If you’re experiencing knee pain and suspect arthritis, you might be wondering: “Should I get an X-ray?” Or maybe a doctor has already sent you for one, and you’re left with more questions than answers.
As a physiotherapist, I see this every day. The truth? While X-rays can be helpful in certain cases, they often don’t tell the full story — and they’re often not needed.
When X-rays Are Helpful
X-rays can be useful for:
- Ruling out other issues, such as fractures or severe bone deformities
- Assessing structural changes, like joint space narrowing or bone spurs
- Planning for surgery, if that’s being considered
If you have sudden, severe symptoms (like intense swelling, trauma, or inability to bear weight), or experienced trauma resulting in injury – then an X-ray might be the right first step.
When X-rays Aren’t Always Necessary
For many people with mild to moderate knee arthritis symptoms, an X-ray won’t change your treatment plan.
Why? Because:
- Pain levels don’t always match what we see on the scan
- Your symptoms, movement patterns, and strength tell us more
- Effective treatment (like physio-led strengthening) doesn’t rely on imaging
In fact, many people with “bad” X-rays feel fine — and many with minimal changes on X-ray are in agony. It’s not always about what shows up on the scan.
MRI vs. X-ray vs. Ultrasound: What’s the Difference?
- X-ray: Shows bones and joint space
- MRI: Shows cartilage, ligaments, inflammation — more detailed but more expensive
- Ultrasound: Can detect swelling, fluid, and some soft tissue issues
Most of the time, a good physical assessment by a physio will tell us what we need to know — no scan required.
What Physios Look For Instead
In clinic, we assess:
- Muscle strength and control
- Alignment and loading patterns
- Joint mobility and stiffness
- Posture and foot mechanics
These are often the root of your pain — and the best place to start improving.
Want to do this yourself at home? I guide you through a full assessment as part of the Arthritic Knee Program so you know exactly what is going on with your knee. Click to learn more.
A Note of Reassurance
Just because you don’t have an X-ray doesn’t mean you’re being neglected. And just because your X-ray shows arthritis doesn’t mean you’re doomed to decline.
There is so much you can do to improve how your knee feels — regardless of what the scan says.
👉 Join my FREE Masterclass to learn how to reduce flare-ups, strengthen safely, and feel hopeful about your knees again. [Click here to enrol.]
Take care, Helen
Helen Manders BSc (Hons) MCSP HCPC
Chartered Physiotherapist
Improving Arthritic Knees Since 2001
