Coming Soon · Arthritis & Joint Health

Hip & Knee Arthritis: Managing Osteoarthritis Without (or Before) Surgery

Told it's "bone-on-bone"? A clinician-led walkthrough of hip and knee osteoarthritis — what exercise can really do, the GLA:D program, an honest look at injections and braces, and when replacement truly is the right call.

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AIM Clinical Team · Physiotherapy & Arthritis Rehabilitation · 35 min

Recording in the works

This clinician-led video guide is scripted and heading into production. In the meantime, our written guides cover the same ground, and our clinicians are the fastest path to a personalized plan.

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What you'll learn

Explain osteoarthritis as a whole-joint process rather than simple "wear and tear."
Describe why X-ray severity correlates poorly with pain and function.
List the components of a structured education-and-exercise program such as GLA:D, and the outcomes it typically produces.
Recognize the role of injections, braces, and walking aids as adjuncts rather than fixes.
Identify when joint replacement is the right choice and explain how prehab improves surgical recovery.

What the video will cover

00:00

Cold open

Hook: "'Bone-on-bone' is a description of an X-ray — it is not a verdict on your knee, and it is not a referral for surgery."
Name and credential; presenter positioning: AIM treats hip and knee osteoarthritis every single day, and direct-bills most extended health plans.
Who this is for: Alberta adults 55-plus — and active people in their 40s — who've been told "it's arthritis," "it's bone-on-bone," or "you'll need a replacement eventually."
Preview the session: what osteoarthritis actually is, what the evidence says exercise can do, an honest look at injections and braces, and when a replacement genuinely is the right call — plus how to go into it strong.

01:00

What osteoarthritis actually is (and isn't)

Osteoarthritis is a whole-joint process — cartilage, bone, the joint capsule, the surrounding muscles, and the nervous system are all involved. It is not your joint sanding itself down like a brake pad.
The old "wear and tear" story implies every step uses up a fixed allowance. Modern evidence says the opposite: joints are living tissue, and like muscle and bone they adapt to the loads we give them.
It's also extremely common — most adults over 55 show some osteoarthritis on imaging of the knee or hip, many with no symptoms at all.
Symptoms naturally fluctuate. Flares and quiet stretches are part of the condition — a bad month is not proof of a downhill slide.
What drives pain day to day is more than structure: muscle strength, activity spikes, sleep, stress, and body weight all move the needle — and most of those are things we can work with.
The theme for this whole session: osteoarthritis is common, it's manageable, and it is not a destiny.

05:00

The X-ray trap: what "bone-on-bone" does and doesn't mean

The finding that surprises most people: X-ray severity correlates poorly with symptoms. Some people with "severe" changes have little pain; some with mild changes hurt a lot.
Studies of adults with knee osteoarthritis on X-ray consistently find a large share — in some studies close to half — report no significant pain at all.
Words matter. When people hear "bone-on-bone," the natural response is to protect the joint — move less, avoid stairs, stop walking. Less movement means weaker muscles, stiffer joints, and usually more pain. The label can do damage the joint hasn't.
What imaging is genuinely for: planning surgery, and ruling out other explanations when the clinical picture doesn't fit. Routine repeat X-rays to "watch it get worse" rarely change the plan.
Progression isn't a straight line either — for many people, X-ray changes creep along slowly for years while symptoms stay stable or even improve with the right program.
One sentence to keep from this section: your X-ray is not your pain — and it doesn't get to make your decisions for you.

09:00

Myth-busting: "exercise will wear the joint out"

This is the most consequential myth in arthritis care — and it's false. Studies following people through structured exercise programs do not show accelerated cartilage loss; if anything, cartilage appears to need regular, cyclical loading to stay healthy.
The payoff is measurable: across trials and program registries, structured exercise reduces osteoarthritis pain by roughly 25–30% on average — in the same range as common painkillers for many people, without the side effects.
Some research even suggests recreational runners have no higher — possibly lower — rates of knee osteoarthritis than non-runners. Load, dosed sensibly, is a friend.
Two related myths, quickly: "rest until it stops hurting" — rest beyond a brief flare feeds a deconditioning spiral. And "clicks and grinding mean damage" — joint noises are common at every age and usually benign.
The rule we actually use — the acceptable pain scale: on a 0–10 scale, pain up to about 5 during exercise is acceptable, provided it settles back to your usual level by the next morning. If it does, the dose was fine.
Pain during exercise is not the sound of the joint being damaged — it's a sensitive joint reporting load. The response to a bad day is to adjust the dose, not abandon the plan.

14:00

GLA:D — the structured program with a track record

GLA:D stands for Good Life with osteoArthritis: Denmark — an education-and-exercise program developed by Danish researchers, running in Canada since 2016 and offered at trained clinics across Alberta.
What it actually is, plainly: two or three education sessions on how osteoarthritis works and how to manage it, plus twelve supervised group exercise sessions over about eight weeks — typically twice a week — led by physiotherapists with GLA:D training.
The exercise style is "neuromuscular" — strength and control in the positions life demands: sit-to-stands, step-ups, balance work, controlled squats. Every exercise scales to your starting point; nobody is thrown into a bootcamp.
The results are tracked in national registries across tens of thousands of participants: pain down roughly 25–30% on average, walking speed up, painkiller use down — and a meaningful share of participants who expected surgery report they no longer feel they need it, at least in the near term.
It works for hips and knees, and X-ray severity doesn't exclude you — "bone-on-bone" participants improve too.
It's not magic. It's dose, consistency, and confidence — and the point of the eight weeks is to leave you with skills and a routine that carry on long after.

19:00

The three levers you control: strength, weight, dosing

Strength. The quads and glutes are the joint's shock absorbers — stronger muscle typically means a less symptomatic joint. Progressive strength work twice a week is the backbone of every good arthritis program, and it's trainable at any age; people in their 80s build muscle in supervised programs.
Weight. Each extra kilogram of body weight transmits roughly three to four kilograms of load through the knee with every step. For many people, losing 5–10% of body weight brings a meaningful drop in symptoms.
A respectful note on weight: it's one lever among several, not a moral judgment — and strength training helps at any weight. We meet people where they are.
Dosing. Most flares are a dose error — too much, too soon, too fast — not new damage. The fix is to trim volume for a few days and keep moving, not to stop.
Alberta reality: winter ice is a legitimate barrier. Plan for it — indoor walking, pool sessions, a stationary bike, walking poles for grip and confidence. The program that survives January is the one that works.
Sleep and general activity round out the picture — a poorly slept week is very often a more painful week.

24:00

Injections and braces — an honest guide

Cortisone injections can settle a genuinely hot, swollen flare for weeks to a few months. Used occasionally as a bridge — calming things enough to start exercising — they're reasonable. They don't change the course of the arthritis, and frequent repeat injections are generally discouraged.
Hyaluronic acid ("gel") injections: the evidence is mixed, guideline support is lukewarm, and they're often paid out of pocket. Some individuals feel benefit — go in with clear eyes about the odds and the cost.
PRP and "stem cell" injections: the research is still evolving, costs are high, and marketing routinely outruns the evidence. Be cautious of any clinic promising regeneration.
Braces and walking aids: an unloader brace helps some knee patterns, especially arthritis concentrated on one side of the joint. A cane or walking poles reduce joint load and — just as importantly — restore the confidence to walk further. Using one is strategy, not surrender.
The common thread: these are adjuncts, not fixes. At their best they buy you a more comfortable window — and the window is for building strength.

28:00

When replacement IS the right call — and how to arrive strong

Joint replacement is a genuinely good operation for the right person at the right time. The broad markers: significant pain despite a real conservative trial, pain that wakes you at night despite medication, and function or quality of life you're no longer willing to accept.
A "real conservative trial" means a structured exercise program actually completed — typically three to six months — not two weeks of walking that hurt. Surgeons increasingly want to see this first, and for good reason.
The honest numbers: hip replacements carry very high satisfaction; for knees, up to roughly one in five patients report some ongoing pain or dissatisfaction afterward. Exhausting conservative care first is how you make sure surgery was the right call — and it identifies the many people who turn out not to need it yet.
Prehab pays. Strength going into surgery is one of the better predictors of how smoothly the early recovery goes. The same program that might delay your surgery is the one that prepares you for it — nothing you build is wasted.
Alberta reality: surgical waitlists commonly run months. That wait is not dead time — it is the prehab window.
And on the other side, post-surgical rehabilitation picks up the same principles — early range of motion, progressive strengthening — from day one.

33:00

Wrap + CTA

Recap: osteoarthritis is a whole-joint, modifiable condition — not "wear and tear destiny." Your X-ray is not your pain. Structured exercise is the best-supported first-line treatment, injections and braces are adjuncts that buy windows, and when replacement is right, you want to arrive strong.
Point viewers to the companion PDF (the Hip & Knee Osteoarthritis Action Plan) and the knee pain: when to rest, when to train article; if a first visit feels daunting, the first appointment checklist covers exactly what to bring.
Alberta note: you do not need a doctor's referral to see a physiotherapist — you can self-refer and be assessed this week.
Two clear CTAs: Book an arthritis assessment and Book Now. Direct-billed to most extended health plans — and if you're on a seniors' plan, ask our front desk to check your coverage before your first visit.

Companion resource

Hip & Knee Osteoarthritis Action Plan

A printable one-page action plan for hip and knee osteoarthritis — the myths to drop, the program to start, and the questions to ask before saying yes to surgery.

Myth vs. fact cheat sheet ("bone-on-bone," "exercise wears it out," "noises mean damage")
The acceptable-pain scale (0–10) and the next-morning rule, illustrated
What an 8-week structured program (GLA:D-style) looks like, week by week
Flare plan: what to trim, what to keep, and when to check in
Injections, braces, and walking aids quick-reference — what each does and for how long
"Is replacement right for me?" question list + Alberta self-referral and coverage notes

PDF ships with the recording. Ask your clinician for a printed copy at your next visit.

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