The knee grumbles on the stairs, so you start taking them more slowly. The hip aches after a long walk, so the walks get shorter. It feels like the sensible thing to do. Yet for most people with aching joints, doing less is not what helps them most. Building strength around the joint usually does.
A Joint Is More Than Its Cartilage
When a knee or hip aches, most people picture worn-out cartilage, the smooth covering on the ends of the bones. But a joint is a whole working unit: the cartilage, the bone underneath it, the lining that produces the joint's fluid, the ligaments that hold it together and the muscles that move and steady it.
Cartilage itself has no nerves, so the ache you feel usually comes from the tissues around it, such as the bone beneath, the joint lining and the structures that are taking more strain than they are used to.
That is an important point, because several of those tissues respond well to the right kind of exercise. You cannot replace cartilage, but you can change how much load the rest of the joint has to cope with, and how well it copes.
Muscle Is the Joint's Shock Absorber
The muscles around a joint do far more than move it. They control how quickly it bends, they steady it from side to side, and they take up a share of the load that would otherwise pass straight through the joint surfaces.
The knee is the clearest example. The large muscle at the front of the thigh, the quadriceps, acts as a brake every time you walk downhill, step off a kerb or lower yourself into a chair. When it is strong, it absorbs much of that force. When it is weak, more of the force is taken by the joint itself.
The same principle runs through the body:
strong buttock muscles help steady the hip and keep the knee in line when you climb the stairs
the calf muscles absorb force at the ankle with every step
the muscles around the shoulder blade give the shoulder joint a stable base to work from
the small muscles of the hand and forearm protect the finger joints when you grip and twist
In our article Why Muscle Health Matters, we described muscle as something that steadies and protects your joints. This is what that looks like in practice.
The Pain and Rest Cycle
When a joint hurts, it is natural to use it less. In the short term that can be sensible, particularly after a knock or a flare-up.
Over weeks and months, though, resting a painful joint tends to set off a cycle that is hard to spot from the inside:
the joint aches, so you use it less
the muscles around it weaken from lack of use
with less muscle support, the joint takes more of the load
the joint becomes more sensitive, and aches sooner
Each step makes the next one more likely. Many people who come to us with a long-standing knee or hip problem describe exactly this, often without realising how much strength they have lost along the way.
Strength work is one of the most reliable ways to break the cycle, because it addresses the part of the problem that is most changeable.
Osteoarthritis Is Not Simply Wear and Tear
Osteoarthritis is the most common joint condition in later life, particularly in the knees, hips and hands. It is often described as wear and tear, and that phrase has done a great deal of harm, because it suggests that every step uses up a joint that cannot be replaced.
The picture is more hopeful than that. Osteoarthritis involves changes in the whole joint, including the cartilage, the bone beneath it and the tissues around it, and the joint keeps responding to how it is used throughout life. Research consistently shows that exercise, and strengthening in particular, reduces pain and improves function for people with osteoarthritis of the knee and hip. UK guidance recommends exercise as a core part of managing the condition, whatever a person's age.
It is also worth knowing that scans and X-rays do not tell the whole story. Many people whose X-rays show clear changes have little or no pain, and others with marked pain show very little. What you can do with the joint, and how strong the muscles around it are, often matters more than what the image looks like.
Three Everyday Things That Change the Load on Your Joints
Strength is the biggest lever, but it is not the only one. Three everyday factors also change how much work your knees and hips have to do.
Body Weight
The knee takes several times your body weight with every step, and more on stairs. Research has found that each kilogram of weight lost takes roughly four kilograms of load off the knee with each step. For anyone carrying a little extra weight, even a modest change can make walking noticeably more comfortable.
Shoes and Feet
The way your foot meets the ground affects how load travels up through the ankle, knee and hip. Supportive, cushioned everyday shoes often make a difference on hard pavements, and worn-out shoes are worth replacing.
How You Spread the Day
A whole morning on your knees in the garden, followed by a long walk in the afternoon, asks a lot of the same joints. Breaking bigger jobs into shorter spells, and mixing heavier and lighter tasks through the day, lets a sensitive joint keep going for longer without a flare-up.
Strength You Can Build at Any Age
Muscle responds to strength work at any age, including in people who already have joint pain. The aim is not to push through pain, but to find a version of each movement the joint is comfortable with and build gradually from there.
Our cornerstone guide, Strength Training After 50: Building Capability for Life, explains how to plan strength work through the week, including how to tell acceptable discomfort from a warning sign.
If a joint has been troubling you for a while, an assessment can make that starting point much clearer. Osteopathy can help you understand what is going on and what is safe to work on, and Reformer Pilates offers controlled strength work where the springs support the movement and the load can be set to suit a sensitive joint. Find out more on our services page.
Coming up in the Library on Thursday 12 November, How to Exercise When You Have Joint Pain sets out simple ways to start and how to judge what your joints are telling you.
Apollo Insight
People often tell us they are saving their knees, as though each joint has a set number of steps left in it. In clinic we see the reverse. The joints that cope best over the years are usually the ones that are used regularly and supported by strong muscles, not the ones that have been protected from use. A joint that has been rested for a long time needs to be reintroduced to load gradually, but it does need to be reintroduced.
How Apollo Health Collective Supports Healthy Ageing
Healthy ageing is about understanding your body, looking after it well and having the right support when you need it.
At Apollo Health Collective, we help people stay active, capable and independent through personalised, evidence-informed care. Our integrated approach brings together different areas of expertise to support movement, recovery and long-term wellbeing.
Our Sheringham clinic offers Osteopathy, Sports Therapy, Sports Massage, Clinical Exercise & Rehabilitation, Reformer Pilates, Podiatry, Biomechanics, and Lifestyle & Wellbeing services. We also offer Osteopathy appointments in Norwich and Coltishall.
Whether you are recovering from an injury, managing ongoing concerns, looking to improve your movement or simply investing in your future health, our team is here to support you.
References
01 Lawford BJ, Hall M, Hinman RS et al. (2024). Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, 2024(12), CD004376. https://doi.org/10.1002/14651858.CD004376.pub4
02 Fransen M, McConnell S, Hernandez-Molina G et al. (2014). Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews, 2014(4), CD007912. https://doi.org/10.1002/14651858.CD007912.pub2
03 Øiestad BE, Juhl CB, Culvenor AG et al. (2022). Knee extensor muscle weakness is a risk factor for the development of knee osteoarthritis: an updated systematic review and meta-analysis including 46 819 men and women. British Journal of Sports Medicine, 56(6), 349-355. https://doi.org/10.1136/bjsports-2021-104861
04 Messier SP, Gutekunst DJ, Davis C et al. (2005). Weight loss reduces knee-joint loads in overweight and obese older adults with knee osteoarthritis. Arthritis & Rheumatism, 52(7), 2026-2032. https://doi.org/10.1002/art.21139
05 Bedson J, Croft PR (2008). The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature. BMC Musculoskeletal Disorders, 9, 116. https://doi.org/10.1186/1471-2474-9-116
06 National Institute for Health and Care Excellence (2022). Osteoarthritis in over 16s: diagnosis and management (NG226). https://www.nice.org.uk/guidance/ng226
