In late April I became a first-time dad. Since then, I’ve been learning slowly but surely how to speak the language of “baby”. So many gadgets and things that I’ve never considered or thought about before. One of those things being: the swaddle.
Since my son was just days old, I’ve been “the swaddle guy”. Since I can’t breastfeed this kiddo, I like doing these other things because it makes me feel like I’m not totally useless (debatable still). The swaddle is my favorite thing because it can morph a hysterical baby into a calm angel burrito in the matter of a few minutes. Why? I assume the tight compression reminds them of the comfort of being inside the womb. They feel safe, secure, and in no need of alarm.
This is exactly how our joints work. We need to learn to treat our joints in the same manner.
Now before you quit reading because you think this blog is a sales pitch for the newest icy hot compression sleeve, it’s not. What I want to explain is the basics of joint stability and how it influences pain signaling.
It’s no secret that joint instability or “hyper-mobility” is a large musculoskeletal problem. Every joint should have some degree of movement and mobility, but excessive motion can become a huge problem. Decreased muscular control can lead to more ligamentous stress and more difficulty with proprioception (sensing where and what your joint is doing). All of this confusing signaling results in some interesting patterns. This can result with you perceiving the hyper-mobile joint as being painful even in the absence of anatomical damage.
Why? I am not smart enough to understand the neurophysiology of this entire process, but it is well documented. Individuals with hyper-mobility syndromes are high risk for chronic joint pain. Think of it as our bodies way of telling ourselves, “I don’t feel safe”. Pain science is complex, but our brains often prioritize things in order of perceived threat (check out the blog “I have pain, is it all in my head”). These joints that feel “unsafe” can be registered as a significant threat.
This can happen on a wide spectrum. This is common in older adults with severe joint degeneration, especially at the knee. Since they’ve lost the structural support of much of their cartilage, there is more joint laxity and stress on ligaments. These people can have joints that clunk, pop, and click with every motion and are often accompanied by debilitating pain. This is often chalked up to aging, but that’s only PART of the story. On the other side of the spectrum, I see this commonly in young females. Girls in their teens, 20’s, 30’s are often seen with poor joint stability in various joints with a common joint being the shoulder. Again, this clinical finding is often accompanied by significant pain even when joint degeneration is 50 years away.
So what does all this mean?
We must learn to swaddle our joints.
Just like a swaddle creates a compressive and welcoming environment for my baby, proper joint compression and stabilization can do the same to your aching joints. When I say compression, I’m not talking about the latest celebrity sponsored knee sleeves either. I’m talking about improving proprioception and muscular strength across the painful joint.
Muscular contraction is a powerful compressive force. There are countless studies indicating that individuals with knee degeneration experience less pain and improved outcomes as their quad strength improves. Why? The quad is a substantial compressive input across the knee. By improving the strength of muscles crossing the knee, they are improving that joints stability, decreasing ligamentous stress, and allowing for better signaling to the brain about where they are in space. This isn’t just about the quads though. It takes multiple muscle groups working together to do this correctly. There is evidence that individuals with good strength and activity levels will have less arthritic pain despite having identical levels of degeneration with diagnostic imaging. Interesting, it doesn’t sound like it’s all about aging to me.
Let’s look at the younger population. As I mentioned earlier, shoulder laxity is common among young females. This is often abolished by improving scapular mechanics and rotator cuff strength. People think of your rotator cuff as the muscles that cause shoulder rotation. Although this is true, rotation is not the primary goal of your rotator cuff. The primary job is instead to hold the head of your humerus (arm bone) as tight as possible to your glenoid cavity (socket) with overhead and various arm activities. The primary job is strong COMPRESSION. By improving this compression across the joint, we’re creating an active shoulder environment that feels safe and minimally threatening to the brain. In other words, we’re not crying for help anymore.
I’m not saying that you can develop brute strength and every ailment will go away. That’s absurd and minimizes mechanical and anatomical factors that often influence injury. What I’m saying is that poor muscular strength and control CAN lead to pain even in cases where nothing else is wrong with the joint. The wonderful news is that if that’s the case, you can improve your joint pain without need for surgery or medication.
You simply have to baby your joints a bit. Wrap them up tight in the loving embrace of good muscular activation and daily training. You have to learn to swaddle your joints. You just might find that that screaming joint will go to sleep before you know it.
Stay Kinetic Friends.
Dr. Levi Kerby is a physical therapist, orthopedic certified specialist, and owner of Kinetic Performance and Rehab in Winston-Salem, NC. He enjoys fly fishing, guitar, various forms of fitness, and treating active and motivated individuals.
If you're dealing with an injury or pain, you can contact Kinetic Performance and Rehab directly below.
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