The Most Effective Treatment for Osteoarthritis Isn’t a Pill or Surgery

Exercise is the most effective and underused treatment for osteoarthritis, protecting joints while improving overall health.

Stiff knees, sore hips, and the persistent ache of joint pain are often seen as a normal part of aging. Yet osteoarthritis, the most widespread joint disease in the world, is not being managed in a way that reflects what the evidence shows, according to many experts.

The most effective treatment does not come from medication or surgery. It comes from movement. Despite this, health systems in many countries still fail to steer patients toward exercise, even though it is proven to protect joints and reduce pain.

Exercise is among the strongest treatments available for long-term, disabling joint conditions such as osteoarthritis. Even so, only a small proportion of patients are actually prescribed or supported to use it.

Studies examining healthcare in Ireland, the UK, Norway, and the United States reveal a consistent pattern. Fewer than half of people with osteoarthritis are referred to exercise programs or physiotherapy by their primary care clinician. More than 60% receive treatments that clinical guidelines advise against, and roughly 40% are referred for surgical consultation before non-surgical options have been properly explored.

Why movement protects joints

The concern around these statistics becomes clearer when we look at how joints actually stay healthy. Osteoarthritis is the most common form of arthritis, already affecting more than 595 million people worldwide and placing a growing strain on individuals and health systems alike.

A major global analysis published in The Lancet warns that the number of people living with the condition could climb close to one billion by 2050. Longer lifespans, less physically active daily lives, and rising levels of overweight and obesity are all contributing to this upward trend.

Regular exercise, however, appears to offer a powerful form of protection. People who stay active are not only strengthening their bodies but also triggering biological processes that help defend joints against damage and reduce the risk of severe symptoms.

At the center of this process is cartilage, the smooth, durable tissue that cushions the ends of bones inside a joint. Unlike most tissues in the body, cartilage has no blood supply, which means it depends almost entirely on movement to receive nutrients and stay resilient.

When a joint is loaded during walking or other activity, cartilage compresses and releases fluid, much like a sponge being gently squeezed. This motion pushes waste products out and draws fresh nutrients and natural lubricants back in, supporting the tissue with every step.

This helps explain why the long-held view of osteoarthritis as simple “wear and tear” falls short. Joints are not passive structures that steadily break down with use, like car tires wearing thin over time.

Instead, osteoarthritis develops through an ongoing cycle of stress, repair, and adaptation. Regular movement and exercise are essential parts of that process, supporting not just cartilage but the health and function of the entire joint.

A disease of the whole joint

We now know osteoarthritis is a whole-joint disease. It affects the joint fluid, the underlying bone, the ligaments, the surrounding muscles, and even the nerves that support movement.

Therapeutic exercise targets all these elements. Muscle weakness, for instance, is one of the earliest signs of osteoarthritis and can be improved with resistance training. There is strong evidence that muscle weakness increases the risk of both developing the disease and seeing it progress.

Nerve and muscle control can also be trained through neuromuscular exercise programs such as GLA:D® (Good Life with osteoArthritis: Denmark) for hip and knee osteoarthritis. Usually delivered in supervised group sessions by physiotherapists, these programs focus on movement quality, balance, and strength to improve joint stability and rebuild confidence.

Significant improvements in pain, joint function, and quality of life have been recorded for up to 12 months after completing the program.

Exercise is good medicine for the whole body: it has documented benefits across more than 26 chronic diseases. In osteoarthritis, it helps not only by strengthening cartilage and muscle but also by tackling the inflammation, metabolic changes and hormonal shifts that drive the disease.

Obesity is a major risk factor for osteoarthritis, and not merely because of the extra mechanical load on joints. High levels of inflammatory molecules in the blood and in joint tissues can degrade cartilage and accelerate disease.

For osteoarthritis, regular activity can counter this at a molecular level, lowering inflammatory markers, limiting cell damage, and even altering gene expression.

Exercise first, surgery later

Currently, there are no drugs that modify the course of osteoarthritis. Joint replacement surgery can be life-changing for some people, but it is a major surgery and does not succeed for everyone.

Exercise should be tried first and continued throughout every stage of the disease. It carries far fewer side effects and brings many additional health benefits.

Osteoarthritis is not simply a matter of “worn-out” joints. It is shaped by muscle strength, inflammation, metabolism and lifestyle.

Regular, targeted exercise addresses many of these factors at once – helping to protect cartilage, strengthen the whole joint, and improve overall health. Before considering surgery, movement itself remains one of the most powerful treatments we have.

Adapted from an article originally published in The Conversation.

Funding: Clodagh Toomey receives funding from the Health Research Board (Ireland) for research in the area of osteoarthritis.

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