Many people with persistent and painful joint issues search for solutions, and intermittent or chronic joint pains are common in people of many ages.

Common doesn’t mean simple, however. Joint health is a highly complex topic — it’s not like fat loss, which, although it can be complicated in practice, nonetheless has a basic formula that underlies any successful strategy: take in less energy than you expend.

To address joint pain, there’s no formula, and the “strategy” tends to look like more this: just keep trying. Don’t fall for “snake oil” or useless remedies — or at least not too often.

Joint pain can affect quality of life, but it’s possible to reduce joint pain, even if someone has “tried everything”, but it definitely helps to understand a bit about joint pain physiology and why the best treatment plans aren’t simple.

The reason that joint issues are so complex is quite interesting. There are many ways that joints can become damaged: by forcing past their range of motion (e.g., an ACL tear in the knee), by routinely perturbing their surroundings (e.g., by letting repetitive stress, positioning, or load compress one of the shoulder joints), or through more insidious processes (e.g., degradation due to aging, disease, or genetics). The multiplicity of possible causes, which often intersect and overlap, makes addressing joint pain difficult, as does the complexity of the joint tissue itself. The following highlights just a few components of articular cartilage:

What is cartilage

When joints are working smoothly, people don’t tend to notice or think about them at all. It’s only when they stop working well ​​— and continue to “not work” — that they become a persistent issue and a subject of persistent worry. And that’s where much of the problem lies.

Humans, with our relatively defenseless bodies, have a fairly robust alarm system that warns our big brains that the body is indirectly in danger (for our distant ancestors, a damaged joint could easily lead to danger or death). Pain is a helpful signal when it works correctly because it helps us live out our long human lifespans. Therefore, to ensure survival, the body can become “better and better” at experiencing pain; in other words, the nervous system lowers the threshold at which signals are interpreted as painful (through varied mechanisms, notably central sensitization^[1]).

Humans respond to pain much differently from most other mammals, which is why painkillers that work in animal studies often fail in human studies.^[2] In humans, there is a pretty clear dichotomy: acute pain (e.g., from overexertion at the gym) responds well to medication and other interventions but chronic pain (sadly) does not.^[3]

If that were the only sticking point, treatment for joint pain would be merely difficult — but joint-pain complexities don’t stop there. Why did Tiger Woods rack up so many injuries after his first one? Why do individuals often develop multiple chronic conditions, with triads such as arthritic joints plus fibromyalgia plus depression? Here are three common reasons:

• Fear of reinjury. If you get hurt, and your performance suffers (your lifts go down or race times get worse, etc.), a bunch of things can change at once.^[4] You start to compensate for the injured joint, you start to resent rehab and physical therapy, and if the pain doesn’t go away, you slowly start to shy away from physical activity. In other words, you begin a cycle in which other joints get injured and you become overall less fit.

• Sleep issues. For people who haven’t been sleeping well for months or even years, “sleep issues” is a grating euphemism. Pain can be a sleep bulldozer, with studies showing that over half of people with joint pain also suffer from disturbed sleep.^[5] Sleep problems tend to worsen with the severity of joint pain, so a nagging knee injury could be merely annoying, but severe knee arthritis could stop sleep in its tracks.^[6]

• The perfect storm. Let’s say you’re heading for the Olympics and aim to set up the optimal conditions to net you a gold medal. Everything you want to ensure (good sleep, support from family and friends, mental and physical well-being) is the opposite of what you’ll get with chronic joint pain. Disturbed sleep is often the catalyst of this perfect storm.^[7] For example, you wake up tired, your pain sensitivity is higher, your family and friends can’t relate to you and sometimes get secretly annoyed, and your body feels less than ready to perform. If this cycle repeats for a few days, it’s hard to climb out of the pain hole.

We’ve established that having chronic joint pain means turning into Sisyphus: you keep trying to roll that pain boulder up the hill, but it’s too heavy. Disturbed sleep, failed treatments, fat gain and muscle loss — these factors are hard to overcome.

Luckily, thousands of studies have been conducted on joint pain. Before distilling them into tips, however, let’s review three very important points.

First, remember that no single study will be the silver bullet that eliminates pain. There are so many different causes for joint pain, and only “snake oil” therapies claim to address them all. In fact, the term snake oil was originally used to describe a literal snake oil therapy for joint pain used in Traditional Chinese Medicine (TCM).

Second, remember that any given individual will not see immediate benefits from most therapies. Joint pain takes a while to resolve, and “a while” could range from a couple of weeks to many months. Also, different people respond differently to the same treatment because human bodies are highly variable and highly complex.

Third, remember that the benefits that any individual experiences might be difficult to assess. Pain management isn’t like muscle gain or fat loss, where one can track pounds or see those biceps veins become more prominent; there is no easy way to quantify pain, and some days will be worse than others due to mysterious factors.

And now onto the “tips” (a term which greatly undersells what they are — they should instead be called Very Important Pointers That Will Help If You Follow Them).

• Follow the sun. No huge randomized trial has been conducted on the effect of sun exposure on pain — or on any other condition, for that matter. There’s simply no financial incentive because the sun can’t be patented. That said, circadian rhythm may be the most important factor in treating pain. Sunlight may decrease pain after joint surgery,^[8] and UV tanning beds have been shown to decrease pain from fibromyalgia.^[9] These clues are just two out of many that point to a simple message: get as much natural light as possible during the day and as little artificial bright light as you can at night.
• Maintain a healthy weight. This one especially matters for knee pain. During walking, each 0.5 kg (1 lb) of excess weight has the effect of about 1.8 kg (4 lb) of extra load on the knees. If a person is just 4.5 kg (10 lb) overweight, that’s 18 kg (40 lb) of extra load per step — and 21,772 kg (48,000 lb) of cumulative load per 1.6 km (1 mile, assuming 1,200 steps).^[10]
• Train the brain. It may seem that the pain is in the knee, but it’s not. It’s also in the brain and nervous system. Signals going up to the brain and back down to the joint modify what a person feels, so that a damaged joint that is painful to one person may hardly be felt by another.^[11] Although it’s not possible to “think away” joint pain, mindfulness meditation appears to reduce pain.^[12] It may sound hokey, but something as minor as reframing might train the brain to perceive pain differently.
• Help your gut bacteria help you. No probiotic has ever been shown to universally relieve pain, probably because different people have such different microbiomes and because there’s only so much one single strain can do when living among the hundreds of others in the gut. Still, certain bacterial strains have shown benefit for specific painful conditions such as rheumatoid arthritis.^[13] Supplementing with probiotics matters less than general care of the gut though, like avoiding too much processed junk food.^[14][15] By decreasing the chance of activating the immune system inappropriately, a happy gut microbiome leads to less pain over time.

Pain science undergoes major new developments seemingly every few months. Nevertheless, chronic pain not only persists, but more and more people have joint pain each year. Don’t fall for the common trap of trying quick fix after quick fix and wasting a lot of money along the way.

A wise strategy for dealing with recalcitrant joint pain is to act slowly and mindfully: figure out which treatments are most likely to net some benefit, pick a couple, and stick with them for at least a few weeks. It’s easy to try some hyped-up treatment and then be disappointed when it doesn’t work. It’s harder to try, over weeks and months, to soothe the brain and gut, get more sunshine, and take just a supplement or two from those presented in this guide. But joint pain is a unique enemy, and to combat it, a uniquely wise strategy is needed. Best of luck.

Kamal Patel, Co-founder and Director
MBA, MPH, PhD(c) in Nutrition