Seeing Isn’t Always Believing: How X-rays Influence Knee Osteoarthritis Beliefs

If you’ve been dealing with ongoing knee pain, it’s only natural to want answers - and for many people, that means getting an X-ray. After all, doesn’t a picture tell the full story?

Well, maybe not. A fascinating new study published in PLOS Medicine by Lawford and colleagues is challenging the way we think about knee osteoarthritis (OA) and the role of imaging in diagnosis and treatment.

GP Looking at X-Ray. Sourced By: Wix

What did the study look at?

The study involved 617 adults aged 45 and older, all presented with a hypothetical scenario about knee pain. Each participant watched one of three short GP consultations:

1. A clinical explanation – the GP explained the diagnosis based on symptoms, movement, and history, without using any scans.

2. A radiographic explanation – the GP described what an X-ray would likely show, but didn’t display or reference an image.

3. A radiographic explanation with an image – the GP showed and explained an actual X-ray image, pointing out any visible changes.

   
   

   

   Methods of study. Sourced by: ChatGPT

After watching, participants answered questions about their beliefs around knee OA and how it should be managed.

What did the results reveal?

1. People who were shown an X-ray and had it explained were more likely to believe that surgery was necessary.
   

2. They were also more likely to think their condition would get worse over time, and that movement might cause further damage.
   

3. Interestingly, beliefs about the benefits of exercise stayed the same across all groups—but people who saw the X-ray were more fearful about moving.
   

4. On the flip side, those who received X-ray explanations reported feeling more satisfied with the consult and more confident in the diagnosis.

   
   

   

   Step Up Exercise for Knee OA. Original image.

So what does this tell us?

X-rays can feel reassuring and help validate a diagnosis—but they can also lead to beliefs that may get in the way of recovery.

Why does this matter?

Because for most people with knee OA, the most effective ways to manage symptoms are: ✅ Movement ✅ Strength exercises ✅ Education and support

In many cases, a thorough conversation and physical assessment is all that’s needed for diagnosis. That’s what clinical guidelines recommend—and it’s what helps people move forward with confidence.

What can we take away?

✅ Imaging isn’t always the best first step.

✅ The way we explain things matters. A lot.

✅ Reassurance doesn’t have to come from a scan—it can come from understanding, clarity, and connection.

If you’ve been told you have "wear and tear" in your knees, or you’re unsure about what’s next, I’m here to help. Let’s build a plan that supports your goals and makes you feel stronger, not stuck.

Because movement is not the enemy—in fact, it’s often the way forward.

BOOK NOW

Reference:

Lawford, B. J., Hinman, R. S., Ferreira, M. L., Bennell, K. L., Hunter, D. J., Slater, H., & Harris, I. A. (2025). Effects of X-ray–based diagnosis and explanation of knee osteoarthritis on patient beliefs about osteoarthritis management: A randomised clinical trial. PLOS Medicine, 21(4), e1004537. https://doi.org/10.1371/journal.pmed.1004537