Arendt-Nielsen (2017) found that 30–50% of people with severe OA do not have symptoms. How is this possible?
The amount of injury does not equal the amount of pain.
Think about the pain associated with a headache — no tissue injury, but high amounts of pain. Or a paper cut: a small injury for a high amount of pain.
The difference is in the nervous system. Arendt-Nielsen found that one reason involves sensitization of the joint — meaning previously non-painful motions are now painful due simply to changes in the nervous system, NOT due to changes in the structure of the joint. This is why some people who undergo surgery do not recover quickly: the nervous system (which did not change) remains sensitive to all movements and continues to send pain signals to the brain after surgery.
The main point: some people have "bone on bone" and don't have pain. So think hard about your pain and ask yourself some questions:
- Have I tried progressive exercises around the joint?
- Have I ruled out muscle pain around the joint?
- Have I ruled out other nervous system causes of the pain?
Related service: Orthopedic Physical Therapy