Patients ask me two questions, always in this order: “should I stop using it?” and “is it arthritis?” The honest answers are “usually not completely” and “possibly, but that is not the interesting part”. What matters is the pattern.
Pain speaks in patterns, not in diagnoses
Mechanical pain behaves like a tired hinge: it builds with load, eases with rest, and is stiff for only a few minutes in the morning. Inflammatory pain is the opposite — worse after stillness, worse first thing, easing as the joint warms up. Knowing which pattern you are in changes what we do before any scan has been ordered.
- Worse at the end of the day, better when you stop: overload, tendon irritation, osteoarthritis flaring.
- Stiff for a long while after waking, better with movement: consider an inflammatory cause and get it checked.
- Sharp, catching, giving way: structural clues — a meniscus, a rotator cuff, a loose fragment.
- Hot, red, exquisitely tender, with feeling unwell: same-day assessment, not a weekend experiment. Infection and crystal arthritis both behave this way.
“Rest is medicine in the first days of a flare, and a slow poison if you keep taking it out of habit.”
How to rest a joint properly
Relative rest means taking the provoking load off while keeping the joint moving and the muscles around it alive. Full immobilisation, by contrast, costs cartilage nutrition, strength and confidence, and it is much harder to undo than a week of sensible offloading.
The first week at home
- Swap, do not stop: cycling or swimming instead of running, stairs less, lifting lower.
- Ice for a throbbing, newly irritated joint; gentle warmth for the stiff, cranky one.
- Move through a pain-free range a few times daily — this is not exercise, it is oil.
- Keep a simple pain-and-load diary; patterns show up faster than you expect.
- Use a support or brace for a defined period, with a plan to wean off it.
Topical non-steroidal gels help many people with hands and knees and are easier on the stomach than tablets. If you have kidney disease, a history of ulcers, are on blood thinners or are pregnant, ask us first — even “over the counter” deserves a check. Oral painkillers are a bridge, not a strategy.
Book an assessment when…
- Swelling, redness or warmth persists more than a few days, or a joint fills up after minor strain.
- Morning stiffness regularly lasts a good while and improves as the day goes on.
- The joint locks, gives way, or you cannot fully straighten or lift against gravity.
- Night pain is now interrupting sleep for weeks on end.
- Several small joints of hands or feet are involved, especially with fatigue or unexplained weight loss.
- Pain followed a significant injury, or you are over a certain age and fell onto the hip or wrist — some fractures hide on early imaging.
- You have a diagnosed inflammatory condition, or a strong family history, and something has changed.
And go the same day for a jointly hot, swollen and severely painful joint with fever, a bite or break in the skin near it, or pain so intense you will not bear weight. Waiting on that combination is how small problems become operations.
What actually happens at the clinic
A good history and hands-on examination still out-perform casual imaging for most joint complaints. We test the movement, the strength, the load tolerance and the nerves, and we look at the joints above and below — hips present as knees far more often than patients expect.
Imaging is used when a result would change management: suspected fracture, inflammatory arthritis (with blood tests alongside), an injection that needs guidance, or pain that is not behaving as predicted. Please do not be annoyed if we decline an MRI for a straightforward ache — incidental findings on scans lead to more worry and more procedures, not faster recovery.
Strength is the treatment nobody cancels
Whether it is a knee with osteoarthritis, a shoulder with a cranky cuff or a hip that wakes you, the highest-evidence intervention remains progressive loading. Slow, monitored strength work reduces pain, improves function, protects cartilage and keeps people independent. It is also the thing almost everyone postpones, because joints hurt when they are weak and rest feels safer.
- Start with isometrics and short-range holds if movement is provocative.
- Add slow, controlled strength two or three times a week; soreness that settles within a day is acceptable, swelling that lasts two days is a signal to adjust.
- Progress load before you progress speed. Tendons like gradual, tendons hate surprises.
- Keep walking and sleeping well: pain thresholds are genuinely lower after a bad night, which is not a matter of attitude.
Three things worth forgetting
- “I am wearing my joints out.” Moderate activity does not cause osteoarthritis; sedentary life, excess load and prior injury are the stronger drivers.
- “Cartilage cannot be helped.” Symptoms, strength, weight and sleep are all modifiable, and most people who commit to that improve — whatever the X-ray says.
- “Injections fix it.” Steroid injections can buy a window of comfort worth using for rehab; they are not a long-term answer and repeated doses have costs.