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Three steps to changing the narrative about knee osteoarthritis care: a call to action
  1. JP Caneiro1,2,
  2. Peter B O'Sullivan1,2,
  3. Ewa M Roos3,
  4. Anne J Smith1,
  5. Peter Choong4,
  6. Michelle Dowsey4,
  7. David J Hunter5,6,
  8. Joanne Kemp7,
  9. Jorge Rodriguez7,
  10. Stefan Lohmander8,
  11. Samantha Bunzli4,
  12. Christian J Barton4,7,9
  1. 1School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  2. 2Body Logic Physiotherapy, Perth, Western Australia, Australia
  3. 3Research Unit for Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
  4. 4University of Melbourne Department of Surgery, St Vincents Hospital, Melbourne, Victoria, Australia
  5. 5Institute of Bone and Joint Research, Kolling Institute, Univeristy of Sydney, Sydney, New South Wales, Australia
  6. 6Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
  7. 7La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Melbourne, Victoria, Australia
  8. 8Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
  9. 9Complete Sports Care, Melbourne, Victoria, Australia
  1. Correspondence to Dr JP Caneiro, School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA 6102, Australia; jp.caneiro{at}

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Knee osteoarthritis (OA), characterised by knee pain and functional limitation,1 2 is widely understood to imply that symptoms are due to structural damage. This view leads to the belief that non-surgical approaches are futile and the structural damage needs to be ‘fixed’.3 4 In contrast, contemporary evidence supports knee OA as a ‘whole person condition’ in which knee health is influenced by the interaction of different biopsychosocial factors that modulate inflammatory processes and tissue sensitivity, as well as behavioural responses that lead to pain and disability.5 6 This contrasting view reinforces the critical role of non-surgical approaches to manage knee OA. To promote this conceptual shift in understanding knee OA, clinicians must take three key actions.

Change the message

Clinicians must explain that knee pain is a modifiable symptom related to sensitised knee structures and influenced by a variety of biopsychosocial factors, rather than solely related to damaged structures. This message is underpinned by knowledge that levels of pain and disability are often poorly explained by the degree of structural change on imaging; and that symptoms are influenced by a person’s individual context, including life stage, psychological, social, physical and lifestyle factors, and health comorbidities. Clinicians should deliver this message with a focus on the person’s own narrative and …

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