WHAT YOUR DOCTOR NEVER TOLD YOU ABOUT ARTHRITIS
During a routine visit for shoulder pain, your doctor considers a range of possible causes. He asks if you’ve had a recent fall and how old you are, noting that some people in their 40s can have arthritis too. You don’t think you fell, and you know you exercise, though it hurts when you bench press or press a shoulder weight. The doctor suggests that heavy lifting can raise the risk of injury and mentions trying a lighter routine like 20 minutes of stationary biking each day, which you view with skepticism.
A quick exam is done. He doesn’t find signs of a rotator cuff tear or instability, and your range of motion is still pretty normal, so a frozen shoulder diagnosis is ruled out. He proposes an X-ray to check for bone spurs or arthritis.
The X-ray shows arthritis in your shoulder. He explains this could be part of the reason for the pain and suggests a few options: anti-inflammatory medicines, continuing exercise, and a set of shoulder-strengthening exercises. If the pain doesn’t improve, an injection of cortisone might be tried.
You worry a bit. You already work your shoulders, so you wonder if you’re weak or if you’ll be on anti-inflammatories for life. The thought of losing the simple joy of lifting, the pride in your workouts, and the ease of doing moves you used to enjoy begins to weigh on you.
A random voice then chimes in with a different perspective, offering to share a few facts about arthritis to help you avoid giving up on activity.
WHAT IS ARTHRITIS AND WHAT DOES THIS MEAN FOR ME?
Osteoarthritis is the most common form of arthritis and is often called “wear and tear” arthritis. That label helps, but it doesn’t tell the whole story. Being able to lift and move can sometimes be linked to more arthritis than just staying still on a bike all day.
Research shows that a sedentary person who is obese may have more arthritis than someone who runs for life, on and off the treadmill. Arthritis comes from inflammation around the joint, and inflammation is the body’s way of healing tissue. But if blood flow to joints and cartilage is not ideal, the inflammation can lead to wear and tear. Many factors contribute to arthritis, including aging, weight, diet, gender, prior injuries, and your natural anatomy.
Arthritis is not a “get out of jail free card” for every pain. When you show up with pain but no recent trauma, doctors still use imaging to check the joint. It’s possible to have arthritis on an image and still have little or no pain. Pain does not always track with what the scans show. In fact, studies have found that many people with spine degeneration on imaging report no pain, while pain tends to rise and fall with other factors.
The brain decides how much pain you feel. In some cases, even people who have lost a limb due to autoimmune disease continue to feel stiffness in a limb that’s no longer there—a reminder that pain can be tied to the brain and nerves as well as to the joint itself. Part of what we do in pain management and physical therapy is help calm the nervous system and teach patients how pain really works. This can involve methods like graded movement and education about pain.
We should approach arthritis with curiosity rather than fear. Instead of assuming arthritis will ruin your life, consider other possible causes of pain and look for practical steps you can take. You may wonder how severe things will be in ten years, or if you should quit the gym. In truth, addressing the simple, everyday factors can make a big difference: sensible training, proper technique, and attention to mobility.
OTHER WAYS TO REDUCE INFLAMMATION
Diet
Sleep
Exercise
Stress, both physical and emotional
When one area is neglected, inflammation in the joints can rise and contribute to pain. We tend to know which foods can worsen inflammation (like refined breads, pastas, dairy, sugar, and red meat), but the key is to lose excess weight, cut back on alcohol, avoid smoking, and keep a steady exercise routine with good programming and proper technique.
Some people consider supplements, but you should talk to your doctor before starting any vitamin or herbal regimen. More is not always better, and taking too much of one vitamin can be harmful or interfere with others. Vitamin D, for example, has been linked to levels of disability in obese people with knee arthritis; getting the right levels matters, but supplements aren’t a cure-all.
IF YOU’RE ALREADY LIVING WELL AND THE PAIN STILL LIVES ON
Muscle and tissue around the joint can drive a lot of pain. Reducing inflammation, easing stress, improving sleep, and refining your diet can help, but you may also need hands-on care. There is overlap among massage therapy, physical therapy, chiropractic work, and acupuncture, and many clinicians use similar approaches to treat muscles and joints. Treatments can include soft tissue work, joint mobilization, and other modalities, along with targeted exercise.
WHAT TO DO IF CONSERVATIVE CARE DOESN’T HELP
If you’ve already tried conservative care, a medical specialist—such as an orthopedic or sports medicine doctor—may evaluate you. They’ll likely order imaging tests like X-rays, ultrasound, or MRI to see what’s really going on. It’s important to remember that findings like degeneration or small tears don’t automatically mean you need surgery. Many people have changes on imaging without pain, and pain isn’t always caused by what you see on the scan.
A few well-known statistics to keep in mind:
– Many people over 70 have rotator cuff changes without pain.
– A large share of knee arthritis patients report no pain.
– Some athletes have MRI-detectable abnormalities without symptoms.
SHOULD YOU TRY A CORTISONE INJECTION?
Cortisone injections are commonly used for shoulder problems. They can reduce joint inflammation and pain, but they’re not a universal fix. Too much cortisone, or injecting too often, can weaken tissues and potentially cause other problems. It’s best to weigh the benefits with your doctor and consider how long you want relief and what other treatments you’ve tried.
SHOULD YOU TAKE ANTI-INFLAMMATORY MEDICINES?
NSAIDs can lower local inflammation and help with pain, but they carry risks—gas and stomach issues, kidney problems, high blood pressure, fluid retention, and skin reactions, among others. They’re not meant for long-term use without a doctor’s guidance.
DOES A HOME EXERCISE PLAN WORK?
Movement is often helpful, as “motion is lotion.” Gentle, non-painful movement can increase blood flow and reduce inflammation. Exercises should be chosen carefully, and you shouldn’t push through sharp or increasing pain. A thoughtful, progressive plan tailored to your shoulder can make a big difference.
OVERVIEW
Arthritis is not a death sentence. It doesn’t automatically mean you must rely on stationary biking or aquatic therapy forever. Arthritis is a common part of aging, much like wrinkles. Before you blame pain on arthritis, consider other factors you may be missing. Sometimes a second set of eyes at the gym or a clinician who focuses on soft tissue and joint mobilization can help you move better and feel better.
LOW HANGING FRUIT FOR RELIEF
– Your weight
– Your diet
– Your sleep
– Your exercise program (how you train and how you move)
– Your self-care and mobility work
– Your stress levels
ABOUT THE AUTHOR
Dr. Michael Infantino is a physical therapist who works with active military members in the DMV area. He shares more articles at RehabRenegade.com.
