Whole body

What It Is

Osteonecrosis occurs when bone tissue dies because of a lack of blood supply.

Osteonecrosis literally translates to bone death (Greek: osteo = bone, necrosis = death). Without blood supply, the bone can develop tiny breaks and may eventually collapse (NIAMS, 2021a). The blood flow into parts of the bone can be interrupted if a joint is dislocated or a bone is broken. The condition is also known as avascular necrosis, meaning bone death caused by a lack of blood supply (NIAMS, 2021a).

Osteonecrosis is linked with long-term use of high-dose steroid medicines and with drinking too much alcohol (NIAMS, 2021a). It is not caused by osteoarthritis; instead, as the condition progresses, the joint may stiffen and osteoarthritis may develop (NIAMS, 2021a).

The hip is the joint most commonly affected (AAOS, n.d.; NIAMS, 2021a). While the condition can happen to people of any age, it is most common in people in their 30s and 40s (NIAMS, 2021a).

An X-ray is not sensitive enough to show osteonecrosis in its early stages. An MRI scan can pick up early signs, sometimes even before symptoms start. In the later stages, the changes can be seen on an X-ray (NIAMS, 2021b).

At first there may be no symptoms, but as the disease develops you may notice joint pain (at first when you put weight on the joint, and later even at rest), a reduced range of movement in the joint, limping if a leg is affected, and pain in the groin if the hip is affected (NIAMS, 2021a; MedlinePlus, 2025). If the end of the bone collapses, the pain may suddenly get worse (NIAMS, 2021a). See your family doctor or nurse practitioner if you have joint pain like this that does not settle.

Osteonecrosis Causes

Some cases have no known cause. Known causes and risk factors include (NIAMS, 2021a; MedlinePlus, 2025):

A broken bone or dislocated joint.
Long-term use of high-dose corticosteroids (steroids).
Drinking too much alcohol, and heavy tobacco use.
Sickle cell disease and other conditions that cause abnormal blood clotting.
Decompression sickness ("the bends") after diving.
Lupus.
HIV, or taking HIV medicines.
Radiation therapy and chemotherapy for cancer.
Organ transplant.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Osteonecrosis

Range-of-movement exercises can help you keep, or even improve, the movement in the joint (MedlinePlus, 2025), and physiotherapy, which may include hands-on (manual) therapy, can help reduce joint tenderness and stiffness and increase the range of movement in the joint (NIAMS, 2021b). I can help with home exercises to maintain strength and movement around the joint, and hands-on work to ease stiffness. These approaches help with symptoms but do not cure the condition. See the My Approach tab for how I work.

Non-surgical treatments can help manage the symptoms of osteonecrosis, but generally they do not cure it or stop it getting worse (NIAMS, 2021b).

1. Anti-Inflammatory Medication

NIAMS says anti-inflammatory medicines may be recommended to reduce pain and swelling (NIAMS, 2021b). (This medicine information comes from the US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.) This is not usually a long-term solution.

2. Reducing the Load on the Joint

Limiting the use of the affected joint, and reducing the weight placed on it, may help. This may include using crutches or a walking stick if a hip, knee or ankle is affected (MedlinePlus, 2025; NIAMS, 2021b).

Treatments you may want to discuss with your family doctor or nurse practitioner

Most people with osteonecrosis eventually need surgery as the disease worsens (NIAMS, 2021b), and your family doctor or nurse practitioner can refer you to a specialist.

Options outside my scope

Treating the underlying cause: if a blood disorder such as a clotting problem is the cause, part of the treatment will be medicine prescribed for that condition (MedlinePlus, 2025).
Core decompression: the most common operation for osteonecrosis, in which narrow channels are drilled into the bone to lower the pressure inside it. It is often combined with a bone graft (NIAMS, 2021b).
Osteotomy: an operation in which the bone is cut and repositioned so that healthy bone takes more of the weight through the joint (NIAMS, 2021b).
Bone graft: healthy bone (from your own body, a donor, or a synthetic material) is used to help repair the damaged area (NIAMS, 2021b).
Joint replacement: if the bone has collapsed, the joint may be replaced with an artificial one (NIAMS, 2021b).

How I can help (see the My Approach tab)

Range-of-movement and strengthening exercises for the affected joint
Hands-on work for joint stiffness and tight, overworked muscles
Setting up crutches or a walking stick
Support with recovery after surgery, once your surgeon clears you

Tips

Limit the amount of alcohol you drink. Drinking too much is a risk factor for the disease (NIAMS, 2021a; MedlinePlus, 2025).
When possible, high doses and long-term use of steroids should be avoided (MedlinePlus, 2025). Do not stop any prescribed steroid without talking to your doctor first.
If you dive, follow safety measures to avoid decompression sickness (MedlinePlus, 2025).
Having radiation treatment or chemotherapy puts you at increased risk of this condition (NIAMS, 2021a).
Osteonecrosis of the jaw is a rare side effect linked with bisphosphonate medicines, most often with high-dose intravenous (drip) bisphosphonates given for cancer (NHS, 2022). If you have any concerns, speak to your doctor.

Treatment

My Approach

Your medical team manages osteonecrosis, which can affect different joints, most often the hip. I work within their plan to ease pain and stiffness, look after overworked muscles, and keep the joint moving and strong. After surgery, I need your surgeon's okay before any hands-on treatment, and during cancer treatment, your oncology team's okay.

Please bring any X-ray or scan reports and notes from your medical team to your first visit. They're an important part of planning safe treatment for you.

I assess how the joint moves, how you use it, and your strength.

Easing Pain and Stiffness

Massage for the muscles around the joint and those compensating, with light pressure over the painful bone
Gentle joint movement within comfort, never forced
Warm or cool applications in the clinic, and safe use of heat and ice at home
Setting up crutches or a walking stick, and easing overworked arms and shoulders
Buttock and hip work needs informed consent and a signed consent form

Keeping the Joint Moving

Range-of-movement and strengthening exercises, with a home programme
After surgery, once you're cleared: lymphatic drainage for swelling, scar work once healed, and a gradual return to strength

If the pain suddenly gets worse, tell your doctor.

What to Expect

Typical Course

Typical course: Most people come once or twice a week at first, then weekly, with a reassessment at about 4 to 6 weeks, then less often, all fitted around your medical team's plan. This is usually a long-term condition, so expect gradual gains in comfort and movement over a few weeks rather than a cure; after surgery, timing follows your surgeon's plan.

What I Focus On

Working Within Your Team's Plan

Compensation Relief

Gentle Joint Mobility

Strength Around the Joint

Walking Aids

Sources

References

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2021a) Osteonecrosis (avascular necrosis): symptoms and causes. Available at: https://www.niams.nih.gov/health-topics/osteonecrosis (Accessed: 7 October 2026).
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) (2021b) Osteonecrosis: diagnosis, treatment, and steps to take. Available at: https://www.niams.nih.gov/health-topics/osteonecrosis/diagnosis-treatment-and-steps-to-take (Accessed: 7 October 2026).
MedlinePlus (2025) Osteonecrosis. Bethesda, MD: US National Library of Medicine. Available at: https://medlineplus.gov/ency/article/007260.htm (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (AAOS) (n.d.) Osteonecrosis of the hip. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/osteonecrosis-of-the-hip/ (Accessed: 7 October 2026).
NHS (2022) Osteoporosis – treatment. Available at: https://www.nhs.uk/conditions/osteoporosis/treatment/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooOsteonecrosis

What It Is

Osteonecrosis Causes

Self-Care & Treatment

How to Treat Osteonecrosis

1. Anti-Inflammatory Medication

2. Reducing the Load on the Joint

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Easing Pain and Stiffness

Keeping the Joint Moving

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooOsteonecrosis

What It Is

Osteonecrosis Causes

Self-Care & Treatment

How to Treat Osteonecrosis

1. Anti-Inflammatory Medication

2. Reducing the Load on the Joint

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Easing Pain and Stiffness

Keeping the Joint Moving

Typical Course

References

Related Conditions

Osteonecrosis of the Hip

Osteonecrosis of the Knee

Amyotrophic Lateral Sclerosis

Anterior Wedge Fracture to the Vertebra

Book a session