What Science Actually Shows About Knee Imaging

Osteoarthritis features are common — even in people with no knee pain.
A large systematic review and meta-analysis in the British Journal of Sports Medicine examined MRI scans of adults with no knee symptoms and still found many OA-type changes (cartilage defects, meniscal tears, bone marrow lesions, osteophytes).

In adults aged ≥40, ~43% had cartilage defects — despite being pain-free.^[1]

Pain isn’t just about “damage.”Another meta-analysis reported a high prevalence of pain sensitization in knee osteoarthritis — meaning the nervous system can become more responsive to pain signals over time. Translation: two people with similar MRIs can feel very different levels of pain because the brain and nervous system play a major role.^[2]

Bottom line: Joint structure ≠ pain. Your scan is one piece of the puzzle. At ProActive Physical Therapy and Wellness, we match imaging with how you move, your strength, your goals, and what actually improves your day-to-day life.

Why Your MRI Can Look “Severe” — Yet You Can Still Feel Better

• Strength & mobility in the hips, quads, calves, and feet change how load moves through the knee.
• Movement patterns (sitting, standing, stairs, squatting) can stress tissues — or spare them.
• Inflammation, sleep, and stress influence how the nervous system processes pain.
• Pain sensitization can amplify discomfort even if tissue changes stay the same.

What Actually Helps Knee Osteoarthritis (Even If You’re “Bone-on-Bone”)

1) Build a stronger “shock-absorber system”

Target the quads, glutes, and calves; improve hip and ankle mobility; and progress load gradually. This reduces joint irritation and improves confidence with stairs, walking, and daily activity.

2) Retrain the way you move

We’ll fine-tune squats, sit-to-stand, step-downs, and walking mechanics so your knee is supported by the whole kinetic chain — not overloaded by it.

3) Calm the system

Flare-up plans, pacing, sleep strategies, and activity “dosing” help reduce sensitivity so you can do more with less pain.

4) Hands-on therapy (as needed)

Manual techniques plus targeted exercise can improve mobility, reduce stiffness, and make strengthening more effective.

People Also Ask

Does “bone-on-bone” always mean I’ll need surgery?

No. Many adults improve pain and function with strengthening, mobility work, and movement training — even when imaging looks advanced.

Can physical therapy help if I have cartilage loss or a meniscus tear?

Yes. While PT can’t regrow cartilage, it can reduce pain, improve strength and balance, and help you stay active longer — often delaying or avoiding surgery.

Why do my X-rays look worse than my pain feels?

Because imaging shows structure, not pain. Sensitization, inflammation, and movement patterns heavily influence what you feel.^[2]

References

1. Culvenor AG, et al.
   Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.
   British Journal of Sports Medicine. 2019;53(20):1268-1278.
   
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2. (Meta-analysis)
   High Prevalence of Pain Sensitization in Knee Osteoarthritis: A Meta-Analysis.
   SAGE Journals.
   
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