All you need to know about joint pain
Analysis: The recommended treatment for most joint conditions is appropriate exercise and education on how to manage pain during daily activities
Joint pain is a common issue for people of all ages and is the reason for over 20% of GP appointments. Given that many of these appointments are repeat visits, combined with the dire state of our outpatient orthopaedic waiting lists (over 64,000 waiting at present), it is clear that these conditions are not being managed well by a large number of people in Ireland.
The recommended treatment for most joint conditions is appropriate exercise and education on how to manage pain during daily activities. Unfortunately, misconceptions about prolonged joint pain can be a stumbling block for people starting a new activity or treatment programme.
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Prolonged, or chronic pain in a joint (such as osteoarthritis) is different from an acute or traumatic joint injury (eg torn ligament), in that it usually lasts for a period of greater than three months. Pain has an important protective role in our bodies, like an alarm alerting us if something is wrong.
But if pain persists for longer than the typical healing period, it no longer serves a protective role and can negatively impact our health and quality of life. Understanding the science of pain and recognising the types of things that influence your pain can be a huge step in learning to live well these joint conditions.
A joint is where two bones meet and allows for our bodies to move. The surfaces of these bones are covered by a tough, slippery material called cartilage and an enclosed lubricating synovial fluid. We used to think that conditions like osteoarthritis were all about the cartilage getting damaged or "worn out", but we now know that there are much more complex things happening in the joint.
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We see changes to the cartilage, the bone and the surrounding soft tissues (ligaments and muscles). We also see more inflammatory markers in the joint fluid, meaning that your joint condition can also be affected by things like obesity, sedentary lifestyles and even the types of diets that we choose.
Do I need an MRI to understand what is happening?
Unless there has been a specific injury or trauma to the joint, there is no need to get an MRI for joint pain. Even an X-ray is no longer recommended to diagnose conditions like osteoarthritis. While the damaged structures in a joint can be a source of pain, almost one in two people over 40 years of age have "damaged" knee joints on imaging and experience no pain.
Findings on an MRI scan, such as cartilage defects, meniscal tears and bone bruises/spurs, should not be a source of worry. We now know they are likely a normal part of ageing – just like wrinkles on the skin!
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Does increased pain mean my condition is getting worse?
Our beliefs, past experiences and worries can all influence the pain we feel. If we take a walk in the woods in Ireland and feel a scratch on our leg, we may not pay any attention to it. If we take a walk in the outback in Australia, we may respond a lot differently to a scratch if we know there are dangerous snakes in the vicinity.
Our bodies react to a potential threat in a different way if we attribute pain to "damage". Muscles are more tense, our stress response increases, which heightens the pain we feel. It can be very reassuring to know that pain does not mean there is any damage occurring to the structure of the joint, and does not mean the condition is getting worse. Temporary fluctuations in pain are very normal and can be exacerbated by increased day-to-day stress in our lives, a poor night's sleep or starting an activity that we are not used to.
Should I stop exercising if my joint hurts?
It is very important to exercise if you have a joint condition, but it is important to identify when activity needs to be modified. Less activity won't protect the joint, and your overall health will suffer in as little as two weeks if you stop completely. It may be helpful to know that it is safe to continue to exercise when you experience your familiar pain, as long as the pain is acceptable to you.
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You can also expect the pain to reduce the more you exercise if you use the following two guiding rules: (i) a pain rating of 5 or less on a scale from 0 to 10 while exercising is considered OK or acceptable and (ii) your pain should return to your baseline level within 24 hours.
This can help you to decide if you are ready to progress your exercise or if you need to reduce the duration, change your activity type or take more rest breaks. While following these rules, even people with moderate to severe osteoarthritis who had been scheduled for joint replacement surgery were able to complete a 12-week progressive exercise programme with acceptable levels of pain. In fact, three in four of those who took part in the programme felt well enough to opt out of surgery in the next year.
Is surgery inevitable if I have joint pain?
Most types of joint pain resolve with appropriate management. The vast majority of people, even with conditions like osteoarthritis, do not get worse over time and do not need a total joint replacement. While many people may be familiar with being told "it's not bad enough YET to get surgery", chances are it never will be. Surgery should only be considered when pain is severely impacting on quality of life and when recommended treatments of exercise and lifestyle management have been adequately trialled.
Surgery should only be considered when pain is severely impacting on quality of life
More information on how to manage your pain, including safe exercises for joint conditions such as hip and knee osteoarthritis, patellofemoral pain, lateral hip pain and degenerative meniscal tears, can be found on the Joint Pain website. This website was co-designed with experts, healthcare professionals and people with joint conditions in Ireland, with the support of a Health Research Board Knowledge Translation Award (KTA-2022-023). This information is based on research evidence but should not replace individualised advice offered to you by your healthcare professional.
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