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Managing Pain 2020

Beating joint pain: it takes muscles

iStock / Getty Images Plus / yacobchuk

Professor Philip Conaghan

Professor of Musculoskeletal Medicine, University of Leeds; Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust

Joint pain is incredibly common and painkillers don’t work very well. However, building strong muscles substantially reduces pain.

Causes of joint pain and the current treatments

Joint pain can be due to arthritis or inflamed tendons (the ends of muscles that anchor them to bone), or a mixture of both. There are many different types of arthritis. Arthritis due to immune system disorders (such as rheumatoid arthritis) is relatively uncommon and needs special drug therapies. Mechanical joint problems (mainly osteoarthritis and inflamed tendons) are very common, with pain generally worsening over the course of a day – due to increased joint use, or after sitting for a while. For these common joint problems, we only have a few drug therapies, such as anti-inflammatories (e.g. ibuprofen or naproxen) or opioids (eg codeine or cocodamol).  They often only reduce pain by a small amount and can have substantial side effects, so many people can’t or shouldn’t take them.

If getting out of a bath, chair or car is difficult, or you find your knee is ‘giving way’, then you have weak leg muscles.

Why are muscles important?

Weak muscles lead to increased strain on joints and tendons. If you cant undo a jar, hold a saucepan or undo buttons, you definitely have weak grip (which means weak forearm muscles). If getting out of a bath, chair or car is difficult, or you find your knee is ‘giving way’, then you have weak leg muscles. If you had intermittent pain but now its becoming more frequent, chances are you have become weaker over time.

And the problems don’t stop with one joint. If you have weak grip, every time you lift or carry you will be transmitting increased load to your shoulder. So you may start with hand pain and over time develop shoulder pain. Similarly, people with knee pain who develop weak leg muscles will develop pain on the outside of their thighs/hip region (due to inflamed tendons) and may aggravate their back pain. Many people will have become weaker from staying indoors during COVID-19 lockdown.

And many research studies show that you can substantially reduce joint pain if you increase muscle strength.

Are there simple ways to get strong?

For weak grip, sit with your arms resting on a cushion/pillow. Put a rolled up sock or squashy ball in one hand and squeeze. Keep squeezing as long as you can without stopping. When you can’t hold it anymore, put it in the other hand. Keep going and swapping hands.

If you have the leg problems I previously described, a good starter exercise is to walk multiple laps in a swimming pool. Another simple exercise uses a rolled up towel under your knees while you are lying down. Bend up one leg and with the other push the back of your knee down into the towel while lifting your heel up and pulling toes toward your head. This gets the leg straight. Hold for a count of 10 (if you can!). Give it a short rest then repeat.

A key to muscle building is repeating and repeating: up to 30 times per arm/leg. It will get easier over time. If you do it daily, you will notice benefits within a few weeks. It is wise to be strong before you start doing more vigorous exercise: if the exercise for leg muscles described here becomes easy, then its time to move onto brisk walking, exercise bike or cross-trainer.

If you need specific advice about muscle strengthening, talk to a physiotherapist or GP, or go to 

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