Osteoarthritis, Posture, and Load – Understanding What’s Actually Happening in the Joint

Many people are told that osteoarthritis is simply “wear and tear.”

But modern research shows something more complex.

Osteoarthritis is not just cartilage wearing out.

It is a whole-joint process, influenced by:

• mechanical loading

• biological responses

• neuromuscular control

• long-term movement patterns

Understanding this helps explain why symptoms appear, why they progress, and why they sometimes improve even when imaging does not change.

WHAT OSTEOARTHRITIS ACTUALLY IS

Osteoarthritis (arthrose) is a chronic joint condition involving the entire joint organ, not only cartilage.

Research now describes osteoarthritis as affecting several structures simultaneously:

• articular cartilage

• subchondral bone

• synovial membrane

• menisci (in the knee)

• ligaments

• surrounding muscles

(Osteoarthritis as a whole-joint disease is well described in modern orthopedic literature (Loeser et al., 2012).)

So it is not simply “cartilage wearing out.”

Structural Changes Commonly Seen

Cartilage changes

• loss of proteoglycans

• disruption of collagen structure

• reduced shock absorption capacity

Subchondral bone remodeling

• bone sclerosis (hardening)

• altered stiffness

• changes in load transmission

Osteophytes

• small bone growths at joint edges

• thought to be the body’s attempt to stabilize the joint

Synovial inflammation

• low-grade inflammatory signaling

Joint space changes

• altered mechanical relationships

• redistribution of compressive forces

Importantly:

Cartilage itself does not contain pain receptors.

Pain usually comes from:

• subchondral bone

• synovium

• capsule

• ligaments

• surrounding muscles

(Hunter & Bierma-Zeinstra, 2019)

WHY OSTEOARTHRITIS DEVELOPS

Osteoarthritis develops through an interaction between mechanical forces and biological responses.

Researchers generally describe three major contributors.

Mechanical factors

• abnormal joint loading

• repetitive compression patterns

• altered alignment

• reduced shock absorption

Biological responses

• inflammatory mediators

• cartilage matrix degradation

• bone remodeling

Neuromuscular factors

• altered muscle recruitment

• joint instability

• reduced proprioception

Over time, joint tissues adapt to the mechanical environment they experience repeatedly.

When load repeatedly concentrates in one region of a joint, the tissue in that region adapts — sometimes in ways that lead to degeneration.

(Andriacchi et al., 2004)

Real-Life Example

Imagine someone who always loads slightly more into one hip when standing.

Or someone whose knee collapses slightly inward with every step.

At first, nothing seems wrong.

But over millions of steps over years, that small bias concentrates stress on specific joint surfaces.

Eventually the joint begins to adapt to that repeated stress.

WHY THE KNEE IS ESPECIALLY VULNERABLE

The knee experiences some of the highest loads in the body.

During normal walking:

• joint compression ≈ 2–3 × body weight

During running:

• 5–7 × body weight

(Kutzner et al., 2010)

Small changes in alignment or motor strategy can therefore shift where these forces concentrate.

For example:

• varus alignment increases medial knee loading

• hip control influences femoral rotation

• trunk position changes knee joint moment arms

This is why osteoarthritis often appears asymmetrically inside the knee joint, with the medial compartment affected more frequently.

Other Joints Can Experience Similar Patterns

Osteoarthritis can develop in many joints.

Common examples include:

Hip

Load increases with pelvic shift or altered gait.

Spine

Segmental overload can affect facet joints and discs.

Big toe (hallux rigidus)

Repeated push-off mechanics concentrate stress.

Thumb base (CMC joint)

High repetitive pinch forces accumulate over time.

In each case, mechanics and motor control influence where forces concentrate.

WHERE SENSORIMOTOR CONTROL ENTERS THE PICTURE

Osteoarthritis is not only structural.

It also involves changes in neuromuscular control.

Studies consistently show that individuals with knee osteoarthritis often demonstrate:

• impaired proprioception

• altered joint position sense

• reduced quadriceps coordination

• increased co-contraction (stiffening strategy)

• changes in gait patterns

(Sharma et al., 2003)

Pain itself can also alter motor control.

This creates a feedback loop:

pain → altered movement → altered load distribution → continued joint stress.

Everyday Example

Someone with knee pain may unconsciously:

• stiffen the knee

• reduce knee flexion while walking

• shift weight away from the painful side

This temporarily protects the joint.

But over time it may shift stress to other structures or other areas of the same joint.

WHERE POSTUROLOGY CAN INFLUENCE THE SITUATION

Posturology does not regenerate cartilage.

But it can influence the mechanical and sensorimotor environment in which the joint operates.

That environment plays a major role in symptoms and progression.

Several mechanisms are relevant.

A) Load Distribution

When postural organization improves:

• center of mass alignment can shift

• joint moment arms can change

• muscle recruitment becomes more balanced

Even small changes in load distribution can reduce stress in overloaded cartilage regions.

B) Neuromuscular Coordination

Improved sensorimotor integration may influence:

• muscle activation timing

• shock absorption

• joint stability

• movement variability

This can reduce repetitive peak loading on joint surfaces.

C) Protective Stiffness Patterns

Pain often leads to:

• increased co-contraction

• rigid movement strategies

• reduced shock absorption

Improved coordination can reduce excessive stiffness and allow more distributed load sharing.

D) Joint Nutrition Through Movement

Cartilage receives nutrients through cyclic loading and unloading.

Healthy movement patterns help:

• circulate synovial fluid

• reduce static compression zones

• maintain joint lubrication

(Mow & Huiskes, 2005)

WHY SYMPTOMS CAN IMPROVE EVEN IF IMAGING DOESN’T

One of the most surprising findings in osteoarthritis research is that:

Pain does not correlate strongly with imaging findings.

Some people with severe cartilage loss report minimal pain.

Others with mild structural changes experience significant symptoms.

Pain depends on many factors including:

• synovial inflammation

• bone stress

• neuromuscular control

• central pain processing

(Hunter & Bierma-Zeinstra, 2019)

WHAT CAN REALISTICALLY BE INFLUENCED

Through sensorimotor and postural recalibration, several factors can potentially improve:

• movement strategy

• load distribution across the joint

• muscle coordination

• shock absorption

• joint stability

• proprioception

These factors can influence pain levels and functional capacity, even when structural changes remain.

EXPLAINING IT SIMPLY

A simple way to understand osteoarthritis is this:

The joint is not just wearing out randomly.

It has been adapting to how force travels through it over many years.

When we improve how the body organizes balance and movement, we can often reduce the stress placed on certain parts of the joint.

That doesn’t regrow cartilage.

But it can allow the joint to function more efficiently and often with less pain.

WHERE POSTUROLOGY FITS

Posturology works at the level of how the nervous system organizes the body in space.

By refining sensory references involved in posture and movement, it can influence:

• load distribution

• coordination

• joint stability

• movement efficiency

For people dealing with osteoarthritis, improving how the body organizes movement may reduce the repetitive mechanical stress that contributes to symptoms.

This is the level addressed in Posturology consultations, where the goal is to refine how the body organizes balance and movement so that joint loading can redistribute more efficiently.

References

Andriacchi, T. P., et al. (2004). A framework for the in vivo pathomechanics of osteoarthritis. Annals of Biomedical Engineering.

Hunter, D. J., & Bierma-Zeinstra, S. (2019). Osteoarthritis. The Lancet.

Kutzner, I., et al. (2010). Loading of the knee joint during activities of daily living. Journal of Biomechanics.

Loeser, R. F., et al. (2012). Osteoarthritis: a disease of the joint as an organ. Arthritis & Rheumatism.

Mow, V. C., & Huiskes, R. (2005). Basic Orthopaedic Biomechanics & Mechano-Biology.

Sharma, L., et al. (2003). The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA.

Andy Audet

Specialist in Body Recalibration and Human Performance

Saint-Bruno-De-Montarville, Québec