My doctor told me that just because there are arthritic changes on my knee X-ray doesn’t mean the pain in my knee is coming from those changes. Why not? Doesn’t it make sense that the damage seen would be causing the problems?

It does make sense and that’s what’s got doctors and scientists scratching their heads. Many studies of the spine and joints show changes where there is no pain and pain where there are no changes. They don’t know how to explain it.

It may be a little like that old question: if a tree falls in the forest but no one is there to hear it, does it make any sound? Are X-ray findings pathologic if the patient doesn’t have any symptoms?

It’s possible the changes will eventually cause symptoms. But it might take an injury or repetitive load to bring on any pain.

Doctors also suggest the joint’s ability to hold up under heavy or repetitive loads may be based on more than just joint alignment. Maybe if the patient doesn’t stress the joint past a certain point, there are no symptoms no matter what shape it’s in.

More study is needed to end the debate of when to treat a joint. Should we apply medical treatment any time there are symptoms (with or without X-ray changes)? Or should we apply treatment anytime there are X-ray changes with or without symptoms.