now understood as an active condition involving the whole joint — the cartilage, the bone beneath it, the ligaments, and the surrounding muscles. It's not a passive process of erosion; it's a dynamic condition that responds to how you manage it.
This matters enormously, because it means there are things you can do that genuinely change how your joint feels and functions.
The single most useful thing most people can do for their osteoarthritis is to keep moving — strategically, progressively, and with the right guidance.
What genuinely helps
Clinical guidelines around the world now point to the same first-line treatments for osteoarthritis, and they aren't surgery or medication:
- Targeted strengthening of the muscles supporting the affected joint
- Graduated activity — walking, cycling, or swimming, built up gradually
- Education — understanding what's safe, what helps, and what to monitor
If you've been told your joint is "bone on bone" and that you should avoid exercise, it's worth getting a second opinion. Current best-practice care looks very different from that advice.
Programs built on this understanding
Structured programs like GLA:D® (Good Life with osteoArthritis: Denmark) are built directly on this modern understanding. They combine education with supervised, individualised exercise — and the evidence behind them is strong. According to the GLA:D® Australia Annual Report 2023, participants reported meaningful reductions in pain and reduced reliance on pain medication twelve months after the program, with many who had been considering surgery no longer wishing to proceed.
The takeaway is simple: osteoarthritis is not a sentence to slow decline. With the right approach, most people can reduce pain, improve function, and stay active for years. The first step is letting go of the "wear and tear" story.
References
- 1. Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd ed. East Melbourne: RACGP; 2018. [Link]
- 2. Roos EM, Grønne DT, Skou ST, et al. Immediate outcomes following the GLA:D® program in Denmark, Canada and Australia. A longitudinal analysis including 28,370 patients with symptomatic knee or hip osteoarthritis. Osteoarthritis and Cartilage. 2021;29(4):502–510. [Link]
- 3. Barton CJ, Kemp JL, Roos EM, et al. Program evaluation of GLA:D® Australia: physiotherapist and patient outcomes. Osteoarthritis and Cartilage. 2021;29(8):1154–1164. [Link]
- 4. GLA:D® Australia Annual Report 2023. La Trobe University, Melbourne. [Link]
This article provides general educational information and does not constitute individual medical advice. It is not a substitute for assessment by a qualified health professional. Always seek advice tailored to your specific circumstances from your treating practitioner.