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Beating joint pain: it takes muscles
Joint pain is incredibly common and painkillers don’t work very well. However, building strong muscles substantially reduces pain.
WRITTEN BY
Professor Philip Conaghan
Professor of Musculoskeletal Medicine, University of Leeds Consultant Rheumatologist, Leeds Teaching Hospitals NHS Trust
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.
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.
The symptoms and stages of a migraine
The debilitating effects of migraine are poorly understood. To understand migraine is to realise it is much more than ‘just a headache’ and that, during the most productive years of life, its impact is huge.
Migraine is ‘featureful’
In reality, a migraine attack will follow four or five stages, each occurring with a range of distinct features. This goes beyond the common perception of a migraine attack as a throbbing headache, which often confines you to a dark room. Not everyone will experience all of the symptoms of each stage and the stages can overlap. The severity and duration may also vary across attacks.
Symptoms and stages of an attack
The premonitory phase is often described as the warning stage, where one may experience tiredness, yawning, food cravings, mood changes (high or low), thirst, neck stiffness and passing more urine. These symptoms will last up to 24 hours and precede the next stages. It is important to recognise this stage as a useful warning, but also distinguish the symptoms from a trigger. For example, if a particular food like chocolate, is consumed during a sweet craving where the attack had in fact already started, this may be incorrectly regarded as a trigger.
The aura phase is experienced by about a quarter of people with migraine who have ‘migraine with aura’. It results from a wave of nerve activation that spreads over the brain (known as cortical spreading depression or CSD). As this electrical wave spreads, the nerves fire in an abnormal way and a range of reversible neurological symptoms develop (typically over five to 60 minutes). These may be experienced as spots, patterns and lines in the vision; numbness, tingling or weakness along the body; and speech or language disturbance. They usually precede the headache.
The headache phase involves moderate or severe head pain. The headache is typically throbbing and made worse by movement. It is usually on one side of the head, though it’s not uncommon to get pain on both sides or all over the head. Nausea and/or vomiting can occur at this stage and the person with migraine may become sensitive to light, noise or smells. Painkillers work best if taken early during this phase, or they may not work at all.
Resolution occurs as the symptoms slowly fade after four to 72 hours, but will stop sooner if treatment is timely and effective. Sleep can also be helpful.
The postdrome phase is the final stage of an attack and is characterised by a drained, fatigued or ‘hangover’ type of feeing that can last for hours or days.
Being able to recognise the different phases of a migraine attack will help to ensure the most appropriate types of treatment are used, and how best to take them. Explaining and educating others will also help mitigate suffering and frustration, and enable better lifestyle and workplace adjustments.
WRITTEN BY
Ria Bhola
Headache Nurse Specialist, The Migraine Trust