photograph by jim roberts / dreamstime
Whenever I experience joint discomfort, my thoughts turn to The Wizard of Oz and, specifically, the Tin Man. As a knee or shoulder protests a certain motion, I’d like a doctor, or a friend, or my wife — anyone, please — to simply squirt a little oil on the area in need … and I’ll be on my way.
Human joints don’t operate on oil, alas. When functioning properly a knee — or shoulder, elbow, or ankle — is a rather brilliant biological mechanism, multiple bones working in coordination with muscles and connective tissue, allowing us to reach our favorite coffee mug on the top shelf, or cross the finish line of a 5K with no more discomfort than some heavy breathing. But when aggravated or jarred severely, inflammation can occur in that connective tissue. And this is where the problems start.
“A lot of things can cause [joint pain], and some of them are physiologic, or normal parts of everyday life,” explains Dr. Tom Giel, a sports-medicine specialist with OrthoSouth and, not incidentally, the team physician for the Memphis Grizzlies. “You’ve overdone it, didn’t sleep enough the night before, or overworked a joint and it’s sore. That happens to all people through the middle-age spectrum.
“But there are also some pathologic conditions — disease processes — that can cause this as well. Inflammatory arthritis is a real problem in that middle-age range, because that’s when it will rear itself for the first time.” The difference is measured between, say, knee soreness for a couple of days, and the same kind of soreness for three or four weeks, without gradual reduction in pain.
Giel has a pair of factors to consider if you’re deciding to involve a doctor for help with a barking joint. “If it’s gone several days, or beyond a week and is still symptomatic, that’s one benchmark,” he says. “Another would be if the pain is significantly interrupting your day-to-day life. Difficulty at your job, difficulty sleeping, difficulty playing with your kids, or difficulty playing a sport you enjoy. If not playing the sport eliminates the pain, that’s not a victory.”
image courtesy mvoge / dreamstime
Back to the root of the problem: inflammation. Why do tissues in our body become aggravated, and why do they let us know in such an uncomfortable fashion? “It’s a chemical process that’s part of our immune system,” notes Giel. “Our bodies recognize an injury or damage, and we release chemicals that increase blood flow to an area. It then makes the area swollen and warm. Those same chemicals irritate the nerves in the area, which causes the pain.”
Joints are distinctive when it comes to functionality in that they can produce sounds: snaps, crackles, and pops that echo a certain breakfast cereal. But Giel says these noises aren’t typically signs of damage, and shouldn’t cause worry. “It’s very normal,” emphasizes Giel. “If it doesn’t cause pain or interfere with your everyday life, ignore it. [The sounds are made by] tissues gliding by each other.”
When it comes to the primary joint groups — shoulders, elbows, hips, knees, and ankles — Giel identifies a primary culprit when it comes to his patient count. “Anything that moves can have a problem, but the most common joints to cause problems are your knees,” he says. “They’re doing more work. If we walked on our hands, our elbows would be more of a problem.”
There are various forms and degrees of treatment for joint discomfort, from the simple (rest) to the complicated (surgery). Giel cites an easy-to-remember acronym for the first stage of treatment: RICE (rest, ice, compression, elevation). “It’s helpful to calm joints down,” he notes. “And with rest, I don’t mean complete cessation of activity. But take it down a notch. Take a break from an activity that aggravates the area.” Over-the-counter anti-inflammatory drugs (NSAIDS like ibuprofen or naproxen) can bring temporary relief, as long as a person doesn’t have underlying conditions that prevent them from using such medicine.
A mysterious condition we’ve come to call “frozen shoulder” causes the tissues in that joint capsule to thicken so much that an arm loses significant mobility. (I’ve suffered bouts with each of my shoulders, both lasting about three months.) It seems counterintuitive, but the ailment requires accessing the pain … and pushing through it as much as one can tolerate.
“It’s a common condition,” says Giel. “It’s unique in that it is not truly an inflammatory condition. The lining of the shoulder — for reasons we physicians still don’t understand — decides to scar itself and limit the motion of that joint. Treatment is slow, deliberate stretching. You put a little pressure on the area, knowing you won’t fix it in a day.”
“Whether it’s walking or jogging or playing pickleball or lifting weights, “if you do it, that’s better than the exercise you talk about doing, but don’t do. If you’re wondering if you should avoid exercise to avoid injury, the answer is almost always no.” — Dr. Tom Giel
That stretching of a frozen shoulder speaks to the general treatment plan for any joint problem, as rest does not mean inactivity. To emphasize, our bodies are healthier when they’re in motion, and our joints allow that motion. Bottom line: Joints must move (or be forced to move), for us to move. “We want to exercise [uncomfortable] joints, and start to strategically load them again,” emphasizes Giel. “That’s why we use so much physical therapy for people with joint pain. Exercise will make a considerable difference for the vast majority of joint complaints.”
If joint pain reaches a debilitating level — that right hip forces a limp every time you take a step — replacement surgery can be a solution. And while every form of surgery is a dramatic step toward healing, joint replacement shouldn’t cause great fear. Hips and knees are being replaced every day, often with rave reviews by those walking away with new equipment. “It’s a treatment for arthritis,” says Giel. “The joint has become damaged over time. There are a lot of biological components that go into arthritis. When your pain reaches a point where we can’t control it with the little things, it’s time to consider joint replacement.
“These procedures are very common now,” he continues. “Because of improvements in technology, they are, by and large, safer. They last longer. And the vast majority can be done on an outpatient basis. You can have surgery today then go home and spend the night with your family. People suffering arthritis are in so much pain, and they feel so good afterwards. The most common thing people say to me after they have a replacement procedure is, ‘I can’t believe I waited so long.’”
If your joints are cooperating today, consider them assets to protect. Instead of allowing a certain twist or fall to change the way you move, prioritize those assets in your daily exercise regimen. According to Giel, the best forms of exercise are those that fit your lifestyle, the activities you already enjoy so you will, presumably, continue to do on a regular basis.
“Whether it’s walking or jogging or playing pickleball or lifting weights,” explains Giel, “if you do it, that’s better than the exercise you talk about doing, but don’t do. If you’re wondering if you should avoid exercise to avoid injury, the answer is almost always no.”
Basketball involves a lot of jumping and twisting for a middle-aged body. But if you’ve played for years, stay on the court. The same goes for tennis (a common injury-causing sport, simply because so many middle-aged people play it). Giel’s lone warning when it comes to exercise is to avoid overdoing it: “If tomorrow, having never jogged at all, I decide to run a marathon, I could seriously damage myself. Taking our time, going in slowly, and being smart about how we do it is the best way to prevent an exercise-induced injury.”
As it turns out, no oilcan is required for achy joints. Attention and activity are enough.
