“Knowing More” Can Lead to Doing Too Much
If you have knee pain, you might think that you need an X-ray to get the full story. If you can see the damage, you’ll know what to do about it, right?
Not so fast.
When it comes to osteoarthritis, research shows that routine X-rays often add more confusion and anxiety than clarity. Seeing an image of your knee can make you more likely to consider unnecessary surgery when less invasive treatments could work just as well.
You don't need an X-ray to diagnose knee osteoarthritis.
Many doctors can diagnose it based on your symptoms and medical history. If you’re over 45, have joint pain during activity, and experience morning stiffness that lasts less than 30 minutes, that’s usually enough to confirm it.
People get X-rays partly out of habit and partly because they make the diagnosis feel more “official.”
It seems counterintuitive, but seeing your joint on an X-ray can change how you think about your pain--not in a helpful way.
When over 600 people with knee pain were shown X-ray images of their knees, they were 36% more likely to believe they needed a knee replacement than people who received a diagnosis without imaging.
They were more fearful of moving, more worried about making things worse, and more convinced that exercise could hurt them, even though movement is one of the best things you can do for knee osteoarthritis.
People were slightly more satisfied with an X-ray-based diagnosis than a clinical diagnosis, possibly because they believed that the “damage” inside the joint needs to be seen to guide treatment.
What you see on an X-ray often doesn’t match how you feel.
Some people have joints that look rough on an X-ray but feel fine. Others have mild-looking changes but serious pain.
There's no direct relationship between "how bad it looks" and "how bad it feels."
More times than I can count, clients have said, "This knee is 'bone on bone' but it doesn't hurt!"
That phrase—“bone on bone”—is one of the most misunderstood and fear-inducing labels out there.
One study found that people told they had “bone-on-bone” arthritis often ignored evidence-based treatments like exercise and instead pursued alternative or experimental treatments they believed could regenerate cartilage.
Um.....that's not a thing......🤔
What does help knee pain??
✅ Exercise and physical activity
✅ Weight management (if needed)
✅ Pain relievers, if appropriate
✅ Education and self-management strategies
Surgery should be a last resort, reserved for severe, life-limiting cases. It carries risks like blood clots, infection, and sometimes, disappointing results.
Reducing unnecessary X-rays can
ease patient anxiety
prevent unnecessary concern about joint damage
reduce demand for costly and potentially unnecessary joint replacement surgery
reduce exposure to medical radiation
Focus on proven strategies that can help you move better, feel better, and stay active, without jumping straight to the operating room.