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Why it's not Bone-on-Bone: And how can we learn from a campfire

Writer's picture: Iain HarringtonIain Harrington

You might be saying, "But Iain, it is 'wear and tear,' my x-ray shows 'bone-on-bone.'"


And that is a very fair point. When we see images of our joints, it provides compelling proof that the concept of "wear and tear" is how our joints work.


If you have persistent hip or knee pain and consult your doctor, eventually, you may undergo an X-ray or MRI. The doctor may observe a reduced space between the bones, along with other features related to osteoarthritis. The report may even contain some intimidating language like "degeneration" or "joint space loss." The doctor may then remark, "It appears to be bone-on-bone."


Your heart sinks - hearing this makes us feel like the problem is too far gone and totally out of our control.


I’m here to say, “Please have hope!”


There's another part of this story that you must hear. Something the doctor may have left out. Almost half of people over 40 years old show the same signs of osteoarthritis, and have no pain! Please read that again, slowly.


A 2020 research paper is really eye opening. Of the 230 knees belonging to healthy adults that were sent through the scanner, around 50% had cartilage abnormalities with no pain. 31% of these were severe cartilage abnormalities. Bone-on-bone with no pain.

How do we make sense of this?


View joint pain like the process of building a campfire. Once the fire is burning, you have pain.


Imagine your arthritic joint is like the kindling, the small pieces of wood we use to start a fire. If I just place kindling on the ground, is there a campfire?


No. Kindling on the ground might increase the chances of a fire happening. But those chances are low.


But, to really start a fire you’ll need:


A spark.

Some oxygen.

More fuel to keep it burning.




Now, I want you to imagine:


A spark = inflammatory diet.

Oxygen = low physical activity levels.

More fuel = increased body weight.



Those are just examples, there are many other factors that can influence your pain.

When you combine kindling with a spark, oxygen and fuel you have a fire.


When you combine a knee that looks arthritic on an x-ray with inflammatory foods, low exercise levels and increased body weight, you may get pain.


Let's go back to the study I talked about earlier.


The one where some people have really bad-looking X-rays of their knees, but surprisingly, they don't feel any knee pain. These folks, despite their X-ray results, might be doing a good job of handling the things that can trigger knee pain, such as their diet (like sparks for a fire), their exercise levels (similar to oxygen for a fire), and their body weight (which is like the fuel for a fire). This could be why they don't experience pain! They are managing their pain factors and whole health so well, they can have “arthritis” on their X-rays but experience no pain.


Why is this so crucial to understand? It’s important for two reason. One, it means what we see on your scan is not your destiny. two, and more importantly, it puts us back in control. Back in control of our joint pain. Instead of focusing on 'bone on bone', we focus on these other factors that influence pain.


So let's recap.


People without pain have cartilage abnormalities on scans.

Your scans are only part of the pain picture.

Joint pain is more complex & multifactorial than we think.


To get control of your pain, focus on what you do have control over.


Pain is complex.


But your pain can change.

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SJT

I work in Campbell River and Courtenay, on the unceded traditional territories of the Laich-Kwil-Tach, Wei Wai Kum, We Wai Kai, and K'ómoks First Nations. I acknowledge and respect the histories, cultures, and contributions of all Indigenous Peoples connected to these lands.

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