--- title: "Can \"bone on bone\" knees get better?" entity: "blog" canonical_url: "https://www.betterknees.com/blog/canboneonbonekneesgetbetter" markdown_url: "https://www.betterknees.com/llms/blog/canboneonbonekneesgetbetter" lastmod: "2025-05-12T21:10:00.000Z" --- I was at a backyard party recently, and an acquaintance approached me saying, “ You help people with knees, right? ” I nodded, and he proceeded to tell me that he is scheduled for knee replacement surgery in October. I’m not a great judge of age, but if I had to guess, I’d say he’s roughly 60 years old. “Yeah,” he said, “I’ve been 'bone on bone' for many years.” ## Here's what we know: Receiving a diagnosis of “bone on bone” knee arthritis occurs when physicians interpret X-rays as grade 4. They use the Kellgren-Lawrence scale – ranging from 0 to 4 – where: - grade 0 = no changes on X-rays - grade 1 = very little, if any, changes on X-rays - grade 2 = bone spurs & possibly less space between bones (minimal arthritis) - grade 3 = bone spurs, less space between bones, & possibly deformity of bone ends (moderate arthritis) - grade 4 = large bone spurs, significantly less space between bones, & definite deformity of bone ends (severe arthritis) The worse the X-rays look, the higher the grade. However, this is not a linear assessment. So grade 4 is not always twice as bad as grade 2. And not all grade 4 knees are the same . X-rays aren’t super-sensitive. X-rays reveal dense structures in your body. Bones show up white on X-rays. And if your bone is broken there will be a dark line where the fracture has occurred. Cartilage – the firm protective substance on the ends of your bones – is more translucent. Because of this, cartilage doesn’t show up very well on X-rays. So physicians infer how much cartilage you have based on how much space they see between your bones. Unless you’ve had a trauma – like when someone breaks a bone – your knee X-rays won’t change instantaneously. If your knees are getting worse – without a sudden injury – it’s similar to the gradual changes that occur during a road trip across the United States. Let’s say you start in San Francisco, California, and you’re headed to Eastport, Maine. It’ll take you a number of days to drive across 4 time zones. The ocean near California represents having strong, healthy cartilage. And the ocean near Maine represents having no cartilage remaining. Using this analogy, each time zone represents a grade of arthritis: - Pacific = grade 1 - Mountain = grade 2 - Central = grade 3 - Eastern = grade 4 X-rays reveal the time zones of your knees. They can tell you whether you’re in the Mountain Time Zone (grade 2) versus the Eastern Time Zone (grade 4). However, they don’t reveal your exact location. If you’ve driven 32 hours and you’re spending the night in Indiana; you’re in the Eastern Time Zone (grade 4). After another 19 hours of driving, you'll still be in the Eastern Time Zone (grade 4) -- but now you've arrived at the ocean (the location that represents having no cartilage left). Likewise, X-rays may show that you have grade 4 knee arthritis. And if this is the case, you’ll likely be told you have “bone on bone” knee arthritis. Despite this, you may still have cartilage remaining. ## Are your bones actually touching each other? It’s easy to assume that “bone on bone” means your bones are touching one another. But the “bone on bone” diagnosis is rather misleading. The firm substance on the ends of your bones, the cartilage, protects your bones and provides a smooth surface for movement to occur. In theory, if you don’t have any cartilage left in your knees, your thigh bones will be touching your shin bones. However, as I described above, cartilage doesn’t show up very well on X-rays. Research published in the journal of Osteoarthritis and Cartilage reveals that additional cartilage damage may still be occurring during grade 4 knee arthritis. ([source](https://pmc.ncbi.nlm.nih.gov/articles/PMC4558267/)) This means that you may have cartilage remaining even if you’re been told your knees are "bone on bone. " Even though further cartilage damage can occur during grade 4 knee arthritis, most medical providers tell people one of two things: - Your knees are “bone on bone,” so you qualify for a knee replacement. - Your knees are “bone on bone,” so “come back for a knee replacement when you can’t stand the pain.” Why don’t medical providers focus on improving the health of your knees? During our recent [conversation](https://www.youtube.com/watch?v=JHct23xxHOY), Dr. Brad Fullerton answered this question saying: “What keeps hospitals open is the operating rooms. It’s not a grand conspiracy; it’s just the natural forces that push people towards the more expensive solution that’s organized into the [medical] system.” ([source](https://www.youtube.com/watch?v=JHct23xxHOY)) Additionally, most doctors, nurses, and physical therapists don’t think it’s possible to improve inside your knees. ## Can “bone on bone” knees get better? When people ask me this question, they usually want to know whether they can enjoy their active lives without being limited by knee pain. Very often, "bone on bone" knees can get better. If you have "bone on bone" knee arthritis and you’re wondering whether your knees can get better, here’s what I want to know: Does your knee pain change related to your activities? If your knees typically feel: - better mid-morning than they do towards the end of the day… - better when you’re moving around rather than sitting still for a few hours (at a desk, in a car or a plane)… - better when you avoid squatting or stairs… - better when you walk or hike with trekking poles (or in a pool of waist deep water)... If any of these apply to you, then your knees will likely get better from the inside-out. Here's a [guide](https://enjoystrongerknees.com/) to get started: You can access it [here](https://enjoystrongerknees.com/) . Inside-Out Knee Health [Inside-out knee health](https://www.youtube.com/watch?v=Wcs2HwW9XLw) refers to our 3-phase solution for knee pain. Phase 1 soothes your knees by using surprisingly simple exercises – including [this](https://www.youtube.com/watch?v=BuVQp23HZGo) and [these](https://www.youtube.com/shorts/_lggPJFnbXU). The right type and amount of exercises will thicken the fluid inside your knees, and spread that fluid around. Healthy knee fluid is viscous & cushiony like the consistency of egg whites – it provides shock-absorption & better protects your knees from harm. During Phase 2, you’ll perform the right amount and frequency of movement to apply force on your knees so the surfaces inside your knees become healthier and more firm – giving you a solid foundation inside your knees. This prepares you for Phase 3. In Phase 3 , you’ll complete more challenging activities and exercises. Muscles on the front and back of your thighs cross over your knees. And so when these muscles work hard, they “squish” everything inside your knees. But since you’ve completed Phase 1 & 2, the fluid and the surfaces inside your knees will be primed to withstand these “squishing” forces, and your knees won’t get hurt. This 3-phase solution allows you to get better knees from the inside-out – without drugs, needles, or surgery – so you can enjoy an active life for many years to come. Let's make knee pain history! Laurie Kertz Kelly When you’re ready to build [Better Knees](https://betterknees.patientbase.io/services) – with personal guidance : Schedule a free 20-minute [Strategy](https://TheKelseyGroup.as.me/) [Session](https://TheKelseyGroup.as.me/) . (Find your best time [here](https://TheKelseyGroup.as.me/) .) [Learn more about Laurie Kertz Kelly](/about) Disclaimer: The information in this blog post is for educational and informational purposes only and is not intended as medical advice. It should not be used to diagnose, treat, or prevent any health issue or disease without consulting with a qualified healthcare professional. The author of this blog and the website do not bear any responsibility for any actions taken based on the information provided in this blog.