09/09/2026
🦿Cartilage does not wear out like a tyre, It depends on cyclical loading to move fluid and nutrients through it. Unloaded cartilage deteriorates. Loaded cartilage adapts.
A large proportion of completely pain-free adults over 50 have imaging changes consistent with osteoarthritis. Some people with severe imaging have almost no pain, and some with mild imaging have a lot. The scan and the symptoms are only loosely related, which is exactly why treating the scan does not work.
Exercise therapy is a core first line treatment for knee osteoarthritis in every major clinical guideline, sitting ahead of imaging, injections and surgery.
The mechanism is unglamorous. Stronger quadriceps and hips distribute load. The same stairs and the same shift take a smaller share of your maximum. Less relative demand, less irritation.
Some discomfort during loading is acceptable. A common clinical rule is that pain up to a moderate level, settling within 24 hours and not climbing week to week, is safe to work through. Pain that keeps building is a dosing problem, not a damage signal.
⚠️Rest feels protective, It is not.
