Joint Pain: A Complete Guide to Understanding and Relieving Your Joints

Joint pain can limit walking, sleep, and daily activities. In a study conducted at 12 British primary care clinics, one in seven visits was related to muscles, bones, or joints¹. Whether it affects your knees, hips, shoulders, or hands, pain deserves treatment tailored to its cause. This guide explains possible causes, how to distinguish between them, when to seek medical advice, and available treatments. For osteoarthritis of the knee or hip, exercise and education are among the first recommended treatments. A physical therapist can help you with these^{treatments2, 3}. Our comprehensive guide to physical therapy explains this discipline.

What is joint pain?

Joint pain refers to pain felt in or around a joint. The medical term is “arthralgia.” In Canada, a study followed 8,817 people between 1994 and 2011. People from more recent generations reported higher rates of arthritis at the same age. Higher body weight was associated with an earlier onset of arthritis⁴. These associations do not allow us to attribute every instance of pain to weight or age.

Several tissues can contribute to pain: the synovial membrane, which lines the inside of the joint; the capsule that surrounds it; the ligaments that connect the bones; and the bone beneath the cartilage. These tissues contain nerve endings. Cartilage, which covers the ends of the bones, does not contain any. The pain associated with osteoarthritis also depends on the muscles surrounding the joint and how the nervous system processes the signals⁵.

Arthralgia refers to a symptom, whereas arthritis involves inflammation of the joint. Arthritis can cause pain, swelling, warmth, or redness. Not all of these signs are necessarily present. Ultrasound produces images using sound waves. In a study on rheumatoid arthritis, this test revealed inflammation in certain joints that were not tender to the touch or swollen upon examination. Palpation involves examining an area by touching it (study on subtle signs of arthritis). Therefore, pain in the area of a joint does not automatically mean that it is arthritis.

Joints allow you to move and use your hands. Age, certain injuries, and being overweight can increase the risk of osteoarthritis, but osteoarthritis is not simply a matter of inevitable wear and tear. A lack of physical activity can also weaken the muscles that support movement. Appropriate care can help manage pain and improve your ability to perform daily activities, even when joint changes persist.

How does a joint work and what can cause pain?

A joint connects bones, allows for certain movements, and can become painful when its nerve-containing tissues are irritated. Movable joints, such as the knee, contain cartilage, synovial fluid, a joint capsule, and ligaments. The table describes these joints. Not all joints between bones—particularly those in the skull—have this structure.

Cartilage covers the ends of bones and helps them glide smoothly by reducing friction. It can become thinner or damaged due to certain diseases or following an injury. Changes in the cartilage alone are not enough to explain the intensity of the pain.

Synovial fluid lubricates the joint and helps nourish the cartilage. Its composition and volume can change with age or due to inflammation. Hyaluronic acid is one of the substances involved in this lubrication.

The joint capsule forms a sheath around the joint. Its inner lining, called the synovial membrane, produces synovial fluid. Inflammation of this membrane can lead to fluid buildup and swelling.

Ligaments connect bones to each other and stabilize the joint. A sprain occurs when they are stretched or torn.

How to tell if my pain is coming from a joint, muscle, or nerve?

The location, stiffness, and sensations experienced can help distinguish between joint, muscle, or nerve pain. These clues overlap: none on its own is sufficient to make a diagnosis. Pain near a joint may also originate from a nearby tendon or nerve. Tendons are tissues that transmit force from muscles to bones.

Characteristics of Joint Pain

Pain may be located in or around a joint. It is not always easy to pinpoint exactly. Stiffness upon waking can make the first few movements difficult. Brief stiffness, often lasting less than 30 minutes, may accompany osteoarthritis. Longer-lasting stiffness may be a sign of inflammatory arthritis⁶. Duration is just one indicator among many. Symptoms and a physical exam do not always reveal knee osteoarthritis, especially when it is in its early stages⁷.

Swelling, warmth, or redness may indicate inflammation. A joint that has recently become warm and swollen requires a medical evaluation on the same day, even without a fever. A single cracking sound is not, on its own, sufficient to diagnose a condition.

Muscle pain

Muscle pain, or myalgia, can occur after unusual physical exertion. For example, muscles may be sore the day after a move. Taking a break from physical activity can relieve this soreness. There are other causes of muscle pain, and their progression may vary.

Nerve Pain

Neuropathic pain results from damage to or a disease of the nervous system that transmits sensations. This system includes the nerves, the spinal cord, and certain parts of the brain. The spinal cord is the bundle of nerves inside the spine that transmits messages between the brain and the body. Neuropathic pain can feel like burning, electric shocks, tingling, or numbness. A nerve root is the part of a nerve connected to the spinal cord within the spine. In sciatica caused by a nerve root, pain may radiate from the buttock down the leg or to the foot. The painful area may therefore be distant from the original problem. These guidelines follow the clinical guidelines of the International Association for the Study of Pain.

What are the main causes of joint pain?

Causes of joint pain include osteoarthritis, inflammatory arthritis, gout, injuries, and infections. Bursitis can also cause pain around a joint. The cause determines the treatment: an infection is not treated the same way as osteoarthritis.

Osteoarthritis: Changes Throughout the Entire Joint

Osteoarthritis affects the cartilage, the bone directly beneath it, and sometimes other tissues in the joint. It becomes more common with age, but it is not an inevitable consequence of aging. The bones may form bony growths called osteophytes, sometimes referred to as “parrot’s beaks.”

Osteoarthritis primarily affects the knees, hips, hands, and spine.Osteoarthritisof theknee andhip can make walking difficult. In the hands, the base of the thumb and the finger joints are often affected. Pain may worsen during certain activities. Stiffness upon waking is often brief, but these symptoms vary.

The progression of osteoarthritis varies from person to person. A change visible on an X-ray does not necessarily mean that the pain will worsen at the same rate. Check out our guides on knee pain or hip pain.

Inflammatory arthritis

Rheumatoid arthritis is an autoimmune disease: the body’s immune system mistakenly attacks its own tissues, particularly the synovial membrane. A meta-analysis of 67 studies estimated its average prevalence at about 0.5% of the population, with significant variations among the studies⁸.

Rheumatoid arthritis can affect joints on both sides of the body, such as both hands. It can cause prolonged morning stiffness—sometimes lasting more than an hour—as well as warm or swollen joints and general fatigue. Different or less painful symptoms are not sufficient to rule it out.

A prompt diagnosis allows for early medical treatment of rheumatoid arthritis. These treatments can reduce symptoms, improve functional ability, and limit joint damage⁹. Physical therapy for pain caused by inflammation complements this medical care by helping to preserve mobility and strength.

Gout

Gout occurs when uric acid crystals build up in a joint and trigger inflammation. An attack can begin suddenly, often at night, with severe pain, redness, and swelling. The base of the big toe is a common site, especially during a first attack.

Certain foods high in purines, such as meat and seafood, are associated with gout. The body converts purines into uric acid. Alcohol—especially beer—being overweight, and certain diuretics are also associated with an increased risk. Diuretics are medications that increase the excretion of water in the urine¹⁰. Do not stop taking a medication without discussing it with your prescriber. Medical treatment can relieve attacks and, when indicated, lower uric acid levels to prevent further attacks¹¹.

Bursitis

Bursae are small fluid-filled sacs that reduce friction around the joints. Bursitis is the inflammation of these sacs. Commonly affected areas include the shoulder, elbow, knee, heel, and hip. Our article on hip bursitis explains this condition.

Bursitis can result from prolonged pressure, an impact, or repetitive strain. Kneeling for long periods while cleaning is one possible example. Some cases of bursitis are caused by an infection. Temporarily reducing pressure and irritating movements can help alleviate non-infectious bursitis. Cold therapy or medication may provide relief, depending on the situation. A warm, swollen, or red area requires medical attention, especially if accompanied by a fever; an infection requires specific treatment.

Trauma and infections

After an injury, pain may be caused by a knee sprain, fracture, or dislocation. A dislocation occurs when bones are no longer properly aligned within the joint. A tear in the meniscus—a cartilage pad in the knee—is another possible cause. Severe pain following an accident, deformity, an inability to bear weight, or numbness requires urgent medical evaluation.

Septic arthritis is a joint infection and constitutes a medical emergency. A joint that has recently become warm and swollen should be evaluated the same day, even if there is no fever. If you have a fever, chills, or feel very unwell, seek medical attention immediately, as advised by the NHS regarding joint pain.

Which joints can be painful?

Joint pain can affect the knees, hips, shoulders, hands, feet, and spine. Each area has different functions and potential problems.

The knee may become painful as a result of a sprain. Patellar tendinitis affects the tendon beneath the patella, the bone at the front of the knee. Goosefoot tendinitis affects the tendons on the inner side of the knee, just below the joint. These conditions can also cause pain around the knee. Body weight influences the forces exerted while walking. In a study of 142 older adults who were overweight or obese and had knee osteoarthritis, each kilogram lost was associated with approximately four kilograms less force on the knee with each step¹².

The shoulder allows you to lift and rotate your arm. Frozen shoulder, which causes significant stiffness, and calcific tendinitis, which involves calcium deposits in a tendon, can cause pain in this area. Check out our guide on shoulder pain.

Pain in your hands can make it difficult to go grocery shopping or cook. Carpal tunnel syndrome involves a compressed nerve in the wrist and can cause pain or numbness in the hand. Osteoarthritis often affects the base of the thumb and the finger joints.

Facet syndrome refers to pain attributed to the small joints between the vertebrae. These joints can contribute to back pain, but they do not account for all pain in this area.Lumbar osteoarthritis affects the lower back, whilecervical osteoarthritis affects the neck. See our guide on back pain.

How does aging affect your joints?

Aging affects the cartilage, ligaments, muscles, and bones in the joints. Cartilage can become thinner, and its cells become less effective at repairing certain types of damage. Muscles can lose strength, and bone remodeling can change. These changes contribute to the risk of osteoarthritis, but they do not make it inevitable¹³. A study of knees without osteoarthritis also found lower concentrations of hyaluronic acid in the synovial fluid of older donors (synovial fluid study).

Age-related changes alone do not determine pain. In a review of knee studies, some people had osteoarthritis visible on X-rays but no pain, while others had pain without visible osteoarthritis. The proportions varied widely across studies¹⁴. The healthcare professional therefore interprets the imaging results in conjunction with your symptoms and physical examination.

Exercise helps maintain muscle strength, mobility, and bone health. Strength-training exercises can slow the loss of strength and help maintain bone density—that is, the amount of bone mass. Flexibility exercises help you maintain the range of motion needed for daily activities, according to the NHS’s guidance on strength and flexibility. Walking, cycling, water-based activities, and adapted yoga are options you can choose from based on your abilities.

When should you seek help for joint pain?

A joint that has recently become warm and swollen requires medical attention on the same day, even without a fever. After an accident, severe pain, deformity, an inability to walk or bear weight, or numbness require urgent medical attention. Persistent pain that interferes with your daily activities also warrants an evaluation, depending on the circumstances described below.

Emergency Signs

Quick consultation

Seek medical attention if the pain does not improve after about two weeks, interferes with your daily activities or sleep, or causes you to limp. Prolonged morning stiffness, pain in multiple joints, or recurring swelling also warrant evaluation. Urgent symptoms require care before this time frame.

When to Wait

Mild pain after unusual physical activity can be monitored if it gradually subsides without swelling, warmth, or other warning signs. Temporarily reduce the activity that is causing the pain and stick to movements that are comfortable. See a doctor if the pain stops improving or if new symptoms appear.

How Can Physical Therapy Help Manage Your Joint Pain?

Physical therapy can reduce pain and improve functional ability through exercise, education, and treatment tailored to the underlying cause. For osteoarthritis of the knee or hip, exercise is one of the first recommended treatments and has a good safety profile². An indirect comparison of trials on knee osteoarthritis found similar average effects on pain for exercise and pain medications¹⁵. This comparison does not prove that both options are equally suitable for every person. An infection or inflammatory arthritis also requires specific medical care.

Comprehensive assessment

Your physical therapist will assess the range and ease of your movements, your strength, joint stability, and the way you move. They will ask you what increases or relieves your pain and how it affects your daily activities. A comprehensive evaluation helps identify potential problems and determine the appropriate course of treatment. It may also lead to a referral to a medical specialist if the cause remains unclear or requires further testing.

Therapeutic Exercises

Exercise is a well-documented first-line treatment for osteoarthritis of the knee and hip². The program may combine strength training, flexibility exercises, and endurance activities. Pain relief may be comparable to that observed with pain medications in trials on knee osteoarthritis¹⁵. Your physical therapist will work with you to select the exercises and determine how to progress through them.

Strengthening the quadriceps can reduce pain and improve functional ability in people with knee osteoarthritis. A review of nine trials reports these benefits from programs that often last eight to twelve weeks¹⁶. Exercises may include knee extensions—which involve straightening the knee—or leg raises, depending on your ability.

Manual techniques and education

Joint mobilizations are movements that a physical therapist performs on a joint. In a trial involving 109 people with hip osteoarthritis, a manual therapy program resulted in greater improvements in pain, stiffness, and range of motion than an exercise program. After five weeks, 81% of the manual therapy group reported an overall improvement, compared with 50% of the exercise group. Some benefits were still present at 29 weeks¹⁷. These results pertain to the programs compared in this trial. The NICE guidelines on osteoarthritis recommend using manual therapy in combination with exercise for knee or hip osteoarthritis.

Learning about your condition helps you understand your symptoms, adjust your activity levels, and gradually resume your activities. Your physical therapist can also examine the muscles and other tissues around the joint to tailor your treatment.

If your joint pain is affecting your quality of life, our physical therapists can develop a personalized plan for you. Check out our guide to physical therapy.

What other treatments are available for joint pain?

Other treatments for joint pain include certain medications, adjustments to your activity level, and, in some cases, surgery. The choice of treatment depends on the cause, your other health conditions, and your preferences. Weight loss may also help some overweight people with knee osteoarthritis.

Medications

A doctor or pharmacist can help you choose a medication and check for interactions. Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen and naproxen. For knee osteoarthritis, a topical form may be recommended before oral tablets. The NICE guidelines on osteoarthritis recommend weighing the benefits and risks of each option.

In a trial involving 140 people with knee osteoarthritis, a cortisone injection every three months for two years resulted in greater cartilage loss than a saline injection. This treatment regimen did not provide better pain relief over that period¹⁸. This result does not reflect the effect of a single injection. When taking acetaminophen, follow the recommended dose and avoid combining multiple products that contain it. Consult your pharmacist if needed, as recommended in the NHS guidance on paracetamol, also known as acetaminophen.

Complementary approaches

Heat can provide comfort and help relax muscles. Cold can temporarily relieve pain in a joint. Small trials involving non-infectious forms of knee arthritis have also shown a reduction in pain and certain signs of inflammation within 24 hours of treatment. The changes measured in joint fluid were primarily seen in crystal-related arthritis, such as gout (study on pain and ultrasound) (study on inflammation-related substances). These results do not prove the same effect for all joints or that the treatment addresses the underlying cause. Protect the skin with a cloth and limit cold application to 20 minutes. A joint that has recently become warm and swollen should be evaluated by a doctor.

Hyaluronic acid injections are intended to alter the fluid in a knee affected by osteoarthritis. In a review, large trials in which the results were evaluated using a blinded design found the benefit to be too small to be clinically significant. An increased risk of serious adverse effects was also observed in the trials that reported them¹⁹. In these trials, the people evaluating the results were unaware of the treatment each participant received. This method aims to limit the influence of their expectations on the evaluation. The NICE guidelines on osteoarthritis do not recommend these injections for osteoarthritis.

Glucosamine and chondroitin supplements are no substitute for exercise. In a trial involving 662 people with knee osteoarthritis, these products—either alone or in combination—did not provide any significant benefit in terms of pain relief or functional ability compared to a placebo over a two-year period. A placebo looks like the treatment but does not contain the substance being studied²⁰. Side effects were similar across the groups in this trial, which does not guarantee their safety for every individual. Discuss supplements and possible interactions with your pharmacist.

Surgery and Lifestyle

Joint replacement may be considered when osteoarthritis significantly impairs quality of life and non-surgical treatments are insufficient or unsuitable. The NICE guidelines on osteoarthritis recommend that this assessment be based on symptoms and needs, rather than on a numerical score alone. It is not necessary to repeat each treatment indefinitely before discussing the option.

In a cohort of 626 people who underwent surgery for advanced osteoarthritis, approximately 80% of those with a knee replacement and 86% of those with a hip replacement achieved a good outcome at five years. This outcome corresponded to an improvement deemed sufficient based on a questionnaire assessing pain, stiffness, and activities²¹. A joint replacement replaces the joint surfaces with artificial components. The surgery does not guarantee the elimination of all pain and requires a recovery period.

For an overweight person with knee osteoarthritis, weight loss can reduce the forces exerted while walking. Appropriate support can help you make realistic changes. Regular activity also helps maintain strength and function; a period of reduced activity does not mean your joints are bound to become more painful.

What exercises can relieve joint pain?

Strength training, flexibility exercises, and endurance activities can relieve osteoarthritis of the knee or hip and improve daily functioning. Walking, cycling, and swimming are some possible options. For other causes of pain, the exercise program must take into account the diagnosis and any necessary precautions.

General principles

With osteoarthritis, a slight increase in pain at the start of an exercise program does not automatically mean that the joint is being damaged. Appropriate exercise is generally safe and beneficial. Gradually increase the duration, resistance, or difficulty. If you experience significantly more pain or if the pain persists after your session, you should work with your physical therapist to adjust your exercise routine. A warm, swollen joint or a recent injury with warning signs requires a medical evaluation first.

Recommended activities

What to Avoid

Running or repeated physical exertion may be difficult during a painful period, but that doesn’t automatically mean you have to stop altogether. Adjust the duration, intensity, and positions that cause your symptoms to worsen over time. Our guide to sports physical therapy explains how to adapt your training.

Frequently asked questions about joint pain

Frequently asked questions about joint pain cover topics such as arthritis, joint creaking, aging, ways to manage discomfort, exercise, supplements, and surgery.

Joint pain does not automatically mean arthritis and can often be managed with treatment tailored to its cause. Exercise, measures to improve comfort, and surgery are indicated in different situations.

Does joint pain mean I have arthritis?

Pain near a joint isn't always caused by arthritis. Bursitis, tendinitis, an injury, or repetitive strain can also be the cause. A healthcare professional will examine your symptoms and range of motion to determine the cause.

Is it normal for my joints to crack?

Painless cracking does not automatically indicate a medical condition. A study of 215 adults found no association between the habit of cracking one’s fingers and osteoarthritis of the hand (study on finger cracking). In another experiment involving ten finger joints, imaging showed the rapid formation of a cavity in the synovial fluid at the moment of cracking²². This mechanism does not explain all joint noises. See a doctor if the noise is accompanied by pain, swelling, or stiffness.

Will joint pain get worse with age?

Joint pain does not automatically worsen with age. Symptoms may progress differently from visible changes in the joint. Appropriate physical activity, regular exercise, and, when necessary, weight management can help you maintain your mobility.

Is cold or heat better?

Heat can improve comfort and relax muscles; cold can temporarily relieve pain. Small studies on certain types of knee arthritis also show short-term changes in inflammation, though they do not prove the same effect for all types of joint pain. Choose the treatment that provides you with relief, protect your skin, and avoid extreme temperatures. A joint that has recently become warm and swollen requires medical attention, even if cold therapy provides relief.

Can I exercise despite my pain?

Exercise is recommended for knee and hip osteoarthritis, with an appropriate progression. It can improve strength, functional ability, and pain relief despite initial discomfort. However, a recent injury or a warm, swollen joint requires an evaluation before following these recommendations.

Do glucosamine and chondroitin work?

Glucosamine and chondroitin did not show any significant benefit in terms of pain or activity levels in the two-year trial described above. They are not a substitute for exercise. Ask your pharmacist if a supplement is appropriate for your situation and your other medications.

When is surgery necessary?

Joint replacement may be considered when osteoarthritis significantly limits your quality of life despite appropriate non-surgical treatment, or when such treatment is not suitable. This decision is made in consultation with a medical team that evaluates the expected benefits, risks, and your priorities. Advanced osteoarthritis may respond well to this surgery, but no surgery guarantees a perfect outcome.

References

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