What Doctors Want You to Know About Joint Pain

It's natural to assume that joint pain after years of physical activity means it's time to put those sneakers away and give your body some proper rest. Not so fast. Experts say many assumptions about joint pain are wrong, including the idea that doing less will make you feel better. We asked top docs to share what they'd tell every person over 65 about joint pain if they had the chance.

Joint Pain Isn't a Fact of Life

Yes, some mild pain and aches are part of the aging process. According to the Centers for Disease Control and Prevention (CDC), the risk of arthritis increases as you get older due to inflammation, loss of the muscle that's crucial for joint stability, and the increased risk for falls and injuries.

"We know that cartilage will thin over time and there are normal degenerative changes," says Jesse N. Charnoff, M.D., the attending spine and sports medicine physiatrist at the Hospital for Special Surgery in New York City. However, significant daily alterations secondary to pain, such as reduced mobility, disrupted sleep, and difficulties with self-care, should not be accepted blindly, Dr. Charnoff adds.

"There are often root causes and treatable conditions to explain severe pain episodes," says Dr. Charnoff. Along with arthritis, these include bursitis, tendinitis, gout, and referred pain (when you feel discomfort in one part of your body while the true source of the issue is located elsewhere).

Early evaluation of your joint pain will help to identify treatable causes and ensure you get the most appropriate and timely treatment.

More Pain Doesn't Always Mean More Joint Damage

The severity of pain and the structural changes visible on an X-ray do not always match. "There are many patients who have severe osteoarthritis—the most common type of arthritis—on imaging without severe pain," reveals Dr. Charnoff. "Alternatively, there are people with more mild degenerative changes with significant discomfort. Thus, we treat the patient and not the radiographs."

The severity of a person's experience with pain is influenced by stress, muscle weakness, joint inflammation, and sensitivity, according to researchers. "It tends to be a mixture of physical, biological, and psychological factors," says Dr. Charnoff. "Other factors are mood, sleep quality, body weight, activity level, and underlying biomechanics."

Resting Too Much Makes Joint Pain Worse

When simply getting out of bed in the morning hurts like heck, it's logical to think moving less is the way to go—but not so, says Dr. Charnoff. "Movement helps with getting nutrition to circulate within the joint, which helps with fluid exchange and maintaining a healthy joint," he explains.

Another problem with remaining sedentary is muscle atrophy. "This is the loss of muscular strength and size due to inactivity, which can happen with osteoarthritis when movement becomes painful," says physical therapist James Higgins, D.P.T., an orthopedic clinical specialist at Integrative Physical Therapy of NYC in New York City. "As a result, patients avoid moving, which can bring on muscle atrophy."

Higgins stresses that good mobility is important for everyone. Even a simple walking routine with arthritis, he says, "allows us to perform daily activities with ease and provides the proper use of muscular force to be balanced."

Exercise Is Medicine (Even When Movement Hurts)

On the other end of the spectrum, a common misconception that physical activity will "wear out" the joints holds some people back from exercising with arthritis. In fact, exercise is one of the first treatments doctors recommend. "Osteoarthritis responds well to movement and strength training," says Higgins. Stronger muscles are better equipped to help absorb the load placed on your joints, says Higgins, who recommends these daily strength and flexibility exercises:

• Doorway stretch: Stand inside an open doorway with your arms stretched out on either side of the door frame, elbows bent. Lean your chest forward slightly through the doorway until you feel a pull across your chest and front shoulders. Hold this position for 20 seconds.
• Hamstring stretch: Stand facing a low step. Place the heel of your right foot on the step, keeping both legs straight. Hinge forward at your hips, back flat, so you feel a stretch in the back of your right leg. Hold this position for 20 seconds. Repeat on the other side.
• Neck rotation: Sitting tall with your shoulders relaxed, slowly turn your head to the right side as far as is comfortable. Keep your shoulders square. Hold for 20 seconds then repeat on the other side.
• Squat: Stand with your feet just wider than your shoulders and your toes pointed slightly outward. Holding onto a chair or sturdy railing, tighten your abdominal muscles, bend your knees, and sink your hips back like you're sitting down. Lower a few inches, then push through your feet to come back to standing.

Remember, some mild stiffness or discomfort when beginning to exercise is normal because you're working into the joint stiffness itself. But always stop if you experience sharp, escalating, or persistent pain and get it checked by your doctor.

Mobility Aids Help You Move More, Not Less

It's wrong to think mobility support will decrease your movement; they are your ticket to doing more, safely, experts say. One recent study of people with COPD found daily steps increased by nearly two-fold when people used a rollator for support. "Once a patient has lost a certain amount of range of motion, mobility aids can be helpful," says Higgins, who adds that people should continue to perform tasks themselves while they are able to.

Aids like rollators (to provide walking support and a place to rest) and electric wheelchairs (to conserve energy over longer distances) can help you feel less fearful of starting an activity and then realizing you're in over your head, while allowing you to move within the community with more freedom, notes Dr. Charnoff. They also help to reduce stress on painful joints, which can lead to fatigue and restricted movement, and prevent further injuries by reducing the risk for falls.

Dr. Charnoff notes that it's critical that your chosen mobility support is the correct height/fit and is being used appropriately, which is where a physical therapist (PT) can help. A PT can also help you work out what type of aid will be most helpful for you.

Muscles Matter More Than You Think

To you, it feels like your knee joint has totally given out on you. In reality, your knee pain is being made worse by weakness in the muscles surrounding it. For instance, weak quadriceps can affect knee stability and weak core muscles, glutes, and hip adductors can alter walking mechanics. A PT can help you work on the areas that need the most attention to improve movement and stability—which in turn has a positive impact on your confidence and independence.

Remember that at any age (but especially as you age) your body will respond better to consistent loads rather than intense spikes in activity, says Dr. Charnoff. "Consistent exercise helps with joint nourishment more than intermittent, intense exercise sessions," he explains. "Muscle strength and endurance tend to build over repetition. The body can adapt when under regular stress as compared to acute intensifications, which are more likely to cause injury and irritation."

Some Joint Pain Should Never Be Pushed Through

Sudden, severe pain is a sign to stop, says Dr. Charnoff. Certain symptoms require prompt evaluation, such as:

• A hot, red, or significantly swollen joint
• A joint that locks, buckles, or becomes unstable
• Inability to bear weight
• New numbness or weakness
• Pain following a fall or injury
• Rapidly worsening pain or loss of function
• Sudden or severe pain

"It's important to have a good relationship with your medical providers, including your physical therapist, to help discuss these acute intensifications," notes Dr. Charnoff.

Seeing Joint Pain in a New Light

If there's one thing Dr. Charnoff could tell every senior, it's this: "Movement is medicine." Whether you're experiencing joint pain or simply want to take steps to keep your joints healthy into old age, make his advice your new mantra.

"Joints that hurt often benefit from some movement and exercise," he adds. So before you shut things down out of fear that exercise is worsening your joint symptoms, talk with your doctor about small steps you can take to remain active. With the right exercise plan, treatment, and mobility support, you'll stay active and engaged for many years to come.