Young Joints, Long Lives: Rethinking Osteoarthritis. Guest Expert Series | Dr Daniel O’Brien

When most people hear the word osteoarthritis (OA), they often think of ageing, worn-out joints and eventually needing surgery.

But modern understanding of osteoarthritis tells a much more positive story.

Our joints are living, adaptable structures. They respond to movement, exercise and the demands placed on them throughout life.

In this month’s Guest Expert Series, we welcome Dr Daniel O’Brien, Associate Professor in Physiotherapy at AUT, who shares both his professional expertise and his own personal experience with osteoarthritis.

Young Joints, Long Lives: Rethinking Osteoarthritis

When I first trained as a physiotherapist nearly 30 years ago, I thought osteoarthritis (OA) was an older person’s condition.

So you can imagine my surprise when, at 25, I was told I had OA in my right foot.

I was training for the Auckland Marathon and had developed foot pain. I thought it might be a stress fracture, so I had X-rays taken.

The sports physician noted moderate osteoarthritic changes in my foot.

After a pause, he looked up and said:

“Actually, your pain is in your left foot, isn’t it?”

I smiled and said yes.

He replied:

“Well, in that case, just ignore those OA changes in your right foot.”

That moment has stayed with me.

I had clear changes on an X-ray, yet no pain in that foot.

More than 20 years later, that right foot still feels pretty good.

I am sure the X-rays would still show the same changes, but the foot itself continues to do its job.

That experience made me rethink what OA actually means.

It is not simply an older person’s disease.

It is not always painful.

And it is not automatically a sign that a joint is “worn out” or heading for surgery.

Myth 1: Osteoarthritis only affects older people

OA becomes more common as we get older, but many younger adults also live with it, particularly after a joint injury.

Being diagnosed with OA at a younger age can be confronting.

People often worry they will need to stop being active, give up sport, or start planning for surgery.

Thankfully, that is not the case for most people.

OA is better thought of as a long-term joint condition that can often be managed well.

The goal is to keep joints moving and strong, and to help the person live the life they want.

Myth 2: An X-ray tells the whole story

X-rays can be useful, but they do not tell us everything.

They show structural changes in the joint, but not the whole person:

• pain

• confidence

• strength

• sleep

• stress

• what someone can or cannot do in daily life

It is very common for X-rays and symptoms not to match.

Some people have significant changes on imaging and very little pain.

Others have pain with only mild changes visible.

As physiotherapists, our job is not to treat an X-ray.

Our job is to work with the person in front of us.

Myth 3: Osteoarthritis always ends in joint replacement

Joint replacement surgery can be life-changing for the right person at the right time.

However, OA does not automatically lead to surgery.

Most people with OA will never need a joint replacement.

For everyone, the focus should be on keeping joints healthy, strong and functional over time.

Why do younger people develop osteoarthritis?

There are several risk factors, including:

• genetics

• body weight

• physical demands of certain jobs

• joint shape

• developmental conditions

One of the major factors, especially for younger people, is joint injury.

A significant injury earlier in life, such as a fracture, meniscus injury or ligament rupture, can increase the risk of osteoarthritic changes later.

ACL injuries are a good example.

A teenager who ruptures their ACL while playing sport will be at greater risk of developing knee OA in adulthood.

That does not mean OA is guaranteed.

It does mean we should take these injuries seriously, not just in terms of returning to sport, but also looking after the joint for life.

Good rehabilitation matters.

Restoring:

• strength

• movement

• balance

• confidence

• good loading habits

can make a real difference.

The bigger aim is to build a knee, hip, ankle or foot that can serve someone well for decades.

The basics still matter most

Managing OA is often less mysterious than people expect.

Braces, injections and supplements may have a place in selected situations.

But the evidence is strongest for doing the basics well.

Movement

Movement is central to OA management.

Joints like regular, sensible loading.

Muscles like being used.

People do better when they stay active in ways that are enjoyable and sustainable.

This might include:

• walking

• cycling

• swimming

• gym training

• Pilates

• yoga

• gardening

• tramping

The best exercise is usually the one you will actually keep doing.

Strength

Strong muscles help:

• support joints

• absorb load

• improve balance

• make daily activities easier

Strength training does not have to mean heavy gym sessions.

It might include:

• bodyweight exercises

• resistance bands

• weights

• hill walking

• step-ups

• progressive rehabilitation exercises

Looking after general health

We now understand OA is influenced by the whole person.

Body weight, diet, sleep, stress and social connection can all matter.

Simple starting points include:

• eating more whole foods

• getting enough protein

• reducing ultra-processed foods

• moderating alcohol intake

• prioritising good sleep

Poor sleep can make pain feel louder, while good sleep habits and stress management can help the nervous system settle.

A joint for life

If there is one message I would like younger people with OA to hear, it is this:

An osteoarthritis diagnosis is not the end of being active.

It is a reason to better understand your joints, build strength, develop good habits, pace yourself when needed, and seek support when symptoms flare.

More than 20 years after being told I had OA in my right foot, I can still run two or three times a week, although admittedly a little slower than I used to.

Osteoarthritis is not simply about age, X-rays or surgery.

It is about people, movement, confidence and lifelong joint health.

That is where physiotherapy can help.

About Dr Daniel O’Brien

Dr Daniel O’Brien is an Associate Professor in Physiotherapy at AUT.

His research focuses on improving the management of osteoarthritis in Aotearoa New Zealand.

https://academics.aut.ac.nz/daniel.obrien

Urban Athlete Guest Expert Series

At Urban Athlete, we believe good healthcare starts with understanding your body.

Our Guest Expert Series brings trusted experts together to share evidence-based insights that help our community stay active for life.