21/05/2026
Radiographs don’t tell the whole story…
and when it comes to joint disease, they often tell very little about the patient in front of you.
Pain is not just a product of structural change.
It is the result of complex pathways involving peripheral tissues, the nervous system, and the brain.
In canine joint disease, multiple structures contribute to pain:
✔️ Synovium and joint capsule inflammation
✔️ Subchondral bone changes
✔️ Ligament and periarticular tissue strain
But the real shift in understanding comes here:
👉 Pain is not a direct reflection of what we see on imaging
Two patients with identical radiographs can present completely differently - because pain is processed, modulated, and amplified at multiple levels within the nervous system.
Peripheral sensitisation increases the responsiveness of local tissues,
while central sensitisation changes how the spinal cord and brain interpret those signals - often leading to persistent pain, even when tissue damage is minimal.
And beyond that…
The brain integrates emotion, experience, and environment - meaning behaviour, movement, and pain are all deeply connected.
This is why:
🔎 Some dogs with severe radiographic OA show minimal clinical signs
🔎 Others with mild changes present with significant pain and dysfunction
As rehabilitation therapists, this changes everything.
It shifts our focus from:
❌ Treating the image
to
✔️ Understanding the patient
Because effective rehabilitation isn’t about what the scan shows…
it’s about how the patient feels, moves, and responds to load.
Comment PNP2 for the link to our blog Treat the Patient, Not the Picture: Pain Pathways in Canine Joint Disease
