Bone-on-Bone Knee Pain: Causes, Symptoms, and Management

Bone-on-Bone Knee Pain: Causes, Symptoms, and Management
Knees bear more than just our body weight. They carry the responsibility of movement, flexibility, and balance, enabling us to walk. But what happens when the very cushioning that protects these vital joints starts to deteriorate, leading to the agonizing scenario of bone rubbing against bone? Bone-on-bone knee pain is a condition that can significantly hinder an individual’s quality of life. This article delves deep into the causes, symptoms, and management of this condition.

What Causes Bone-on-Bone Knee Pain?

What Causes Bone-on-Bone Knee Pain?Bone-on-bone knee pain is a descriptive term often used to indicate the severe loss or complete absence of the cartilage cushioning in the knee joint. The main causes of this condition include:

  • Osteoarthritis (OA):  This is the primary cause of bone-on-bone knee pain. OA is a degenerative joint disease characterized by the gradual breakdown and loss of cartilage in the joints. As the cartilage wears away, bones start to rub against each other, causing pain and stiffness.
  • Traumatic Injuries: Acute injuries to the knee, such as fractures, torn ligaments, or meniscal tears, can damage the joint’s cartilage. Over time, this can lead to post-traumatic osteoarthritis, eventually culminating in a bone-on-bone situation.
  • Rheumatoid Arthritis (RA): RA is an autoimmune disease where the immune system mistakenly attacks the joints’ lining. Persistent inflammation can lead to severe cartilage loss, resulting in bones rubbing against each other.
  • Repetitive Stress: Occupations or activities that involve repetitive knee bending or carrying heavy loads can increase the risk of cartilage wear and tear.
  • Congenital or Developmental Abnormalities: Some people are born with irregularly formed joints or misaligned bones that can lead to uneven stress on the cartilage. And, causing it to wear out more quickly.
  • Genetics: There is some evidence to suggest that a predisposition to osteoarthritis and cartilage deterioration can run in families.
  • Obesity: Carrying extra weight increases stress on the knee joints, accelerating cartilage breakdown and increasing the risk of developing osteoarthritis.
  • Infections: In rare cases, a joint disease can damage the cartilage, leading to a bone-on-bone situation.

What Are The Symptoms To Know? 

What Are The Symptoms To Know? The symptoms associated with bone-on-bone knee pain can vary in intensity but typically include:

  • Pain

The pain can range from a dull ache to sharp, severe pain. It may get worse with activities like walking, squatting, or climbing stairs. And, in advanced cases, the pain might persist even at rest or during the night.

  • Stiffness

The knee may feel stiff, especially after waking up or after periods of inactivity. Over time, the range of motion in the joint may decrease.

  • Swelling

Swelling can be due to increased synovial fluid or inflammation. The knee may appear enlarged or puffy.

  • Crepitus

A grinding or crunching sensation may be felt when moving the knee. There can also be audible cracking or popping sounds.

  • Instability

The knee might feel weak or as though it might “give way.” There may be episodes where the knee unexpectedly buckles.

  • Reduced Mobility

Over time, the ability to move the knee fully can diminish. Activities like bending, squatting, or kneeling can become challenging.

  • Deformity

In severe cases, the knee might appear bow-legged or knock-kneed due to uneven wear and tear of the joint.

  • Joint Locking or Catching

The knee might feel stuck or locked in place at times. This can result from loose fragments of cartilage or bone within the joint.

  • Warmth and Redness

The knee may feel warm to the touch and appear reddish, indicating inflammation.

  • Muscle Atrophy

Surrounding muscles, particularly the quadriceps, might begin to weaken and waste away due to decreased use.

Recognizing these symptoms early and seeking appropriate medical evaluation and intervention can help in managing the condition effectively. And improving the quality of life.

How Do You Treat Bone on Bone Knee Pain?

How Do You Treat Bone on Bone Knee Pain The primary goals are pain relief, improving mobility, and enhancing quality of life. Here are some of the treatments for bone-on-bone knee pain:

1. Weight Management

  • Rationale: Reducing weight can decrease the stress on knee joints, alleviating pain and slowing the progression of joint damage.
  • Methods: This might involve dietary modifications, regular low-impact exercises, and other weight loss strategies.

2. Physical Therapy

  • Benefits: Helps strengthen the muscles surrounding the knee, offers better support, and improves flexibility and balance.
  • Regimen: Involves targeted exercises, stretching routines, and sometimes modalities like ultrasound or electrical stimulation.

3. Medications

  • Analgesics: Non-prescription pain relievers such as acetaminophen (Tylenol) help alleviate pain.
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Drugs like ibuprofen (Advil, Motrin) or naproxen (Aleve) can reduce pain and inflammation. Long-term use can have side effects, so it’s essential to follow a doctor’s advice.
  • Corticosteroid Injections: Delivering steroids directly into the knee can offer temporary relief by reducing inflammation. The effects are short-lived, and repeated injections can cause joint damage.
  • Hyaluronic Acid Injections: Acts as a lubricant and shock absorber. It might provide relief for some patients, although its efficacy is still debated.

4. Braces or Orthotics

  • Knee Braces: Can provide additional joint support. Some are designed to offload certain areas of the knee to relieve pain.
  • Shoe Inserts (Orthotics): Can help align and stabilize the feet, reducing stress on the knees.

5. Lifestyle Adjustments

  • Engage in low-impact exercises like swimming, cycling, or walking to maintain joint mobility.
  • Avoid activities that exacerbate the pain.

6. Surgery

  • Arthroscopy: Minimally invasive procedure for removing loose fragments or smoothing out rough surfaces. However, it’s typically not a long-term solution for severe osteoarthritis.
  • Osteotomy: Involves realigning the bones to take the pressure off the damaged part of the knee.
  • Partial Knee Replacement: Only the most damaged portion of the knee is replaced.
  • Total Knee Replacement (Arthroplasty): In advanced cases, replacing the entire knee joint with an artificial one can be the best solution.

It’s crucial to collaborate closely with healthcare professionals when managing bone-on-bone knee pain. An orthopedic surgeon or rheumatologist can guide treatment decisions based on individual needs and the latest medical evidence.

How Can I Lubricate My Knee Naturally?

How Can I Lubricate My Knee NaturallyLubrication of the knee is essential for smooth joint movement. And it helps to reduce the wear and tear of cartilage. There are natural methods to support joint health and promote the production and quality of synovial fluid:

Stay Hydrated

  • Importance: The cartilage in our joints is mainly water. And staying hydrated helps ensure it remains lubricated.
  • Recommendation: Drink sufficient water throughout the day. The exact amount can vary based on age, activity level, and climate. But a general recommendation is about 8 glasses (64 ounces) daily.

Maintain a Healthy Diet

  • Omega-3 Fatty Acids: Found in fish (like salmon and mackerel), flaxseeds, and walnuts, these fatty acids have anti-inflammatory properties and can support joint health.
  • Antioxidants: Found in fruits, vegetables, nuts, and seeds, antioxidants combat oxidative stress that can damage joints. Foods rich in vitamins C and E, such as oranges, strawberries, almonds, and spinach, are particularly beneficial.
  • Bone Broth: Contains collagen, glucosamine, and chondroitin which are beneficial for joint health.
  • Avoid Processed Foods and Sugars: These can promote inflammation and worsen joint pain.

Physical Activity

  • Low-Impact Exercise: Activities like swimming, cycling, or walking can help improve blood flow to the joints and promote the production of synovial fluid without causing excessive stress.
  • Strength Training: Building the muscles around your knee can provide better joint support.
  • Stretching: Regular stretching keeps joints flexible and can help maintain the range of motion.

Use of Supplements

  • Glucosamine and Chondroitin: These are natural compounds found in and around cartilage cells. They can help support joint health, although results from studies are mixed.
  • Turmeric and Ginger: Both have natural anti-inflammatory properties. Turmeric contains curcumin, which can help reduce joint pain.
  • Hyaluronic Acid: A natural component of synovial fluid that can be taken as a supplement. Some believe it can help improve joint lubrication.

Avoid Repetitive Stress

  • Continuous repetitive movements can wear down the cartilage and reduce synovial fluid quality. Take breaks if you engage in repetitive tasks and ensure you maintain proper ergonomics and posture.
  • Regular massage can improve blood circulation, reducing joint stiffness and promoting better synovial fluid distribution.

Always consult with a healthcare professional or nutritionist before making significant changes to your diet or starting new supplements. They can provide guidance tailored to your individual needs and circumstances.


Bone-on-bone knee pain, predominantly a result of advanced osteoarthritis, poses a significant challenge to many individuals, impacting their mobility and quality of life. At the same time, there are various treatments available, from conservative approaches to surgical interventions. Each person’s journey with knee pain is unique, and what works best for one may differ for another.

Collaboration with healthcare professionals ensures that individuals navigate their knee pain journey with knowledge, support, and optimism. If you’re experiencing Knee pain, physical therapy for knee pain at PhysioMantra can help: Book an online physical therapy session.