Non-surgical joint treatment Gilbert: plain help for soreness

Wear, strain and old injuries cause many familiar aches

Arthritis often brings stiffness after rest and aching after longer use. A strained tendon may hurt during one certain reach, step or lift. An old injury can leave weakness that makes normal work harder. Swelling may come and go after a full day.

A sudden sharp change is different from the usual steady ache.

Notice where your soreness sits and which movement starts it. Also note swelling, catching, weakness or sleep lost to the ache. These details give the doctor a place to begin the exam. Pain near a joint can also come from a nearby muscle or tendon.

A lighter day and gentle movement can ease familiar soreness

Too much rest can add stiffness, while hard activity may keep the joint sore. Try a shorter walk, fewer games or less yard work. Heat or cold may ease an ache you've felt before. A cane or brace fitted well may also take some work off the joint.

The right amount lets you move as usual the next morning.

Mild soreness may be acceptable when it settles by bedtime or morning. Cut back if you limp, lose sleep or wake with more swelling. Pain medicines aren't safe for everyone. Check with a doctor or pharmacist before adding one, especially with kidney, stomach or heart trouble.

An exam shows when home care isn't enough

At the visit, point to where you hurt and show which movements bring soreness. During the exam, a doctor tests how far the joint moves, its strength and any swelling. The doctor also watches you walk or reach. An X-ray may help when arthritis or an old injury seems likely. Every sore joint doesn't need one.

Before leaving, ask when the joint should be checked again.

Prompt care is needed for a hot, red joint, fever or sudden loss of use. New weakness, a locked joint or fast swelling also needs attention. Call a doctor the same day for those signs. After an injury, seek urgent care if the joint looks bent or won't hold weight.

Sources

1. The Cochrane review of land-based therapeutic exercise for knee osteoarthritis extracted data from 54 randomised trials, assessing pain, physical function and quality of life immediately after treatment and the sustained effect at 2-6 months and beyond 6 months. Only 19 of the included studies (20%) met all three low-risk-of-bias criteria the authors applied.

   Fransen M, McConnell S, Harmer AR, et al. — Exercise for osteoarthritis of the knee.. Cochrane Database of Systematic Reviews, 2015. DOI: 10.1002/14651858.CD004376.pub3.

2. A systematic review and meta-analysis of 120 randomised trials (10,253 participants) covering resistance training across the knee osteoarthritis continuum - 88 trials in early OA, 13 preoperative, 19 after knee replacement - found improvements in mobility, walking capacity and knee extension strength in early OA (SMD 0.46-0.81, moderate-to-high GRADE), in preoperative knee extension strength (SMD 0.47, high GRADE) and in mobility after knee replacement (SMD 0.58). Resistance training improved pain, symptoms, function and quality of life in early OA but showed NO significant effect on those outcomes preoperatively, with no increased risk versus controls at any stage.

   Brown RCC, Mora-Traverso M, Fernández-González M, et al. — Efficacy and safety of resistance training for knee osteoarthritis and subsequent knee replacement: A systematic review and meta-analysis.. Annals of Physical and Rehabilitation Medicine, 2026. DOI: 10.1016/j.rehab.2026.102122.

3. A 2021 JAMA review states that osteoarthritis affects an estimated 240 million people worldwide including more than 32 million in the US, that 33% of people older than 75 have symptomatic and radiographic knee OA, that diagnosis is clinical despite widespread overuse of imaging, that people with OA are more sedentary and carry a 20% higher age-adjusted mortality, and that the cornerstones of management are exercise, weight loss where appropriate and education, complemented by topical or oral NSAIDs, with opiates to be avoided.

   Katz JN, Arant KR, Loeser RF. — Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review.. JAMA, 2021. DOI: 10.1001/jama.2020.22171.

4. OARSI 2019 designates arthritis education plus structured land-based exercise (with or without dietary weight management) as CORE treatments for knee OA, and education plus structured land-based exercise as core for hip and polyarticular OA. Topical NSAIDs are strongly recommended for knee OA (Level 1A). Intra-articular corticosteroids and hyaluronic acid are Level 1B/2 for knee OA depending on comorbidity and are NOT recommended for hip or polyarticular OA. Oral NSAIDs are not recommended for people with cardiovascular comorbidity or frailty, and oral and transdermal opioids are strongly not recommended (Level 5).

   Bannuru RR, Osani MC, Vaysbrot EE, et al. — OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.. Osteoarthritis and Cartilage, 2019. DOI: 10.1016/j.joca.2019.06.011.

5. In the only randomised controlled trial to compare total knee replacement directly with non-surgical treatment in patients already eligible for surgery (n=100), the replacement group improved more at 12 months than the non-surgical group (KOOS4 32.5 vs 16.0; adjusted mean difference 15.8, 95% CI 10.0 to 21.5) but had four times the serious adverse events (24 vs 6, P=0.005). Only 13 of 50 patients (26%) assigned to non-surgical treatment alone had undergone knee replacement by 12 months.

   Skou ST, Roos EM, Laursen MB, et al. — A Randomized, Controlled Trial of Total Knee Replacement.. New England Journal of Medicine, 2015. DOI: 10.1056/NEJMoa1505467.