Pain is your body’s way of getting your attention.
It’s your own internal smoke alarm or “Check Engine” light. You shouldn’t ignore it any more than you’d ignore a warning about your car or home.
All three of these warnings can go unheeded for a time. But sooner or later, your car will quit running, your house may be filled with smoke and that dull, occasional ache in your knee will have become debilitating.
Dr. Payton Fennell of Novant Health Orthopedics & Sports Medicine - Cotswold (and senior medical director at Novant Health Sports Medicine in Charlotte) sees cases like this daily. And he hates telling those patients that their delay means they now need a more invasive, extensive treatment than they would have otherwise.
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Read highlights from our conversation below.
What are some joint pain conditions that somebody could possibly ignore only to have them get worse?
Any painful condition that doesn’t stem from a specific injury.
If you fall and break something, that's an injury you’ll address immediately. But if there’s pain you experience when doing something repetitive — a dull ache that lingers for a time — that’s something you could ignore. That is, until you realize it’s not going away and is only getting worse.
When should you see a doctor for joint pain?
If the pain persists for more than four weeks, it’s time to get the condition looked at.
And the pain doesn’t have to be constant. Even intermittent pain that goes on for longer than four weeks when doing a certain activity should be examined. Let’s say I'm reaching into the refrigerator for something and notice that when I pick it up, it hurts a little bit. That’s the kind of pain I’m talking about.
Is it OK to start with your primary care doctor for joint pain?
Yes, start with a physician you trust and have a relationship with.
How does delaying treatment impact the health of the joint and recovery?
If you delay treatment when something’s hurting, your body will compensate for that pain, which works great in the short term. It could lull you into thinking you don’t need to seek medical care.
But in the long term, it can lead to significant problems. What started as one simple pain can turn into multiple pains because the body is being used in a way it isn’t normally used. By delaying care, you can cause a small problem to become a lot bigger — possibly even one that requires surgery. Plus, as we age, our bodies don’t heal themselves as easily as they once did.
Are there any specific joint injuries where timing is critical?
Time is critical for anything you suspect could be a fracture or anything that leads to an inability to bear weight. If you have trouble walking or using your hands and feet in any way, you should seek medical attention right away.
What issues do you see most often in patients who've waited too long to treat joint pain?
For non-traumatic ones, I see tendinopathy, which is chronic inflammation of a tendon. (A tendon is what connects muscle to bone.)
Our bodies are good at healing some minor injuries on their own. But over time, the body doesn't know how to repair an injury that’s been going on too long. So, instead of developing good, normal tendon tissue, your body develops scar tissue, and it’s not nearly as strong as normal tissue. Because of that, you’re more prone to re-injuring this area, sometimes with even the slightest motion.
Is there a point at which joint damage becomes irreversible?
Yes. When you have truly full-thickness tearing to a tendon or a ligament, you can develop arthritis. That’s why it’s so important to address joint pain when it first starts hurting rather than waiting and hoping it’ll get better.
Is there any joint pain that actually does get better on its own?
Very mild muscle pulls can get better on their own, but it’s hard for most people to recognize what’s mild and what’s not.
With almost any injury, medical intervention can speed up the healing process. A doctor can advise you on the correct way to limit motion so that you can, hopefully, continue to do close to 95% of what you want to do while continuing to get better.
When we intervene early, you can generally ride the wave of your body's natural healing abilities. When you wait and it becomes more of a chronic issue, your body has shut that down. It doesn’t understand that it needs to continue to try to heal itself. It thinks it already has.
How often do you see patients who’ve finally come in because the pain became unbearable? Weekly?
And I imagine there's some regret that goes along with waiting too long?
There is. I can't tell you how many times I've heard, “I did this while playing football in high school,” and they’re in their 50s with significant arthritis. They tell me they thought they had to live with pain — that it was just the cost of being a high school or college athlete.
It’s hard to tell them, “You didn't have to live with pain, but now you're going to need a knee replacement because it's significantly arthritic.”
If they’d come in sooner, there would’ve been less invasive things we could’ve done. Recently, I had a middle-aged patient who’d played sports most of his life come to my office. He’d been having pain in his Achilles tendon for months, and it was progressively getting worse. But he continued to play through it until one day the tendon ruptured, which led to him needing surgery followed by extensive physical therapy and rehabilitation. He couldn’t walk for eight to 12 weeks.
An Achilles tendon tear sounds painful.
It is very painful. People report hearing a significantly loud pop. Many people say they thought they’d “been shot” or “a rubber band snapped” in the back of the leg. Once they realize they weren't hit, they discover they have a difficult time pushing their foot down.
What hidden or intangible costs are there to delaying care for joint pain?
It depends on the problem, but most people who have surgery will be taking two to three months off work and then a portion of the next two to three months will be spent in rehab.
And if you’re already retired, that’s still several months you’re not playing with your grandkids or doing other things you enjoy.
Anything else you want to share?
If there’s trauma involved — meaning, a specific, recent injury — you really need to be seen right away. Traumatic injuries cannot wait. When there isn’t trauma, and the pain doesn’t stem from a specific injury, you may be OK waiting a couple of weeks. But not months.
And although I do see lots of athletes, it’s not just athletes this advice applies to. Anyone can injure themselves doing anything. You don't have to be playing football or running a marathon.
The point I want to stress is: It’s really best not to wait.
