PODCAST: What to Do When Your Joints Are Starting to Hurt

ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore. I’m a photographer and editor here, and I’m also a long-time podcaster.

KATIE MCCALLUM: I’m Katie McCallum. Former researcher, turned health writer, mostly writing for our blogs.

TODD ACKERMAN: I’m Todd Ackerman. I’m a former medical reporter, currently an editor at Houston Methodist.

KIM RIVERA HUSTON-WEBER: I’m Kim Rivera Huston-Weber and I’m a writer here at Houston Methodist.

ZACH: Katie, how often do you stretch?

KATIE: I actually stretch a lot, which I don’t know if that was the answer you were expecting. But I have a reason that I stretch pretty often.

ZACH: Why is that?

KATIE: ‘Cause I often suffer from joint pain and if I don’t keep up with my stretch routine, I do find -- I know this may be debatable, but I do find that if I don’t stretch, you know, probably two or three times a week, especially if, like, I haven’t really worked out on a day, like, I need to at least stretch so I don’t, you know, can get myself so I’m not so tight. I find that, like, typically it’s my knees. My knees are, like, achy the next, like, week if I get out of my stretch routine. I’m -- I mean, anyone else stretch this much? I’m guessing I’m in the minority here.

TOOD: Yeah, I’m not a stretcher.

KATIE: Yeah, that doesn’t surprise me.

[Laughing]

Kim, come on, do you stretch? Help me out.

KIM: I wanna affirm you, but I’m gonna have to tell you, at the end of my workouts when the instructor, like, “Make sure you get a good stretch in,” I’m off that bike, I am doing something else, I’m getting a glass of water, I’m sitting in front of a fan, I am not stretching, so I’m not a good help.

TODD: I will admit that I’m not a stretcher if that makes you feel better. But I just don’t have the patience for it.

KATIE: Well, that used to be me, Kim, and then I, kinda, just have, like, accrued these years of, like, achy knees or, like, all of a sudden my shoulder’s bothering and my neck or my lower back. And so, somewhere along the way, I’ve, kinda, like, tried everything and stretching is -- This is the thing, I don’t know what’s actually helping ‘cause I do a bunch of stuff. But I’m in the stretching routine now and I think that’s better than not being in one for myself.

ZACH: I am not into stretching. Does that surprise you?

KATIE: No, I, kinda, like -- I mean, look, I know a lot of people don’t stretch ‘cause, like, look, I didn’t use to either, so, I mean, like, it’s not -- It’s something I have forced --- Literally forced myself to do, so I’m not surprised that.

ZACH: Well, my wife, she stretches before bed, when she gets up, she’s like, “I gotta stretch,” I’m like, “Okay.”

KATIE: It’s a good habit, it’s a great habit.

ZACH: Well, she’s sore all the time so -- I think this podcast will be very helpful to her.

KATIE: Okay, yeah. I was gonna say me and Sarah got some stuff to talk about.

ZACH: Yeah, because, yeah, I’m like, “Well, I’m not sore and I don’t stretch,” so, I’m, like, “Let’s talk about it.”

KATIE: And I think that’s, you know, and we’re gonna get into all this today, but I think that’s, kinda, the prevailing theme of there are all these different things you can do to prevent joint pain, but if you don’t have any, you don’t probably need to be doing them. And that’s debatable whether some of these different things actually help with joint pain. What were you gonna say, Todd?

TODD: Oh, I was gonna say do you work out? Yeah, you do.

ZACH: You gotta stretch before that. You gotta warm up some.

TODD: You do stretch then?

ZACH: Well, of course.

TODD: Okay, but you were saying, like, you never -- You never feel the need to stretch, you’re never tight, usually that --

ZACH: I stay loose, man. I stay loose.

[Laughing]

TODD: Okay.

ZACH: Yeah, no, I warm up before I’m, like, gonna go exercise ‘cause that’s just foolish --

KATIE: A lot of people don’t warm up either is what I was gonna say.

ZACH: No offence to you, you don’t, but you should.

KATIE: Yeah, yeah, I agree.

ZACH: It makes a difference.

KATIE: Oh, it makes a huge difference.

TODD: You can warm up with, like, light exercises opposed to stretching. I think there’s some debate now, isn’t there? About whether stretching is that necessary?

KATIE: We’re gonna get into that a little bit. Today, we’re talking, if you haven’t guessed, we’re talking about joint pain and things you can do to mitigate joint pain if you get it often, prevent it if you haven’t had it, but you’re heading into those years of your life like me where it’s all of a sudden piling on. And we’re talking to two different people today, we’re gonna start though with one of our Sports Med doctors, Dr. Scott Rand.

[Sound effect signaling beginning of interview]

KATIE: We’re here with Dr. Scott Rand, sports medicine doctor at Houston Methodist, thanks for being here with us today.

DR. SCOTT RAND: Thank you so much for inviting me.

KATIE: I consider myself to be a pretty achy person I would say. I’ve dealt with joint pain for a while now. It’s, kinda, one of my chief complaints about my health because I’m a pretty active person, I like to be active, I like to work out most days of the week. I love, just, going to play basketball on the weekends. When we go on vacation, we’re hiking and we’re doing things like that. So, I have joint pain, I would say, fairly often enough that it bothers me quite a bit and so this is a topic today that’s near and dear to my heart. I know I’m not the only one dealing with this, it’s probably something that spans all ages, we could get into all that. But I would say my personal, sort of, demon is knee pain. I have things that I think I know trigger it, it’s, kinda, just spanned several years for me. What are some of the other joints that you often see people in the clinic for when it comes to pain?

DR. RAND: So, we see patients with virtually every joint pain, you know? You know, back pain is one of the most common things that people come to the doctor for. In the athletic population we deal with, often their joint, or muscle, or tendon complaint relates to whatever sport they do. Typically, runners will have problems from the waist down, they’ll have very predictable injuries or problems that usually as they start running, start at their ankles and sort of work their way up. Weightlifters, tennis players, overhead athletes like swimmers, basketball players, volleyball players will have fairly predictable shoulder pains. Most of them are related to overuse and I tend to think of things in, sort of, bigger picture things. When I talk to my fellows or when I talk to patients and I explain how I think about this stuff, I think about, “Okay, is this pain you earned or pain you didn’t earn? Did you do something to cause this pain, was there an injury, or are you doing too much too soon, and it’s caused you to develop an overuse injury? Or did you just wake up with this pain? And then when you just wake up with pain for no good reason, that, kinda, changes the things I think about and things I worry about for what’s causing it.

KATIE: And getting into -- You know, you mentioned overuse and one thing that’s been perplexing to me, I would say, is that I do think a lot of my pain is probably overuse at the end of the day. What are the range of causes that you would say for achy joints? So, I wake up in the morning and my knee’s pretty stiff. Did I work out too much the day before? Like, what are those reasons that that might be the case?

DR. RAND: So, it’s important to define what that means for people and if you wake up in the morning and your hands are stiff and your wrists are stiff and you haven’t -- Takes a couple hours to get to where you can make a good grip, then you worry about some of the things like some of the auto immune arthritis problems. Rheumatoid Arthritis classically has morning stiffness as a symptom. If your knees are stiff, then it’s important to, kinda, define what that stiffness means. Are they stiff because there’s fluid in the joint? Is it stiff because the tendons and the muscles around the joint have become tight as they, sort of, repair from the exercise you did the day before? That’s how we, sort of, approach that and look at it. So, understanding the why of where that stiffness comes from or what you exactly mean by stiffness just, sort of, guides what we do for you.

KATIE: To that point, joint pain, it’s not necessarily serious acutely, is that correct? Like, I don’t need to go to the doctor immediately if I’m experiencing joint pain. I mean, as someone who has it a lot, I’m assuming I’m okay trying to deal with it. Maybe we’re saying when is joint pain something more just so we can, kinda, clear the air on that in the sense of if you’re feeling pain, something not to ignore, what would be those signs?

DR. RAND: Joint pain that affects function is usually something to pay attention to. If you wake up in the morning and your knee hurts but ten steps into your gait, you’re walking normally and it doesn’t limit your gait, doesn’t make you change what you do, you live with that. You know, there -- I’m a big fan of “It’ll go away.” And sometimes going to the doctor for things gets you overtreated with medications you don’t necessarily need or activity restrictions that aren’t really good for you. So, my threshold for going to the doctor is does the pain you’re having limit your function, or was there an acute injury that significantly caused you to not be able to do something? Did you fall and break your elbow? Did you trip and twist your knee? Did you land and feel a pop and then have all of a sudden, swelling your knee? Those pains that are severe or affect your function for more than just a little while are the things I’d say, yeah, needs to go to the doctor.

KATIE: Got ya.

DR. RAND: And the other part is if it’s just been going on so long and you’re just tired of putting up with it and what -- Whatever you are having is going away. When I talk to patients with knee arthritis, I tell ‘em, “I’m not gonna make your arthritis go away, but we need to get to a point where your arthritis doesn’t limit what you do.” You don’t make decisions on what you do during the day based on whether or not your knee will let you. If you’re at that point where your knee or your shoulder or your back are keeping you from doing things you wanna do, go to the doctor.

KATIE: Yeah, I think that’s an interesting point because it’s one of the, sort of, parts of my personal journey with -- I keep bringing this back to myself, sorry. But my personal journey is that I -- the movement aspect is what confuses me a lot because like you’ve mentioned overuse. You know, let’s say I work out five days in a row, I’m usually fine, I’ll go months without knee pain, just for some context, I usually do a lot of, like, body weight circuits and stuff like that, and I let my app, kinda, just build my body weight circuit for me. Every now and then, jumping jacks will pop in there and I have seen that as a trigger in the past, but when I have had knee pain for a couple months, I’m like, “Yeah, I’ll do ‘em.” But then the next day, I’m like, “Here’s the knee pain.” How do you know when it’s, like, let me just stop doing jumping jacks forever or is this something I can fix so that I can do jumping jacks in the future?

DR. RAND: Usually, that’s something that you can fix. Everything, kinda, depends on where it hurts and when it hurts. So, if you do jumping jacks, and you notice the next day that the outside part of your knee hurts and that’s most likely the place…

KATIE: Yes, it is.

DR. RAND: That’s usually a problem called Iliotibial band syndrome and it happens because as you land on that leg, the extra rotators in your hip have to fire to keep your knee from falling in. When those aren’t tight enough or aren’t strong enough to absorb that, then your IT band, or a muscle called the tensor fasciae latae that starts at your top of your hip bone and, kinda, goes down to your knee, has to be overused and it gets tight then the place where it crosses your knee gets real sore. Okay? So, the fix for your knee is actually not in your knee, the fix for your knee is up in your hip and exercises that strengthen those external rotators, keep you from having problems with your knee down the road.

KATIE: Got you. That’s always such a weird concept to me that where you’re feeling the pain is not necessarily where the problem is. I’m sure it’s true all over the body but, like, joint pain for sure seems to be, like, the classic example of that.

DR. RAND: Yeah, the idea is victims and culprits.

[Laughing]

Okay? The -- It very commonly, especially with anterior knee pain, the knee is the victim, the culprit is very commonly up in the hip or down in the foot.

KATIE: Okay, got ya. The other side of movement, kinda, confuses me too, though because, you know, my knee pain seems to be triggered by overuse but then, let’s say, you know, I’m on a flight, we’re going on vacation, I’m on a flight for three and a half, four hours, when I get up, like, that first couple of steps I’m just like, “Oh my gosh, this is so stiff.” And like, I haven’t really had trouble with my knee lately, so, the lack of movement is that also some here -- In here somewhere with knee pain, I’m thinking -- or just sorry, joint pain. ‘Cause I’m thinking of people who -- I’m really active but I’m sure people who aren’t super active also have joint pain, so is it inactivity just as much?

DR. RAND: So, that holding still for a long time, for any of us, when you’re over thirty and sorry, it doesn’t get better.

KATIE: I know.

DR. RAND: It’s that immobility, that sitting still for a long time, we call it the theatre sign. If you have to sit for three hours and watch a movie or be on a flight or sit at your desk and do work, that causes some kind of constant pressure between the underside of your kneecap and where it hits against the bottom of your thigh bone. If you do that for 15 minutes, nobody cares, you do it for a longer period of time like that, you get some inflammation, it gets really complicated, but it’s that function right there at that anterior part of the knee that develops that pain. It’s normal, you get up and move around. If it bugs you a lot, you take an anti-inflammatory medicine or some Tylenol. It’s nothing you should have to take all the time, but it’s a common, normal pain.

KATIE: Yeah. I’m glad you mentioned pain relievers, I wanna get to that. But before we do real quick, you did mention knee arthritis at some point. How does someone know if it’s joint pain caused by overuse or joint pain caused by arthritis and you do need something like a pain reliever at that point every now and then?

DR. RAND: There’s a big overlap, obviously. And any kind of knee pain can be related to arthritis. A lot of times, I always have young people come in and say, “I have arthritis,” and they really don’t. Arthritis means there is inflammation inside the joint and usually it goes along with joint damage, damage to the cartilage. And it starts in some people earlier and some people later. It’s not caused by activity. Okay? That’s an important point. I have a lot of people come in and say, “I had to quit running because I didn’t want to get any arthritis.” That’s absolutely false. We know that people who run have statistically less arthritis than people who don’t. The thing that causes knee arthritis is genetics and big injury. Okay? So, if you’ve torn your ACL, you’re gonna get knee arthritis. If both of your parents had knee arthritis, you’re gonna get knee arthritis.

KATIE: Got ya.

DR. RAND: Picking your parents is important. So, knee arthritis is managed like many overused things, it’s consistent activity, sometimes not doing too much too soon, and what we find is that what flares knee arthritis or other things is novel activity. If you block stairs and you do things and your knees don’t bother you, but then all of a sudden, you decide to go to the beach and walk four miles on the beach and you don’t do what you normally did, your knees don’t tolerate that, and they’ll get inflamed. They’ll get sore, they’ll get swollen. And it’s that swelling inside the joint that’s usually a sign of cartilage damage or arthritis.

KATIE: That explains a lot to be honest. Because sometimes I feel like I am just more prone to this knee pain, whether I am prone or not staying active, I think I clearly have decided is helpful. But what you just said, doing something novel or new. For instance, we hike a lot. I say, when we go on vacations we hike, but in Houston, we don’t hike a lot, so I’ll go from, you know, no real incline miles to, “Let’s do a 12 mile hike,” and then surprise, surprise, I am in serious pain the next couple of days for a few weeks. So, I think that piece of it maybe is the bit I’m missing. I’m so excited to talk to you, like, I just haven’t been managing my joint pain very well, I don’t think. I’ve come to see sports medicine doctors, I even dabbled in physical therapy but I’m now mid 30’s at the point where I think about it a lot and I’m ready to just, like, rain it in and be, like, everything I can do, I wanna do, ‘cause I guess I wanna be active, to that point. You, kinda, mentioned pain relievers, I’ve read a lot of the different, sort of strategies to help relieve joint pain all the way from ice packs after exercising to, you know, maybe wearing a knee sleeve or some other type of brace in different -- Depending what your joint pain is. In your mind, I know it can vary by joint, but what are some of the key, like, best strategies for relieving joint pain once it’s started?

DR. RAND: Some of it is just living with it and realizing sometimes things hurt and that you’ll get over it. It’s sort of the American way to have a pill for everything. We don’t necessarily have to do that. You know, sometimes stuff hurts and it’s okay and there’s evidence that you know, like ice packs, although they may be nice pain relievers, the decreased blood flow to an area and -- May limit that healing inflammatory response that we’re supposed to have. There’s argument about that both ways. In general, I tend to tell athletes to ice things that hurt after exercise but there’s evidence to say that maybe we shouldn’t do that. So, there’s no perfect answer, just do what works best for you. From a physical standpoint, it is, don’t do too much too soon, concentrate on your kinetic chain, make sure that if you do get knee pain, if you’re doing a bunch of hiking, prepare for that by doing glute strengthening exercises. The stronger you are, typically the less joint pain you have. Okay? Specific to the knees, the stronger you are -- Stronger you are in your gluteus muscles and in your quads, the less knee problem you’ll have. If you’re gonna do something topically, Diclofenac gel is a good choice. It’s recently gone over the counter, very safe and effective for the majority of joint aches. There’s a lot of other topical things that are out there that people use for muscle aches and joint pains. Most of them are skin irritants. Icy Hot.

KATIE: That’s my problem, I have really sensitive skin and I cannot use Icy Hot, it is -- It’s worse than the joint pain.

DR. RAND: What they do is they irritate the skin to increase blood flow and they decrease pain by doing that. You know, they’re all the same. They have different names, but they all do about the same thing. So, if you want to use them, they’re fine. They’re a symptom treatment, they don’t cure anything. There’s actually, over the last few years, some pretty good evidence that CBD cream helps with muscle aches and joint pains and good level one evidence, as in, it makes a difference. Doesn’t help everybody but is worth a try. If you’re going to go to medications, American College of Rheumatology first line recommends topical, like diclofenac gel, but then after that is Tylenol or acetaminophen. It’s very safe to take up to 3,000 milligrams of acetaminophen a day. So, if I have somebody who’s having pain, I tell ‘em that taking two extra strength acetaminophen three times a way, is a very safe and very effective thing for a lot of people. The anti-inflammatory medicines, whether they’re over the counter or by prescription, all work about the same way. They decrease inflammation and decrease pain. They’re hard on the stomach and hard on the kidneys. So, you shouldn’t live with it. You being basically a healthy 30 year old, you’re fine. Take some ibuprofen if you’re hurt, you’re fine. If you have to live on it then or if you have some other chronic medical conditions that make anti-inflammatories not safe for you, then you wanna be much more careful about that. But any pill you’re taking, whether it’s over the counter or by prescription, if you’re having to take it every day to function normally, it’s time to go to the doctor.

KATIE: That’s, kinda, the perfect segway into my next question. Having to rely on pain relievers too long, a reason to come see a sports medicine doctor. Any other ones that you would point out where it’s, like, hey, it’s just time to come in, let’s get to -- Let’s figure out what the problem is and go from there.

DR. RAND: And that’s exactly when you have pain that alters your function, that’s my threshold to say, yup, you need to come to the doctor, you need a diagnosis.

KATIE: And by function, you mean, like, just my ability to, like, to do jumping jacks for instance.

DR. RAND: Right, or your ability to walk with a normal gait, your ability to flex or extend your knee all the way, your ability to pick your shoulder up over your head. Those are the things -- Or a lot of times people with shoulder issues will have a lot nighttime pain. If your pain keeps you up at night to where you can’t sleep, time to come to the doctor. And it’s not because there’s anything horrible or dangerous going on, but there are a number of things that we can do to help with that that make your life better and make you better able to do the things you wanna do.

KATIE: Yeah. And I know we’ve -- I’ve, kinda, hogged the time talking about knee pain and you mentioned shoulder pain again, you’ve mentioned back pain, so I don’t want people to think that this is all just about knee pain. So, any other messages you would, kind of, send. I know you mentioned not being able to lift your shoulder is a sign, back pain, when is that a sign to come see a sports medicine doctor?

DR. RAND: So, again, back pain is one of the things we see very commonly. On any given day, 30% of the population has back pain that gets their attention or makes them limit in what they do or take something for it or alter their life, it’s there, it’s very prevalent. Most back pain problems are related to posture and related to core weakness. So, the first thing to do for that is pay attention, okay? Be mindful of your posture, be mindful of -- And that shoulder pain very commonly also is posture related. Okay and so, be mindful of those things. And if you have back pain that seems to radiate into a leg and it alters your gait, if you have any functional deficit, if your gait is abnormal, if you feel like you can’t pick up a leg or if it feels abnormal, if you have a foot drop, those are things to come to the doctor sooner rather than later. Personal story, two years ago, I ended up having to urgently lift a rather large patient and felt a sudden pain in my back and was bothered by that a little bit. I said I just strained it, I’m fine, press on, three days later, I’m out for a walk, the day after Christmas, I develop a foot drop and I couldn’t pick up my foot anymore. I noticed as I’m walking, it’s hitting every time very hardly. And I ended up rupturing a disc in my back that, kinda, needs to be addressed sort of acutely when you have a neurologic deficit. Okay, so I’m fine, it all works out okay, but it’s that loss of function more than pain by itself that says, “This needs to be seen sooner rather than later.

KATIE: Yeah, I think your example paints a perfect picture ‘cause as you were saying it, you, kinda, start to realize what the problem is. If you have loss of function and you’re not doing something about it ‘cause then you’re just gonna get injured and that’s, like, definitely what you don’t want ‘cause sometimes that’s something really serious, surgery perhaps, even. So, important message to actually do something about the pain when it starts to affect function I would say. As far as when someone comes to see you for an appointment, what are some of the first things you try to help rectify the pain? What are the, kinda, like, go to treatments at that point?

DR. RAND: I guess the short answer is, it depends.

KATIE: Okay.

DR. RAND: The best thing, the most important thing is to get a diagnosis. And to get a diagnosis, what I concentrate on are the -- And what I teach my fellows is, you know, when you think about where does it hurt and when does hurt? So, if you know the anatomy of where things hurt, and you know biomechanically what’s going on as they have pain. You know, do they have growing pain at foot strike? Do they have pain just going downstairs in the anterior part of the knee? Do they have pain when they land on the inside of their ankle? Those -- Understanding the anatomy of where they’re having their problem really drives what we do next. And then, the treatments can be physical therapy, very commonly, almost nobody leaves my office without some sort of exercise to do to help alleviate their problem, okay? And sometimes that requires physical therapy, sometimes it doesn’t. I’m very aware of the fact that the exercises I give people to do often aren’t done.

[Laughing]

And you just -- It’s human nature. I mean, I do the same thing. I don’t want to have to waste my time worrying about making my body work better. That’s a, sort of, normal human nature. But at the same time, the exercises do work, okay? But sometimes people have enough muscle disfunction that they really need a professional to help them fire their muscles the right way and get things to work well, and that’s where physical therapy comes in, okay?

KATIE: Gotcha.

DR. RAND: Sometimes it’s medications, truly not that often but sometimes medications are useful and then the other things we do are a lot of injection, kind of, therapies depending on where they hurt and why they hurt. Sometimes decreasing that pain with some sort of an injection allows their muscles to work better and overall makes them better.

KATIE: Yeah, I mean, you’ve talked a lot about, when we were talking about how my knee pain, and how the problems in my hips and how my hips aren’t strong enough. I think for me, it took me a long time to realize that it’s a strength problem. I guess when it’s pain, you’re like, “No, this means something’s not working, som”-- And then you don’t really ever expect this, I’m not strong enough in certain areas. Also, it’s just like, “Hey, I’m active. I’m on the elliptical every other day, I’m lifting weights, I’m doing body weight exercises.” It’s, kinda, hard to believe but I guess what I’ve learned is that there’s all these, you know, sort of muscle groups that you don’t use commonly or you don’t really not -- I know when I’m lifting, you know, through my knees, I can feel my hamstrings but I don’t really feel all the other tiny things, so I’ve always found that interesting.

DR. RAND: Runners are probably the worst.

KATIE: Okay.

DR. RAND:  Runners just wanna run. They’ll run five days a week, six days a week --

KATIE: It is true, yeah. I’m not a big runner, but my friends who run, yeah, it’s almost all they do sometimes, yeah.

DR. RAND:  They become remarkably quad dominant, and they get very, very tight in the piriformis muscle. I mean, it’s runner butt pain. You know, it’s classic when they come in and they have this pain on the inside of their knee and, you know, I can tell where that comes from but then I turn around and I press on that piriformis muscle and they didn’t realize it hurt, but it hurts like crazy. Then you watch them do a single leg squat and they can’t keep their knee straight as they do that ‘cause it falls in. So, successful runners cross train. Okay? They have to do core strengthening exercise specific to the glutes and single leg exercises are usually the best. The quote I like is that running six miles is like doing 10,000 single leg squats. Biomechanically, they’re the same thing. So, when you go out and run 6 miles, you’ve done 10,000 single leg squats.

KATIE: That’s crazy.

DR. RAND: Go you.

KATIE: Yeah, that’s crazy to think about. ‘Cause I don’t think I could do that many. But I also don’t really run a lot so that -- Maybe those go hand in hand.

DR. RAND: So, the point of that is, if all you do is run and you don’t specifically train the muscles to do that, they get tight, they get overused, and then you, kinda, get this cascading pain here that is very predictable. So, the fix for that is sometimes alleviating the pain and then convincing the runners that they have to strengthen these particular muscles in order to be a successful runner.

KATIE: You know, as we close out here, it sounds like a lot of what you’ve been talking about is prevention related almost so, I mean, take home message that you would give the listeners who are struggling with joint pain like me. How key is prevention and what are, kind of, like, your pillars of prevention and preventing joint pain that you think are important.

DR. RAND: Well, the first thing is pick your parents better.

[Laughing]

‘Cause if you’ve picked your parents well, you’re gonna do fine. But separate from that, strength helps, okay? If you’re training, don’t do too much too soon, pay attention to -- If you’re a lower body exerciser, runner, jumper, that kind of stuff, if you have bone pain at foot strike, if that pain is in your foot in the front of your leg, in your groin and it happens at foot strike, those are stress fractures, that’s a big red flag, go to the doctor for that. Okay? If you have pain after you’ve worked out, stretch, live with that, understand delayed onset muscle soreness  just happens and that the more you do, the less it will bother you. Don’t let your joints run your life. If they’re running your life, go to the doctor. If you’re just having some soreness that limits you a little bit, but it goes away through the day, good for you.

KATIE: Alright, this is life, you earned it.

DR. RAND: Yeah.

KATIE: Okay, gotcha. Alright, well thanks so much for coming on today. This was a great conversation, I really appreciate it.

DR. RAND: I appreciate being here and having the opportunity, thank you very much, Katie.

ZACH: So, apparently, we need to pick our parents better, is what I learned from that.

KATIE: Yeah, that’s true. I, kinda, laughed at that because it’s --

ZACH: He did keep going back to that one, it’s a good joke.

KATIE: Well, and it’s -- it, kind of, like, points to the fact that -- What he said that resonated with me is that some people are just predisposed to this more than others and that I need -- I think I need to stop thinking of joint pain as, like, this thing I’m going to just, like, crush and it’s my fault and I’m never gonna have it again. I think I’m always gonna, kinda, come in and out of it but there’s certainly a lot of stuff I can do to keep me out of the joint pain more than in it is kinda what I took away.

TODD: I think Zach and I both picked our parents well.

KATIE: Nice job, guys.

KIM: Yeah, and in that -- To that point, you know, I thought about my own family history and there are folks that have knee pain and at some point, it did lead them to have mobility issues so it’s something to keep in mind and a reason to really get strong and focus on my mobility like that because I think as we age, you know, I think working out and stretching and all of the good things that we can do, it becomes less and less about aesthetics and more about just, hey, I wanna live my life well.

KATIE: Yeah, I could not agree with that more. I think when I was in my 20’s, I was working out solely just to be like oh, keep myself, like, you know, fit and slim and now I’m like, I just wanna be able to, you know, go on these hikes that we’re about to do in a couple weeks. And, like, I wanna be ready for them, I want to be able to do those hikes and not feel sore after and not feel like I’m in pain for months after. So, it truly is exactly what that is. And you know, Kim, you mentioned it. Strength, I think that was, like, the theme of what Dr. Rand was mentioning. The stronger you are, the less joint pain you have.

ZACH: Just another reason that everybody should do some strength training.

KATIE: Yeah, I think the official recommendation is twice a week. You know, he mentioned physical therapy as a part of dealing with joint pain. I myself have done physical therapy a few times and so, next we’re gonna talk to a physical therapist. We’re gonna talk to Corbin Hedt, he’s a physical therapist here at Houston Methodist and he’s gonna walk us through that part of the journey when you have joint pain and you’re going to a physical therapist, what to expect in an appointment, you know, what things does he, sort of, recommend for dealing with joint pain. So, that’s up next.

[Sound effect signaling beginning of interview]

Alright, well, I’m here with Corbin Hedt. Corbin, thanks so much for being with us today.

CORBIN HEDT: Absolutely, thank you.

KATIE: You know, it’s interesting because I know some of what you do is probably rehabbing people after an injury, so, let’s say they tear an ACL or let’s say it a torn Achilles. I picked two of, like, the worst ones, sorry.

CORBIN: No, those are very common, yeah, yeah.

KATIE: You know, you’re taking someone but you’re, like, bringing someone back after that, like, getting ‘em, you know, fit and physical again. How much, I’m curious though, how much of what you do on your day to day, is -- Is it, like, people like me who just have these aches that won’t go away? Like, let’s say, I’ve got shoulder pain that’s just not going away or, you know, my lower back is just hurting so much, I can’t get it to go away. How much of your day to day is, like, helping those people?

CORBIN: Yeah, so I guess what you’re describing is, like, the dichotomy between the surgical cases and like, the non-surgical cases. For me at least, it probably averages at about 50/50 where half of my case load is post-op, half the case load is people trying to prevent surgery or, who are kinda just dealing with those nagging things that limit them in life and they’re not happy with it so they wanna just get that better. So, yeah, it’s kind of a good split between the two.

KATIE: Yeah, I mean. So, I guess maybe more common than I was thinking actually. My personal demon, you know, we’ve talked about this, my personal demon is knee pain. I honestly have been dealing with it since, like, my mid 20’s. And when it started, I was very, like, hesitant to, like, accept that it could be anything other than, like, an injury. So, I was like, I -- You know, I grew up playing sports and when things hurt, it was because, like, oh, I rolled my ankle in a basketball game. Like, there was a very, like, tangible reason why, like, oh this hurts. In my 20’s, I got to a point where, like, I just had a nagging knee pain that I could not get to go away.

CORBIN: Just ‘cause you woke up one day, right.

KATIE: Exactly, yeah. Every day it would be, like, clicking while going upstairs and, like, would hurt when I bend. And so, it took me a while, I think, to -- I would go see a sports medicine doctor, they would say, like, “Look, it’s probably time for physical therapy,” and I’d be like, “What’s that?” You know, “I don’t know anything about this, and I don’t think I need that.” Typical, you know, 20-year-old type stuff. When I did finally go see a physical therapist, I had my mind blown by the fact that at the time, like, kind of, one of the things that was said to me, and again, we don’t need to take this as medical fact ‘cause it’s been ten years, but the gist of it was, like, “Well, your hip -- Your hip muscles are kinda weak. Like, we actually just need to work on your hip muscles.”

CORBIN: Right, and you’re like, “I came to you for my knee, why are you looking at my hip?

KATIE: Yes, exactly. And that’s what I wanna ask you about. I mean, this is -- There’s this thing of where I’m feeling the pain in my knee but that’s not the source of the problem. So like, talk to us about, like, as far as the anatomy of some of this joint pain goes. Like, what is this mystery of, like, pains in the knee but the problem is somewhere completely else, probably.

CORBIN: Yeah, the phenomenon that you’re talking about there is, like, regional interdependence or the, like, kinetic chain where everything, even though it’s independent of, like, the knee is obviously separate from the hip, they’re very much connected pretty directly. But even, like, further distal things, so, like, the back and the ankle can have a good play on each other or, like, your shoulder and your elbow. And you know, there’s various things and patterns that we, kinda, see that interact with each other pretty dominantly. And so, the knee for instance is so predominant on what the hip and the trunk or the core are doing. And if you have any big deficits either in, like, your glute muscles or anything like that that aren’t allowing your knee to, kinda, work in that proper functional position or plane, you end up with these, kind of, wear and tear type situations where, you know -- There is some natural wear and tear throughout life but when you have structures that are, you know, adversely stressed for a given amount of time, they’re eventually gonna hurt.

KATIE: Mhm.

CORBIN: And that’s a very common thing that we see and a lot of times, the art of our, like, evaluation processes is not just looking at the joint that you’re coming in with the pain for, but what’s also happening above and below that to make sure that we don’t miss anything because if I were to just, like, directly only, kinda, you know, horse blinders look at your knee, I might miss some things that are leading into it.

KATIE: And that part is what’s so interesting to me because I think when I was younger, a lot of the, like, my knee pain was, like, okay, maybe it’s your IT band is tight, and your hips are tight and stuff like that. And that’s when -- You know, before we move into, like, what a physical therapy appointment looks like and things like that, I wanted to ask you, on the prevention side of joint pain. So, I guess in my mind once I realized, oh, it’s my muscles around my knee that might be, kinda, some of the problem and maybe they’re tight and sometimes, you know, there’s a lot of, like, things you can use to relieve tightness. And so, to take a segway into the prevention here real quick ‘cause I think a lot of people listening to this are probably like me, they’re dealing with joint pain and they, kinda, like, maybe, don’t want to have to come see someone quite yet.

CORBIN: And I don’t blame them.

KATIE: Yeah. The first one I think about is stretching and that comes from a place of -- I keep getting ads for these, like, stretch labs where the concept is, like, once a week, you come in and someone, like, literally stretches you for 60 minutes. My first part of this question as far as preventing joint pain is, like -- How important is stretching first of all?

CORBIN: Not as important as some people make it seem. There are instances where there are certain groups of people that absolutely need more flexibility in certain occupations where you’re sitting for eight, ten, twelve plus hours a day. There’s a good chance there are certain muscles that are very tight and that need to be stretched out. But I think what we’re starting to see a lot more in the clinic is that there are folks out there who are doing all these stretching activities and, like, your yoga purists and your Pilates folks. Like, all those are really cool, really great things but we have this subgroup of people who are what we call hyper mobile, meaning their joints are already really flexible. Occasionally, their muscles will be tight, but a lot of times, that sensation of tightness comes from a lack of motor input into the muscle, so it gives you that perception of tightness rather than it actually being tight. I can’t tell you how many times I’ll get somebody that comes in and they’re like, “Yeah, my hamstrings are just always so tight so I’m constantly stretching them,” this and that. And in the back of my mind, I’m like, “Well, if you’re constantly stretching them, why are you tight?” And so, naturally I’ll put them on the table, and I’ll look at their hamstring and they’re going miles beyond what I could ever dream to go and I’m like, “Yeah, you’re not tight, but what you are is weak.” And so, we see a lot of these folks who just focus -- hyper focus on stretching, stretching, stretching, but they don’t get the balance of the strengthening aspect of it. And so, very often we see more of a weakness component feeding into that and generally that should be, kinda, more of the focus on the prevention side ‘cause if you’re strong, that’s gonna outweigh any, like, flexibility deficits that you may have and that’ll help with keeping the joints happy, keeping the bones and muscles happy overall.

KATIE: The next two, kind of, things I wanted to ask you about might follow down this train, but we can kind of, like, mix them or not. The tool that I’ve used forever, Foam roller, excruciatingly painful at times. Like, when I roll on my IT band, like, it’s -- I mean, it’s better now, I would say, because I’ve been doing it so long. But when I first started, I was like, “This cannot be good for me, I feel it hurting, this is worse than knee pain.” What is a foam roller doing? Should we be using ‘em? Like, what role can they play in joint pain prevention when it’s tight muscles, things like that?

CORBIN: It’s, kind of, one of those things, it’s an enigma. We aren’t exactly sure, like, the underlying principle of what’s happening. You’re basically, you’re creating this, like, physical -- You’re mushing your muscles up, right? Your IT band itself, that’s the number one thing that people will foam roll. Your IT band itself doesn’t actually stretch, it’s a very firm, taught structure and it’s meant to be that way, it just, kinda, encapsulates to the side of your leg. But when you’re actually foam rolling the side of your leg, you’re actually more so, for your lack of a better term, massaging out your lateral quad or your hamstring. And what will happen is if you do have any little trigger points in there, bands of, like, top muscle, you’ll physically force those to elongate and that’s kind of partially the theory of why you gain range of motion quickly thereafter, why you feel a little bit better after. My thought is you’re no longer putting yourself through torture so naturally, you’re gonna feel better.

KATIE: It’s a good point, I do feel better after I foam roll.

CORBIN: Exactly. And so, there’s something also to be said about that noxious input that you give in your body to where you’re, kind of, giving your nervous system a little reset. And so, it takes a little bit of the focus off of the knee pain that you have. And there are certain situations where, yeah, it’s absolutely appropriate to do it. In my case, I had an ACL reconstruction six years ago and I got to just this point where I was stuck and not being able to be productive with a few different exercises. And my therapist, I was a PT but I had somebody guiding me through it at the time. He suggested me to foam roll and I was like, “Oh, that doesn’t do anything, that’s hocus pocus.” So -- But I actually did it and it was remarkable how much better it made me feel, even if in the short term, it allowed me to be more productive with certain things. And so, for folks who like to do it, I’m all for it, I say go for it, you’re probably not gonna hurt yourself as long as you’re doing it right. But in terms of, like, directly suggesting it. There’s certain, like, times and places where I’d say that’s probably beneficial and, like, massage guns too, along the same principle.

KATIE: Yeah, yeah, massage guns are what I was gonna ask you about next. They’re tricky because, you know, I bought a quote unquote “Cheap one,” and I mean cheap ‘cause it was $70, like, these things can go up to, like, $300 so I’m calling a $70 a cheap one. And the battery died in, like, a year and a half. So, it’s, like, are they worth the cost in the sense of, like, am I getting enough bang for my buck there knowing that I might need to spend, like, quite a bit of money? Can I do something else like foam roll or is all of it just a no-no?

CORBIN: That would be a cheaper kind of version of it. But the massage gun, folks have studied it, and they’ll say that it’s analogous to do 15 minutes of foam rolling but only, like, two minutes with the gun. So, it’s a time saver, I guess, if anything, you’re able to adjust the intensity of it so while the foam roller is  just a ten out of ten --

KATIE: It seems to hurt less I will say.

CORBIN: It definitely hurts less, there’s something to, like, the vibration stimulus of it that can tone down some painful effects but again, it’s one of those things where I’m like, you know what? If you like it, if you can afford it, go for it, but at the end of the day, we should probably be correcting the issue of, like, what’s causing this perceived tightness in the first place?

KATIE: Yeah, absolutely. I mean, even as you’ve been talking about these three things, you’ve mentioned that art of physical therapy and stuff and it does, like, as you’re talking about it, it’s like, yeah, it does sound like an art in kind of like, maybe why physical therapy becomes the treatment for some of these issues, and you mentioned strengthening and it’s, like, I would’ve never known what to strengthen when my knee was hurting. Like, absolutely, there’s no way I could know that. So, along that line, and you know, moving into the physical therapy, let’s say, you know, your doctor’s like, “Hey, I think you need to go see a physical therapist about this, like, whether it’s lower back pain, shoulder pain, for me, knee pain. Talk us through, like, the basic principles of physical therapy, what it’s trying to achieve, what you’re doing when you’re working with someone.

CORBIN: So, basic concept is any time we get somebody for the first time, that first visit’s always a one-on-one evaluation. So, I’m face to face with you for at least 60 minutes and I’m trying to get to the root of the problem that you’re coming in for. And a good portion of that is talking and getting an understanding of what you’re dealing with, kind of, why you’re dealing with it, when you’re dealing with it, and what’s the frequency of your symptoms? What’s the intensity like? The duration? That type of thing. Were there any specific mechanisms involved? And really just painting the picture of the history leading up to that point ‘cause that’s gonna give me a better idea at trying to diagnose the situation more than anything is what does the history look like? And then, you know, once we’ve talked through some things, and for a lot of folks, just that therapeutic, like, venting, talking it out is more beneficial than anything honestly. But I try to just put on my listening ears and sit there and be a sponge for everything that they can give me. And then from that, I’m building in my head throughout the course of them talking to me, the foundation of what I wanna look at from a physical standpoint. So, we take our subjective information and then we look at them from a physical capacity be it functional, testing, how do you walk? How do you climb stairs? How do you reach overhead? Things like that. How do you squat down and, you know, get to the floor, that type of thing. And maybe more specifically, at strength of individual muscles, you know, what’s potentially weak here? What’s causing these weird functional things? ‘Cause somebody could do something in a weird way but that’s just because that’s how they’ve done it all their lives and they didn’t know that was maybe not a benefit. I don’t like to say you’re doing something wrong, it’s just inefficient or not beneficial for you. And maybe it’s due to weakness or maybe it’s just due to the fact that they haven’t been exposed to the right way or the best way to do that. Or range of motion, you know? Are certain joints limited? Are muscles tight? Are, you know, different structures limiting you from moving the way that you should? And things like that. What’s the tissue quality feel like? I’m getting, usually 99% of the people that I get and evaluate, I’m getting hands on I’m getting a feel for the area that they’re talking about so that I can better just grasp what’s happening from a regional standpoint. And then from that, we gain our information, what’s weak, what’s tight, what’s whatever. And then we develop our plan together and -- Cause we’ll have folks that come in, they’re like, “Hey, I knew I needed to come see you, I don’t want this to be a recurrent thing, I have a very busy life but if you could show me, like, the most bang for my buck type thing so I can keep up with, that’d be great.” Or we have folks that are set and they’re like, “I wanna come in and see you for three days a week. You know, the doctor wrote the script for it and I’m here for it, let’s do it.” So, from all that information, we develop our plan on what we wanna do from, like, a therapeutic standpoint in the clinic and what you need to be doing at home.

KATIE: The homework.

CORBIN: Yeah, exactly. ‘Cause so much of what happens from that standpoint on is dependent on what we teach you. So, it’s very much an educational thing in addition to a physical thing. Because if you’re seeing me once or twice a week for six to eight weeks or whatever, in totality of it all, that’s a very short amount of time but if we can teach you how to keep up with things and how to be very consistent and diligent at home, that’s gonna make a world difference because you’re gonna get way more time and just exposure to the things that you need to get. I know that’s a long, convoluted answer to it, but all in all, the biggest thing that we’re trying to do is educate people and teach them and then when they’re in the clinic, we adjust and basically modify and progress as much as we can.

KATIE: Yeah, as you talk about education, I think -- I’ve done physical therapy a few times and it always amazes me, like, when I’m starting. It’s very basic, fundamental things that they’ve had me do and it’s, kind of, like, make me realize that, like, I think sometimes when I’m working out and exercising, I’m way focused on the end product and not, like, the process. And physical therapy has helped me, kinda, realize, like, no, there’s a lot of process here.

CORBIN: Very much so. Yeah. And it’s a humbling experience for a lot of people. We’ll get them in and we’re doing little one pound weight exercises, and they look at us like we’re crazy when we hand them these little pink dumbbells and it’s like well yes, it seems rudimentary, it seems very, like, benign and fundamental but there’s a reason behind it, right? Generally, like, it’s those little, small muscle groups that you don’t work in the gym that end up weak, that end up over elongated and things like that and those are the ones that are, kind of, the trouble factor, the root cause of the issue. And so, yeah, whenever I get a 18 year old in here and I’m giving them little pink dumbbells, I have to very, very carefully approach that to gain their buy-in so that they’re not saying, “This guy doesn’t know what he’s doing, I’m gonna just go back to the gym and hopefully it gets better on its own.” We’re having to very, very carefully educate them on like, “So, the muscles that we’re working are very small, they’re, like, less than an inch in diameter. These light weights are gonna help you target that area that we want specifically which will ultimately, eventually get us to the point that we want, but that way we’re not missing the boat. And if we lift too heavy, you end up working the wrong muscles,” so on and so forth so.

KATIE: Yeah, it’s exactly that I think in my mind ‘cause I mean, in -- It’s these large muscle groups. Like, when I’m doing, like -- When I’m working out, I’m going, like, full speed and, like, the goal is to, like, lift as hard as I can or something like that. I often don’t take a step back and I’m like, “What about just” -- You know, like you said, these fine motor skills, the basics, the fundamentals and --
CORBIN: Exactly. I try to preach, like, we never wanna forget the basics and I teach this to all of our students and residents. If you neglect the basics, that’s when the bigger, sexier stuff will not happen the way that you want it to. And if you want to be successful with that stuff, I’m all for it and that’s what I’m pushing for, but we always have to bring it back down to, like, those foundational elements because if there is weakness in any little group or if there’s a range of motion issue that we’re just glossing over and neglecting, that’s where those problems, kind of, compound down the road.

KATIE: Yeah, so when it comes to achy, achy knees in my case or achy shoulder, is it often -- It sounds like to me what you’re saying is, you know, yeah, maybe there’s some tightness here and there, but more often than not, it’s just these weakness in these small muscles that just don’t get worked when you’re doing your workouts and that’s what we’re trying to correct here.
CORBIN: Yeah, yeah, a lot of times, it’s very much a strength issue, weakness issue, or just a motor control issue. You may have the strength, but you don’t know how to engage those muscles in an efficient pattern to help yourself out more.

KATIE: I wanna circle back to, sort of, like, a prevention topic again, but in my mind, maybe not say prevention, but if someone does tend to have achiness here and there, would you say -- ‘Cause I would say, like, I just feel like everything hurts sometimes. Like, I’m focusing on my knees right now, ‘cause, like, right now I have some knee pain actually. But I mean, like, I don’t know, I just feel like I’m achy, would you say there’s benefit in someone seeing a physical therapist just to say, like, “Hey, head to toe, like, what are you using wrong? Where are you imbalanced?” Like, I don’t want -- I like to -- I love being active, I’m an active person. We go hiking several times a year, I hate this thing of where, like, I feel like my body is failing me. And so, like, is just trying to, kinda, come in once a year and being, like, “Look at me, tell me what I’m doing wrong. Like, I’ve been trying to do all the right things, you guys are teaching me but I’m still just, like, messing up somewhere.”

CORBIN: Obviously, I’m biased a little bit. Yes, I would love if everybody could go to a PT, like, once a year to get a checkup or a, kind of, refresher on things. Inevitably, like, we look very closely at things and often times, if you look hard enough, you’re usually gonna find something, right? But I try to toe that line and just be very careful with my language with folks, like, even though I’m finding things in here, it’s all in all not to say that anything’s wrong or to be too scary. Like, something’s gonna break or anything like that, ‘cause often times that can be more damaging than whatever they’re dealing with. My usual, like, spiel is, like we’re trying to make you as efficient as possible, so you don’t have to deal with things down the road, so that whenever you do encounter things like this, you’re empowered with the tools to, kinda, manage it on your own. And so, that’s again where the educational piece comes in. It’s funny, we’re in a profession where we are trying to get people better so that they never have to come back and see us.

[Chuckles]

KATIE: But inevitably, maybe you probably do I would say, yeah.

CORBIN: I think just with everybody living longer and stuff, we’re naturally gonna be in demand for a long time but yeah. I don’t want you to feel like you need to come see me too often, too long, etc. So, I want to -- To yeah, have that opportunity to intervene with -- Even if it’s a simple thing, like, just  this is what you should work on for, like, a once or twice a week basis to keep those knees healthy and happy and these are some of the mechanical things that you can think of going forward so that when that new habit is engrained, well, now you won’t -- You probably won’t have to deal with some of the things that you’ve -- That have, kind of, boiled up until this point.

KATIE: Yeah, I think -- One question I have coming out of that is, I hate to say this is how I think about exercise, but it is, and I don’t think I’m alone. I think of, like, you hear you’re supposed to exercise some certain amount a week. Like I said, I’m trying to, like -- My end goal is, like, to stay fit and healthy. Like, you just mentioned well, maybe work on these things twice a week. Like, what can I trade those for? Because my question, like, does it count my strength training, like, or is this really, like, an add on that I need to be doing for the long-term investment? Like, how would you talk about that?

CORBIN: And that’s a good question and that’s really where the, like, getting to know the patient in front of us, kind of, falls in. Like, what are your goals? What do you like to do? What are you ultimately -- Like, what’s feasible in your week? Like, are you a mom of five and, you know, you literally don’t have time for exercise? How am I gonna, like, maximize your productivity in that time? Or are you a marathon runner or that’s your job and, you know, you’ve already got your training schedule and there’s certain things that, you know, they can only afford to give up and trade or whatever. So, that’s where the art of that comes in and just getting to know the goals and stuff.

KATIE: Okay.

CORBIN: More often than not, it’s just about educating on how to be active and how to remain active as much as possible. It’s the sedentary ones that we get that are, kind of, the tough eggs to crack where we have to, you know, get them moving again, get them working again, but also find ways that they’re comfortable with doing that and that we know that they’re gonna actually keep up with and not just be like, “Yeah, yeah, yeah, I’ll do that.” And then as soon as they leave you, they never even look at it again.

KATIE: Right, yeah. Well, it’s that homework, you know. You’re just like, “Oh, man, I gotta do more?”

CORBIN: Right, right, right, right. And that’s part of our job too, is recognizing, you know, when that can become a hindrance. Like, I don’t wanna give somebody 20 different things. If they were actually gonna do all that, that would be fantastic but I know the odds of somebody -- Me giving somebody a packet of 20 exercises and going home and actually doing that are relatively low, so that’s where I get a feel for the person and what they’re actually gonna do and what’s feasible and you know, what they’re gonna keep up with.

KATIE: Yeah. You know, you mentioned being sedentary and it’s interesting because I think -- I have noticed even with my own, sort of, like, achy joints, is it gets worse when I’m not active. So, I’m fairly active to be honest, but even just that one or two days that I’m not working out in a row, I’ll notice is, like, when I’m the achiest. So, I mean, how much of preventing joint pain too is like you just said, like, staying moving even if it’s, you know, some of the basic stuff?
CORBIN: So much.

KATIE: Yeah.

CORBIN: Honestly, like, if we could just keep people moving, you could do away with so many surgeries and PT appointments, and medications, all the opioids and stuff like that. I pulled up a couple studies that I have in my notes that found that people who exercised for at least 30 minutes most days of the week were 40% less likely to develop Osteoarthritis than those who did not exercise. And that’s just -- You know, they talk 30 minutes most days, that could be something as simple as taking a walk around the block, you know, walking up and down the stairs a few times, doing some squats in front of the TV. It doesn’t have to be anything, like, overbearing or over taxing or anything like that. But the fact that you’re moving and you’re giving that input to the muscles and the joints and the bones, that’ll keep things from becoming fragile because our body has these mechanisms of maintaining or degrading. And if you’re not using something, naturally you lose it, that old adage. And so, if you can stay moving, you can prevent a lot of this stuff. I mean, back in 2020, there was 790,000 total knee replacements and 450,000 hip replacements in just that year alone. So, that’s well over a million in just one year and that continues to go up every year. And so, for a lot of those folks, if they could just develop those good habits early on, ideally, we could prevent a lot of that.

KATIE: Yeah, yeah. So, I mean, moving sounds like a take home message, making sure even small muscles are strengthened and able to support, you know, the bigger muscles, sounds like a take home message. Anything else you would say to people, you know, as a physical therapist and you’re saying, like, “Hey, here’s what to do if you’re getting achy, and even before you’re getting achy.” Like, what do you say to people?
CORBIN: Seek professional help whenever you have pain. Pain is not a natural thing. It’s not something necessarily to be scared of but at the same time, you want to understand, like, why that’s happening, especially if it’s a consistent thing, if it’s a chronic thing. Seek help, see what’s going on, advocate to see a PT. Obviously, I’m biased. But --

KATIE: I will say, I wish I could see one like -- I wish I could see a PT, like, once a month. I feel like, maybe again, it’s ‘cause I’m achy but, like, I just lo -- Like you say -- You mentioned education and I never thought of it like that, but I always do feel like I leave those appointments where I’m just, like, “Wow. I just learned so much that -- I move all the time, but I do not what I’m doing it turns out.”

CORBIN: Yeah, and understanding, like, you may be an active person but at the end of the day, there’s always little nuanced things that can be worked on and that can be improved. And it’s a investment, obviously, and time, and effort, and all that, but worthwhile when you talk about the longevity of things and wanting to stay active and remain active to prevent a lot of these things that happen later on down the road.

KATIE: Yeah, I know, and I think that’s me. Like, I wanna stay active and -- Well, thank you for -- Thank you for coming on today, this was super awesome, very helpful, we’re so glad you joined us.

CORBIN: Thank you so much for having me.

[Sound effect signaling end of interview]

ZACH: “You’re not tight, you’re weak.” I wanna put that on a poster, like, look at it for motivation during that last set, you know? It’s just, like, that’s very, like, that’s hardcore. I like it.

KATIE: No, I loved it too. And it makes the point perfectly of, you know -- I think my stretching helps but I think, you know, I could agree. I could say, you know, he said this from in the beginning, like, I don’t actually know what it is that I do that helps me keep the joint pain away. One of the many things I do is stretch, but I certainly also do way more strength training now, so I am much stronger than I was ten years ago when I started dealing with joint pain.

ZACH: Well, continuing on talking about stretching, I think it was interesting that you guys talked about some people overstretch.

KATIE:  I might, who knows? But yeah, I think.

ZACH: ‘Cause you just think, like, “Oh that’s what you’re supposed to do.”

KATIE: Well, and it does -- I agree -- He said it, there is a temporary relief that comes after stretching, if my knee’s hurting and I stretch the muscles around my knee, I do feel better for the next 30 minutes. Now whether, you know, like I said, maybe it’s temporary. The long-term solution is obviously strength training and figuring out what muscles are weak, where is there imbalance. Going to a physical therapist has been really helpful for me in that regard because, I mean, I can’t tell what muscles aren’t strong enough. They’re tiny and they’re inside of there and it’s not like they’re what’s hurting so. Yeah, it’s always fun for me to talk to Corbin.

KIM: Yeah, I appreciated what he said about, you know, using smaller weights and really focused movements for certain muscles because, you know, I think when you hear the phrase “Strength training,” you think, you know, you need to be doing it for the gains, you need to be -- You need to be, like, really lifting and that’s not me. I like my little small threes and fives.

ZACH: You know what that reminds me of? Is the episode of “The Office” where they open up Michael Scott’s trunk. He uses those two-pound weights, he was like, “Going for tone not bulk.”

[Laughing]

But -- It’s a joke, but there’s some logic to it.

KATIE: Oh, absolutely. Yeah, yeah. I’m glad you brought that up Kim, I think. And even in physical therapy, sometimes they, like, give you this tiny, little, thin band and they’re like, “Put it around your ankles and do” -- And you’re like, “Please.” And they’re like, "Do two sets of ten,” you’re like, “I could do this in my sleep.” And then halfway into the first set, you’re like, “Wow, I didn’t know there were muscles where, like, I’m feeling the burn right now.”

ZACH: Band training is, like, the worst, it’s so deceptive. ’Cause you’re right, it’s like a rubber band, like, how hard could it be? And that’s one of the most exhausting things I’ve done.

KATIE: Yeah, I think they -- It’s the targeting of these little muscles that, kind of, get overlooked when you’re just sprinting down a basketball court in a pickup game or something like that. You do have to -- To Kim’s point, like, you do have to take time to actually work on those. Fine tune those small muscles. It’s definitely helped me a lot. Maybe I was late to the game but…

KIM: Yeah. I’ve never been the type that’s like, you know, I’ve gotta lift X amount of weights to feel like I’m meeting some goal. And I think valuing that it is a journey and that when you’re dealing with something like pain or you’re just trying to get stronger in general, you know, the little things can help you build up to those bigger goals.

KATIE: Yeah, and I would just say, when I talk about strength training for myself, I do body weight exercises, so I do not pick up a single weight, but I can tell how much stronger I am and, like, I’ve been doing this for two or three years and yeah, it was slow and it took time, but I can tell I’m stronger and I’m just doing pushups or just squats with my own body weight, so I mean it’s -- Kim, you mentioned strength training can come with this very, like, scary picture of, like, this big dude in a gym, like, tossing some, like, bags around, got the, like, cords doing this --

KIM: You need protein powder.

KATIE: Yeah, protein powder and I gotta start thinking how much protein I’m taking in every day and I gotta, like, wake up at 4:30 in the morning or I have to stay up till 12. Like, no, I just literally do 20 minutes of body weight training twice a week.

TODD: That’s my natural inclination is to always push. At some period of time, I wanna keep adding on the weight until finally I injure myself, strain a muscle, and then I lay off, and then I stretch, that’s when I really do stretch, and I start the weight very low to build up again. So, I have been incorporating those things.

KATIE: I think that’s a good point, that’s a whole ‘nother, probably, topic we need to address, ‘cause I think that’s very common, people, kind of, ramping up either too much or too fast or even if it’s not too fast, just, your body can really only do so much and knowing what your own limits are. Because yeah, that’s another thing too. The whole point of all this is to be mobile and stay active so, if your workout regimen’s injuring yourself with these overuse injuries, that’s no fun either.

ZACH: Well, as someone with the most joint pain of all of us, Katie, did you find this a productive conversation, and can you walk away with some good tips?

KATIE: I really did. So, I think I have always had a bit of a pessimistic attitude towards my joint pain, but I actually left both of these, kind of, chats feeling like okay, this is actually just part of my life, I need to stop, like, running away from it and run, like, towards it with all this, like, new, like, these pieces of advice of, like, “Okay, I’m doing the right thing with my body weight training, like, that’s helping. The stretching, I could be over stretching, maybe I need to rethink that.” You know, I think, really just dedicating my mind towards the things that, like, I know are working. Yeah, I took a lot out of this. And, you know, I chatted with these guys a few months ago now, and I have not had -- Not in joint paint right now, so, that gets an upvote. Check.

ZACH: Alright, well that’s gonna do it for this episode of On Health with Houston Methodist. Share, like and subscribe wherever you get your podcasts. We drop new episodes every Tuesday morning, but until then, stay tuned and stay healthy.

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