#6 – Can you really have arthritis?

Arthritis is commonly considered the source of pain for creaky, painful joints.

Bone spurs and narrowing joint spaces are its hallmarks, and pain is the alleged consequence. But is this narrative really true? Find out how a large scale study seriously undermines the generally accepted idea of arthritis.

Referenced resources:

Stages of Osteoarthritis

Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee


Hey, everybody. This is Matt Hsu from Upright Health, and welcome to Episode 6 of the Upright Health Podcast. Today, we are going to about arthritis – Osteoarthritis. Specifically, we’re going to talk about it in terms of the knee. So a lot of people worry about their knees. I’ve had plenty of clients tell me they’ve got bad knees — or least one bad knee — it might be arthritic etcetera, etcetera.  The knee doesn’t feel good. They can’t bend the knee properly. There’s crunching, there’s popping noises, they get sore with activity – all that nasty, terrible stuff. And you know, a lot of people are told that they have arthritis. They’ve had had x-rays done to check to see whether or not they have arthritis. And they get told, “Well, yeah, you got arthritis and that’s that. You just shouldn’t use your knee anymore.”

So I’ve always found this to be a very curious perspective. And I’ve long thought that there was something about this that didn’t make sense because I’ve seen clients who have been told they got bone spurs in their shoulders, they’ve got bone spurs wherever. And just by doing some careful exercise, doing some stretches, doing some manual therapy or some self-massage and tissue work, they could get better. So it always struck me as odd that if they could get better without having shaved any bone off, that arthritis could be… it just made me think that arthritis couldn’t possibly be exactly what I had grown up thinking it was. So just the other week, I started looking around at information on arthritis, and I came across this study and that was done in the… it was published in the Journal of Rheumatology in June of 2000. And it’s got a great name. It’s called, “Analysis of the discordance between radiographic changes and knee pain in Osteoarthritis of the knee. So basically, they are looking at how different diagnostic criteria sync up when you’re looking at arthritis of the knee.

And so the objective of this study was to look at three indicators of Osteoarthritis — the knee. One of them is radiographic evidence of structural damage (so that means X-rays), self-reported knee pain (that means the patients complaining that their knee hurts), and self-report of a diagnosis of arthritis at any joint by a physician. So, the three things we’re looking at are pain, x-rays and whether or not they’ve ever been diagnosed by a doctor for arthritis. And so what they did was they looked at data for 6880 people between the ages of 25 and 74 in the United State. And it was pretty interesting.  So to give you a little bit of background, there are stages of arthritis. When you look at the stages, well, I guess there are technically five stages, but one is just kind of not worth mentioning. But the first  stage is stage zero, which is when you have a normal knee — which means you don’t have arthritis. So it’s not really an arthritic stage but it’s there.

So you have Stages One to Four of arthritis. And Stage One is basically defined as very minor  bone spur growth. You supposedly will have no pain. Probably doesn’t bother you much, but you should just be aware if you have Stage One. Stage Two is a mild stage.  If you have x-rays of your knee, then you might notice that there are some more bone spur growth but the bones aren’t rubbing or scraping against each other. The joint spacing is pretty much the same. Stage Three is called “moderate Osteoarthritis.” And in this description (I’m reading actually from healthline.com), people with stage three Osteoarthritis are likely experiencing frequent pain when walking, running, bending or kneeling. They may also experience joint stiffness after sitting for long periods or when waking up in the morning. Joint swelling may be present after extended periods of motion as well. So then in terms of treatments, they are talking about cortisone injections, which is good times for everybody. Also, anti-inflammatory prescription pain medicine — more good times for everybody. Stage Four Osteoarthritis is considered severe. So people in Stage Four have great pain and discomfort when walking and moving the joint. The joint space is dramatically reduced; cartilage is almost completely gone and the joint is stiff and possibly immobile. At this stage, you’re looking at bone realignment surgeries (osteotomy.) Basically, cutting bone, which as we’ve talked about is a really good time for everybody.

So we’re concerned really in terms of the descriptions here, we’re really concerned with Stage 2-4 in terms of people experiencing pain. Assuming that X-rays are a good indicator of whether or not you have pain. So the diagnosis of arthritis is coming based on what you see in the x-ray. The stage is determined by what you are seeing in the x-ray. So we should hopefully see a very strong correlation between what you see in the X-ray, and what you as a person, experience if we think arthritis is the way it is commonly described. So the way we think of arthritis is there are bones rubbing together; there are weird growths, the cartilage is going bye, bye and that is leading to pain. So if we see in an X-ray, that you have a bone spurs growing, and that your cartilage is disappearing and joint space is narrowing, then we can assign you a certain stage and predict how much pain you would have, roughly. At least saying, “Hey, if it’s stage three or four, you’re going to be in bad pain.”

So what did we find in this study done back in 2000? Well, let’s see. The report they’ve found Stage 2-4, knee Osteoarthritis in 319 people, which was 3.7% of the total population that they studied. Of the 3.7%, only less than half. So 47% of them had knee pain. So let’s back that up. You have 6,880 people. Of those 6,880 people, 319 — a tiny percentage – had radiographic evidence, x-ray evidence of Stage 2-4 Osteoarthritis. That’s when they should be having knee pain. But of those 319, only 47% of them had knee pain. So we’re talking about a tiny, tiny percentage. We’re talking about less than 2% of this total population had knee pain. And it’s literally only half of the population that you would expect to have knee pain. So they also found from these 319 people that only 61% of them reported that a doctor had actually diagnosed them with arthritis. Now, that doesn’t mean that you only have knee pain if you have signs of arthritis. So, knee pain was actually reported by 1,004 people in this study, which is actually 14.6% percent of this whole 6,800 people.

So of these 1,004 who had knee pain, only 15% of them had signs of Stage 2-4 Osteoarthritis. Okay? So, what you’re seeing is that you can have knee pain and no arthritis in the X-rays. And you could also have arthritis in the X-rays, and have no knee pain. So I’m going to recap that again. 319 people who have arthritis in an X-ray, only 47% reported having knee pain. Then when you look at 1,000 people who have knee pain, only 15% of them had signs of arthritis in their x-rays. Kind of odd, right? Now, what’s more interesting is that then of those 15% of people who had knee pain and had x-rays, only 60% of them reported being diagnosed with arthritis by a physician. So, kind of interesting, right?

The conclusion of the study was that: “Substantial discordance exists in this population based study between radiographic Osteoarthritis of the knee versus knee pain, versus a diagnosis of arthritis by a physician. These phenomena may be important in the design of clinical research studies, as well as in criteria for Osteoarthritis.” Which basically means you need to think about whether or not the diagnostic criteria for arthritis even made sense. If you’re looking at the x-ray and the x-rays are supposed to be predictive and tell you whether or not you’re supposed to be in pain, then this study seems to greatly undermine that idea, and dovetails with what I’ve seen with people when they train their bodies well. If you can get your body to coordinate movements better, a lot of times, these issues that are supposedly a result of bony problems, seem to go away.

If bone spurs in these radiographic images are really true, if they are truly predictive, if they really do describe what is possible in terms of your movement, then it would be impossible to get any improvement by doing any kind of movement. I’ve seen it in my practice with people that I train. I’ve seen people with crunchy, crunchy knees, have their knees smoothed out. The more they actually squat, the more they stretch out the tight stuff that’s causing the faulty mechanics. I’ve read about all kinds of stories online. You can find people who talk about how weight lifting actually helped their knee arthritis. There are countless anecdotal pieces of proof for this stuff. And it makes sense, given that a large study like this that the bone spurs are really are not predictive; that the X-rays are not predictive; that even the diagnosis of arthritis… I mean, it just doesn’t makes sense, right? It’s basically showing that diagnosing arthritis through x-ray makes no sense.

So if you, or somebody you know has been diagnosed with bone spurs and that bone spurs are the cause of your problem, it’s something to really, seriously rethink. And to, I would suggest, push out of your mind. I’m going to link to this study, so that you can just read the abstract for it yourself, so that you know I’m not making this up. And you can share that with yourself or share it with other people that you think it might help. Especially if they’ve got knee pain and they’ve been told its arthritis, make sure they take a look.

Well, that’s going to wrap it up today. I hope you’ve found todays talk on the Osteoarthritis educational and that it inspires you to move more and move better; get stronger and be well. And please remember that “Pain Sucks, Life Shouldn’t.”


About the Author

Matt Hsu is a trainer and orthopedic massage therapist. He fought a long battle with chronic pain all over his body and won. He blends the principles he learned in his journey, empirical observations with clients, and relevant research to help others get their lives back.