If you’ve been told you have osteoarthritis — or OA — you’ve probably heard words like “wear and tear,” “bone on bone,” or “there’s nothing you can do.”
Those phrases are common. They’re also incomplete — and for a lot of people, they make things worse.
This post is about what OA actually is, why pain in OA doesn’t always match what’s on an X-ray, and what the current evidence says about managing it well.
OA Is Common — Especially in BC
Osteoarthritis is the most common form of arthritis in Canada. About 3.9 million Canadians aged 20 and over live with a diagnosed case. In British Columbia specifically, roughly 18% of adults report having OA — and the most common site is the knee.
OA becomes more common as we age. By the time people are in their 70s, about 30–40% of men and women in BC have a physician-diagnosed case.
That’s a lot of people living with joint pain — and a lot of people being told things that may not be helping them.
What OA Actually Is
OA is a condition that involves changes to joint tissue over time. It most often affects the knees, hips, hands, and lower back.
These changes can include:
Thinning of the cartilage that cushions the joint
Changes to the bone beneath the cartilage
Some changes to the joint lining
Occasional swelling or stiffness, especially in the morning or after rest
What OA is not is a simple breakdown from overuse. The “wear and tear” label is misleading. Joint tissue is living tissue that changes and adapts throughout life. These changes are normal parts of aging — and they don’t automatically mean pain or loss of function.
Why Pain Doesn’t Always Match Your X-Ray
This is one of the most important things to understand about OA — and one of the most consistently supported findings in pain research.
X-ray findings and pain levels often don’t match. Some people have significant structural changes on imaging and little or no pain. Others have moderate imaging changes and significant pain.
Associate Professor Tasha Stanton, a leading OA pain researcher at the University of South Australia, has spent much of her career studying exactly this. Her work and that of colleagues shows that pain in OA is shaped by more than what’s happening in the joint itself. The nervous system — including how the brain processes threat and sensation — plays a major role in how much pain a person experiences and how it varies from day to day.
This doesn’t mean OA pain “isn’t real.” It very much is. It means pain is more complex than structural damage alone. And that matters for how you approach it.
The “Bone on Bone” Problem
If you’ve had imaging and been told you’re “bone on bone,” you may have left that conversation feeling like there’s nothing left to protect — and that movement will only cause more damage.
That fear is understandable. But the evidence doesn’t support the idea that movement causes harm in most OA cases. In fact, the opposite is closer to the truth.
Stanton’s research found that people with knee OA tend to perceive their environment as more threatening than it actually is — they estimate hills as steeper, for example. Higher fear levels were associated with greater overestimation. This kind of “protective” response may feel rational, but it can make people less active — and that tends to make symptoms worse, not better.
What the Evidence Says Helps
The current evidence for managing OA is clear, and it doesn’t lead with medication or surgery.
The OARSI guidelines — an international standard for OA care — identify the following as core recommendations:
Exercise (land-based and aquatic)
Weight management where relevant
Education about OA and pain
Self-management support
Hands-on care, including massage therapy, is listed as an adjunct — not a replacement for exercise and education, but a useful support alongside them.
Aquatic exercise deserves a specific mention. Moving in water reduces the load on joints while still allowing you to build strength and keep active. For many people with OA, water-based exercise is a practical entry point when land-based movement feels too uncomfortable. In Kamloops, the Tournament Capital Centre offers pool access that many of our patients use as part of their routine.
What This Means for You
A diagnosis of osteoarthritis is not a sentence. It’s information.
The people who tend to do best with OA are those who stay active, understand their pain better, and work with a team that doesn’t use fear to explain what’s happening in their bodies.
At Well+Able, our Registered Massage Therapists work alongside that kind of care. We don’t treat a diagnosis — we assess you as an individual, talk about what’s going on, and work with you on what’s most useful for your goals.
If you have OA and you’re wondering whether massage therapy might be helpful for you, we’re happy to talk through it.
Related reading on this site: What Arthritis Pain Can Feel Like — When Pain Is Worse in the Morning
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