These cursory facts alone reveal  ‘arthritis is just old age’ to be little more than a contemporary superstition. Just like ‘pain is just old age’. 

To make this more tangible, let’s take a closer look at a very typical pair of 75-year-old knees. 

Gary is tough, way harder than your average customer and for good reason. His childhood was very impoverished by modern Western standards. Then his early adult life was difficult too.  

Gary’s unique selling point is that he once raised three children alone with essentially no money. His wife died suddenly, leaving him unable to reconcile the logistics of paid work with the full-time care of 3 small children. He had no extended family or childcare to lean on. And was too proud to receive government support.

He survived by growing his own food and hunting constantly to feed his family, subsidised only by a very small amount of paid employment. Very few people alive today have lived as a borderline hunter-gatherer, so it makes him a rare and interesting case history. His is an impressive story of love, grief,  hard work and ultra-resilience. And what makes Gary even more extra-appealing to me personally is that despite the hardships, he has no rough edges to his character. He’s like a teddy bear made of thick indestructible canvas.

If there was a flaw in Gary, it would be that he is far too willing to put up with pain and hardship. He goes through all sorts of difficulties without asking for help. And it’s not hard to guess why. 

Self-sufficiency is clearly a virtue, but excessive self-sufficiency can become dangerous, especially when it comes to health-related matters that need treatment. It’s a well-documented source of problems in male patients.

Gary’s right knee had hurt for decades, so much that it had genuinely tested Gary’s toughness to its limits. All said and done, it had severely reduced his ability to live the life he wanted. He’d been on a fraction of ‘the walks’ (hunts) and had a fraction of the decent sleep that he deserved to have had; over many years. And his day-to-day life was blighted with chronic disability. All because of his knee. His right knee had progressively worsened over 30 years and eventually reached its 75th birthday. So no surprise it had extensive arthritis as well as pain.  

Meanwhile, Gary’s left knee had never hurt a day in its life. ‘My left knee is perfect’, he would often say. Although if you squint hard enough at the left knee x-ray, it has a tiny bit of painless arthritis. 

Asymmetric problems like Gary’s are very typical for older patients with knee and hip pain/arthritis. A closer look at this fact reveals the absurdity of casually dismissing knees like Gary’s and the suffering they cause as ‘just old age’.

Both Gary’s knees have done the exact same mileage – both had the same job – both played all the same sports – both raised the same children –  both had been on all the same hunts – both worn all the same boots – both lived and worked on the same surfaces – both been on all the same runs – both slept in all the same beds –  both had the exact same nutritional support – both have the exact same genetics – and above all else..  both knees are the same age. 

Yet Gary’s two knees had in some way led to such different lives. Going back 30 years, his right knee already had intermittent niggles that stopped him from road running. Then 15  years previously, the right knee even made walking on gentle hills and sleeping afterwards  a challenge. By the time Gary was 65, he felt 85 half the time, just because of the right knee. His left knee had never hurt even once.

This is routinely how life impacts pairs of identical neighbouring joints in the same person. So looking with open eyes, how can we keep a straight face and say the right knee has pain and arthritis because of old age? 

If arthritis was ‘just old age’, it would develop symmetrically in pairs of joints that had done the same work. Which it almost never does. The same is true for all musculoskeletal pains.

In the real world, pain and osteoarthritis are not simple; they are complex. They relate to the intermingling of genetics + lifestyle + psychosocial stress + biomechanics + injuries + mileage. And these complex truths definitely applied to Gary’s case.

The arch of Gary’s right foot collapsed when he walked millions of times a year. He also had very weak muscles in his right leg from an early age. This situation developed after a very bad sprain to his right ankle, sustained on a hunting trip when he was 28.  

After the injury, the disastrous decision was made to put him in plaster for five weeks and then in a moon boot for six months. When he finally escaped the damn boot, it took him another year to be able to walk properly. There was never any actual rehab. Compounding this, Gary has also led a very physically and emotionally stressful existence. Also, tellingly,  both Gary’s parents had arthritic joints.

It may not have rolled effortlessly off the tongue like ‘it’s just old age’. But the above paragraph is the authentic explanation for why Gary’s right knee had mysteriously disintegrated. And after addressing these factors, Gary was able to enjoy more hunts in his late 70s than he had in his early 60s.

So even arthritis in 75-year-olds is not simply ageing. Let alone lower back pain in 45-year-olds. For many, this knowledge opens the door to a far happier, healthier, more connected and more comfortable life.

Next time you are at a large international airport walking (hopefully) to your gate,  pay close attention to your fellow passengers. When it’s time to walk the half mile to your gate, you get a chance to see how age does not determine pain and immobility. 

There are those 70-plus’s who walk the half mile quite normally, keeping up with the younger passengers. There are those who walk okay but much slower than the herd. There are those 70-plus’s who walk with some degree of assistance, like a stick; most of these need to take breaks too. Then finally, there are those 70-plus’s who are in such a poor state that they require the nice man driving ‘the golf cart of shame’ in order to get to their next gate. Yet all these elder folks are in the same age group.

Obviously, our bodies naturally stiffen up as we get older. The average age of those riding the golf cart is far higher than those who walk to their gate; that’s pretty obvious. Wear and tear is a real part of life, after all. This is not in doubt. The thing is, though, ‘correlation’ and ‘causation’ often look like the same thing. But they are not the same thing. 

Wear and tear happens over time, but it’s not the time itself that inflicts it.  

I challenge you to name one chronic physical problem that doesn’t tend to show up more in older people.

Older smokers cough more and get cancer more; are their coughs and tumours ‘just old age?

Older couch potatoes are more obese and have higher BP, is their physical deterioration  ‘JUST old age’?

Older type 2 diabetics suffer from terrible skin sores and neuropathy as they get older; is that ‘just old age‘? Or is it the long-term ravages of a disease?

Older sugar addicts have worse teeth than young sugar addicts, are their black teeth ‘just old age’?

Tissues that are exposed to long-term stress suffer more and more with the passage of time. But it’s the stress and not the time itself that’s the primary problem. 

‘JUST old age’ means that time and mileage are the only factors that led me to where I am at. This is literally never the case with pain or with arthritis.

People can get pain at every stage of life. Some knees wear out by their 70th birthday; some don’t. Some humans wake up on their 80th birthday and throw themselves at 18 holes of golf; other 80 yr olds can barely get to the toilet unassisted. Some people have a hip joint replaced at 45. Some people have terrible back pain in their teens and then none later in life. Pain and mobility are complex issues. If we can learn to respect these facts, it opens us up to a world of pain solutions that are otherwise ruled out.

The person who has flat feet and a strong tendency towards ankle sprains in their teens and 20s. Then later develops chronic knee pain in their 40’s & 50’S; will tend to suffer a lot when they are older. 

The person who is vigorously healthy but suffers a dramatic motor vehicle accident followed by a sloppy rehab process in their 50s has a far higher probability of chronic pain when they are older.  

The person who lives with long-term neck pain throughout their whole life and never seeks treatment will tend to suffer more when they are older. 

People who go through substantial emotional adversity in their childhoods tend to have far more chronic pain throughout their lives. Then when they are older, their arthritic joints hurt far more than people who haven’t held stress and trauma in their body’s for a lifetime.People with untreated trauma and  PTSD suffer from a lot of pain and disability later in life.

People who don’t exercise and carry extra weight for long periods tend to suffer with pain and mobility when they are older.

These are the type of poor souls who rely on sticks and golf carts in their latter life chapters. And when they are younger, for that matter.

The milder patterns of pain we live within the first half of life often herald the onset of premature disability later in life. There is nothing random, mysterious or inevitable about any of it. 

Many much younger patients show early signs of arthritis on x rays. Some studies have even shown that up to 15% of school leavers have the tiny but demonstrable beginnings of spinal arthritis. Arthritic changes often start slowly, very early in life.

Our beliefs hold great power over what happens to our bodies. Even a physical challenge as simple as the removal of a splinter becomes impossible if we say that it is. Simply because we seldom put any real effort or energy into tasks we believe are impossible. The chances of us truly applying ourselves to treatment and rehabilitation for a body part we believe is fundamentally ‘worn out’ are slim to none. This is the power beliefs have to determine our health.

Yes, older people suffer more joint pain in their lower limbs, but conversely, they get far less back pain and headaches. So we must be careful not to conflate all pain into a single ‘old age basket’. 

The ‘Just old age myth’ is ensnared into the fabric of how we approach pain as a global culture. It isn’t just a superstition held by those without the advantage of a medical degree. Elders with pain are systemically under-served. 

A 2011 study published in The European Journal Of Pain found that the median duration of a doctor consultation for elderly patients requesting help with pain is 2.3 minutes. It’s fair to surmise that this is most likely a clear non-verbal cue that these doctors subscribe to the old age myth. For comparison, at a clinic like mine, it is 45-60 minutes, and that is just the first step.

Over the course of my career, I’ve met literally thousands of older patients who had been told in no uncertain terms that their pain was untreatable when in actual fact, it was eminently treatable. This systemic neglect is driven in no small part by that malignant little phrase that just rolls off the tongue so effortlessly ‘It’s just old age’. 

My advice is to reject our culture’s catastrophically oversimplified ‘just old age’ narrative. Instead, open your mind and your body to the far more complex and fruitful truth about pain. If you can do that, you’ll naturally open up to the countless solutions for pain that actually work at every stage of life.