By definition, start-up pain, or run-away pain, is joint pain that occurs in the early stages of a movement, such as when running away from standing or when standing up after sitting for a long time. As the physical activity progresses, the pain then usually improves. Start-up pain is a so-called leading symptom for degenerative joint arthrosis, but it can also occur in acute joint inflammation (arthritis).
What is pain on onset?
The start-up pain is the typical symptom of osteoarthritis: while the joints do not initially cause any discomfort when sitting or lying down, the pain starts the moment you get the bones moving. The start-up pain is the typical symptom of arthrosis: While the joints do not initially cause any discomfort when sitting or lying down, the pain starts the moment the bones are set in motion. The consequence is with many concerning that one remains rather immediately seated. However, this cannot be the point and does not improve health in the end, not to mention the effects on the quality of life. Understanding the phenomenon of “start-up pain” and learning about the possible approaches to personal and medical (self-)therapy is therefore worthwhile for all sufferers and is the goal of this medical article.
Causes
Osteoarthritis is a chronic joint disease, which in the end results from degeneration, i.e. wear and tear of the articular cartilage. It is thus a disease of aging people and in the vast majority of cases affects the hip joint (coxarthrosis) and the knee joint (gonarthrosis). The background of the disease is a permanent overload of the joint cartilage. Our joints are not actually designed by Mother Nature for us to move them on asphalt for life, where the constant shock absorption on the hard surface sets small micro-damages in the joint cartilage in the long run, which can then grow into a serious problem after years. In addition, people today are getting older on average than they used to be, and degenerative diseases are of increasing importance in the overall development of society for this reason as well. Other causes of arthrosis can be competitive sports: By repeatedly running marathons on hard asphalt, one naturally damages one’s cartilage even more and possibly gets joint complaints such as the typical start-up pain at a younger age. Malpositions such as bow legs or knock-knees also contribute to additional stress on the corresponding side of the joint, especially in the knee joint. Joint injuries, often dating back many years, or systemic diseases such as gout or diabetes can cause osteoarthritis. Last but not least, there are also genetic influences, so one person is more prone to osteoarthritis than another. Another cause is often overweight and lack of exercise. People who sit a lot and rarely move are more often affected by morning start-up pain. A change of nutrition (approx. 80% of the nutrition should consist here abwechslunsgreich of vegetables, further 20% from fresh fish, fruit, nuts and berries, on all industrially processed food may be renounced as far as possible, as beverages recommends itself water, tea and little coffee. Alcohol, smoking and the consumption of sweets should be stopped) and, in consultation with the doctor, moderate exercise or sports (for example, an hour of fast walking every day or alternately swimming) can be helpful here.
Diseases with this symptom
- Chondropathy
- Hip joint arthrosis
- Pubitis
- Osteoarthritis
- Knee joint arthrosis
- Polyarthritis
- Inflammation of the joints (arthritis)
- Rheumatism
- Polyarthrosis
Diagnosis and course
Since osteoarthritis is a slowly progressive degeneration, the complaints also often increase over years: the start-up pain is often an early symptom and is usually not considered further, because it improves a few seconds after occurrence – the joint “runs in”, synovial fluid is distributed in the joint and can dampen the initially painful cartilage damage with further movement. After the next break, however, the joint hurts again when starting up – in the long run, the pain wears most people down and leads, at the latest, to a presentation to the doctor and a diagnosis of arthrosis.As a differential diagnosis, the physician must first consider arthritis, i.e. inflammation of the joints. This can occur as a result of a bacterial or viral infection or as part of a rheumatic disease. The difference, however, is that the pain is usually not the typical initial pain of arthritis, which improves after a short time. Arthritic pain remains permanently present, rheumatic pain typically occurs as “morning stiffness” at the beginning of the day and then improves after a few hours during the course of the day. It is important to note, however, that osteoarthritis, as so-called “activated osteoarthritis,” can also transition to an acute inflammatory state and then also causes permanent pain. In addition to the exact symptom questioning, the doctor, optimally an orthopedist, finally makes an X-ray of the affected joint and the adjacent bones and can diagnose the arthrosis based on this.
Complications
Onset pain is a first sign of osteoarthritis or arthritis and can promote some joint complications. First, the initially mild pain develops into inflammation of the joint, i.e. activated osteoarthritis, which then leads to increasingly severe pain, especially when standing up. As the disease progresses, the pain center then shifts from the joints to the entire limb. As the onset of pain is more difficult, the mobility of the affected person may be severely restricted and limping and other movement and gait disorders such as stiffening limp or Trendelenburg limp may occur. The pain then occurs when standing up or after prolonged standing and disappears again after a few seconds. This can quickly become a burden for those affected and have a strong negative impact on their quality of life. Especially when it is cold, hot or the joints are subjected to heavy loads, as is the case when cycling or jogging, the start-up pain continues to increase and leads to unnatural movements due to the aforementioned gait disturbances. This results in further joint damage. Full-blown tendonitis can also develop from the pain, depending on the age and constitution of the patient. When treating onset pain, prescribed antirheumatic drugs may cause permanent damage to the gastric mucosa and other side effects, so conservative therapeutic measures should be preferred in this case.
When should you see a doctor?
Start-up pain occurs right at the beginning of a movement, such as when standing up after sitting or walking after standing. They always indicate joint disease, usually wear and tear. Affected people often only go to the doctor when the arthrosis is far advanced. But they could positively influence its course by early treatment. Since osteoarthritis is one of the most common joint diseases, there are many effective treatment concepts available today. The start-up pain is typical of arthrosis in its early stages. After a few minutes, the pain is gone again and the affected person forgets the discomfort. This behavior is unfavorable because cartilage damage, once present, does not heal on its own. If the arthrosis remains untreated, pain soon develops even after small loads. Consequential diseases occur, the joints swell and movements become increasingly difficult. Ultrasound or X-ray examinations can be used to make a diagnosis at an early stage. For this reason, those affected should consult an orthopedist at the first signs of onset of pain. The pain can be treated with rheumatism medication. More important than pain relief, however, is the restoration of joint mobility. The patient must be made mobile so that the joints do not stiffen. Only through movement are they supplied with synovial fluid, which contains important nutrients and ensures the health of the joint. Age and menopause are risk factors.
Treatment and therapy
Therapy consists first of all of relieving the joint, and in the case of overweight, this means losing weight. Physical measures can alleviate the start-up pain, in addition to heat or cold applications and massages, physiotherapy is in the foreground, which is intended to improve joint stability by strengthening the muscles and improve the synovial fluid by constantly keeping the joint in motion. In principle, gentle exercise is also a good thing in osteoarthritis, and sports without impact stress such as swimming or cycling are certainly the optimal case here.Aids such as shoe insoles or a walking stick can also help to alleviate the discomfort of the pain on onset. Anti-inflammatory drugs such as ibuprofen can be used, but etoricoxib is better in the long term. However, they should be used with caution – especially in the case of ibuprofen – if taken continuously, as they damage the stomach lining in many people. The above measures should therefore actually be preferred to drug pain therapy whenever possible. Measures such as injecting hyaluronic acid into the joint should also be viewed critically: Credible scientific evidence of their effectiveness is still lacking, and it is not uncommon for the physician to still carry germs into the joint space via the injection, which then leads to acute arthritis. Certainly, however, many people felt better after this therapeutic measure. Surgical measures are finally the end of the line: At first, “minor” joint lavages sometimes help for a short time, but in the long term, the implantation of an endoprosthesis as a joint replacement is almost always necessary. A big step, but one that brings very good results for most people and makes the initial pain forgotten within a few days of hospital discharge.
Outlook and prognosis
Start-up pain occurs quite often in athletes and in old age. The prospect of recovery is very high if the affected person is willing to incorporate a few exercises into his daily routine to get rid of the tarnish pain. Athletes who don’t warm up enough can get run-up pain while sprinting and other fast sports. People who sit all the time and rarely move will also struggle with movement problems at first, which can end up manifesting as start-up pain. An ointment can help relieve the pain in the short term. However, in the longer term, it is not a solution. If you struggle with start-up pain as an athlete or even in everyday life, you should definitely consult an orthopedist. He or she can loosen the affected areas with targeted exercises and massages and thus stimulate healing. During this time, the affected areas should not be subjected to additional stress. For athletes, this means taking a break if they want the treatment to be positive. Pain during start-up can affect anyone. The only important thing is to notice the symptoms quickly. Then the prognosis looks good and you can heal the affected areas again with a few exercises.
Prevention
In principle, prophylaxis of osteoarthritis already includes hip ultrasound in infants, which can be used to detect congenital deformities so that they do not lead to osteoarthritis later. Even in adolescence and adulthood, care should be taken to ensure that no malpositions of the legs creep in – if necessary, these can be treated with a great deal of effort by physiotherapy. One-sided and monotonous stress on the joints should be avoided, as this will cause permanent damage to the joints. If you want to do sports that are easy on the joints, you should jog on moorland and forest paths instead of on asphalt, or concentrate on swimming and cycling right away.
What you can do yourself
The so-called start-up pain can be unpleasant and are usually early indicators of incipient arthritic changes in the joint in question. Self-help and “correct” behavior in everyday life help to reduce the pain again or at least not let it become stronger. Because initial pain usually indicates degradation processes in the joint cartilage or inflammatory processes, it is important to move the joint under reduced load. This promotes blood circulation, the joint cartilage is better supplied, and degradation substances can be better eliminated via the blood and lymph. It is helpful to have a good supply of minerals and micronutrients so that the chondrocytes in the articular cartilage can perform the appropriate rebuilding work or at least the degradation process is slowed down or stopped. If the start-up pain is not triggered by inflammatory rheumatic processes, heat applications through passive or active heat pads are helpful in reducing the start-up pain. The application of heat allows the muscles to relax and the metabolic processes are significantly accelerated, so that the supply of nutrients to the articular cartilage is also improved. If the pain is caused by inflammatory reactions, cooling measures such as cold compresses are helpful instead to contain the inflammatory reactions.Unilateral, static loads and chronic stress have an unfavorable effect because one-sided muscle hardening and muscle shortening can then set in, leading to one-sided joint loading and promoting the risk of arthrosis.
