Joint Pain: A Q&A with Jeffrey Richard, Exercise Physiologist

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Jeffrey Richard, Clinical Exercise Physiologist at Joslin

A version of this article was originally posted on February 10, 2014. 

This Q&A was conducted by Nora Saul, M.S., R.D., C.D.E., Manager of Nutritional Services at Joslin.

It is a foregone conclusion that good nutrition and adequate physical activity go hand-in-hand in maintaining health. That’s why the amount and type of exercise you do comes up as part of the complete nutrition assessment.  A number of older patients complain that they aren’t able to do any exercise because of the pain they experience from joint problems.  Since lack of exercise reduces the effectiveness of any weight management program, I asked one of Joslin’s Exercise Physiologists, Jeffrey Richard, about tips he could give patients with joint pain.

Nora: Jeffrey, I don’t know what to tell my patients who have joint pain. I usually send them to you but sometimes they don’t want an extra appointment.  And I know we have many of our blog readers who are also interested.   Why do these people have so much pain?

Jeffrey: The muscles of the body are there to provide support and structure to the bones. Without them, we can’t maintain the proper upright posture. When those muscles become weakened via advanced age or from lack of use, imbalances form. As a result of these imbalances, some muscles are overworked while others become underactive and the body falls out of alignment. Pain may be the result of overuse, injury, or a simple imbalance. For all of these cases, the right type of exercise can be of great benefit. Take the knees for example; the lack of even support can cause potential strain on one portion of the knee, leading to pain. The same is true for the back. Improper functioning muscles can alter the alignment of the spine leading to pinched nerves, instability, and an increased risk for disc injury.

Nora: Is there anything to do?

Jeffrey: I usually tell people to start with some aerobic exercise. Begin your aerobic exercise plan with walking. Walking is the best place to start. On your first day, walk at a pace a little bit faster than your regular speed for whatever amount of time you are comfortable.  Make sure you keep track of your time. Every week, try adding a little extra time whether it be 1 -10 minutes. As long as you are trying hard, it doesn’t matter how small the increase is. Progress is progress.

When you achieve your goal timeframe (anywhere from 30-60 minutes), it is time for you to start increasing the intensity of your exercise. This can be done by either walking at a faster pace or by changing the terrain, perhaps including some hills.

Nora: What about something to strengthen muscles?

Jeffrey: Resistance-style exercise will act to strengthen knee and back muscles. This is very important not only for your health management, but for pain management as well. There are many forms of chair exercises that can be done as a starting point such as; leg lifts, knee raises, leg extensions, calf raises, knee bends and leg curls for the knees. Since using a chair provides good support the back, the same exercises one does standing with resistance bands can be done in a chair such as chest press, row, shrug, bicep curl, shoulder press, tricep pressdown and many more.   A good rule of thumb is to stay away from exercises which cause a drastic increase in pain or very sharp jolting pain.

For either aerobic or resistance training, a steady progression is the key to success. Many injuries occur as a result of increasing the total volume of exercise before your body is ready for it. Progressing at a pace that is comfortable for you will ensure your body has enough time to recover from  previous exercise.

Chair exercise fit the bill for this type of person perfectly. They are usually easy on the back since they are in a seated upright posture. Utilizing the bands for this, if available, would expand the amount of exercises they would be able to complete, but they could also be done with soup cans, books, or with nothing at all. The main emphasis starting out shouldn’t be to overstress the person with a whole lot of resistance, but to enable the individual to be able to move again. With many people, simply going through the motions without resistance can release some of the tension in some muscles which cause them pain.

Nora: Any other suggestions?

Jeffrey : For either aerobic or resistance training it is important to pace yourself, a steady progression is the key to success. Many injuries occur as a result of increasing the total volume of exercise before your body is ready for it. Progressing at a pace that is comfortable for you will ensure your body has enough time to recover from the previous exercise.

Click here to learn more about making an appointment with a Joslin Exercise physiologist

5 Responses to Joint Pain: A Q&A with Jeffrey Richard, Exercise Physiologist

  1. sharath chandra says:

    I enjoyed reading question & answer
    Like to continue reading recommendations

  2. Maricarolyn Rucker, FNP says:

    Hi, My patients ask me why they have pain and stiffness in their joints. Could you briefly explain the pathophysiology that causes these symptoms? Or perhaps suggest a reference that would enhance my own understanding of the mechanisms involved?
    Enjoyed this article and thank you.

    • Thank you for your question! Here’s a response from Jeffrey Richard:
      “The mechanisms involved that may contribute to joint pain are numerous, but a few of the most prevalent are arthritis (osteo and rheumatoid), inflammation, or misalignment. Osteoarthritis involves degradation of the cartilage between the joints. When that cushion is no longer there, much of the shock from everyday activity for that joint does not get absorbed and could be imposed directly on the bones. This is seen frequently seen in overuse situations since the cartilage breaks down overtime.

      Pain from inflammation caused from an infection, injury, could be putting pressure on a nerve, or causing a shift in the bone structure of a joint leading to discomfort. When the nerves are “pinched” form the pressure of inflammation muscle tightness, or from improper bone alignment, they tend to send a radiating pain down the length of the area innervated by that nerve. The space nerves have to run through in some joints is rather small and if something imposes on that space, pain or discomfort may result.

      Identifying a problem while it is still in its early stages could lead to better outcomes. Joint pain of unknown origin may be an early warning signal.”

  3. I’m feeling an occasional “snapping” while walking around. What’s the exact cause?

    • Thanks for your question! Please see the above response for a detailed answer from Jeffrey Richard. If you are suffering from joint pain or any unusual discomfort with daily activities or exercise, he recommends you mention it to your physician so he or she can figure out exactly what’s going on.

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