When your shoulder, elbow, knee, hip, or ankle hurts, it is natural to call it joint pain.

But the joint itself is not always the structure causing the problem.

Pain around a joint can come from many different tissues, including muscles, tendons, ligaments, bursae, and the joint itself. Figuring out what structure is irritated—and why—is an important part of choosing the right treatment.

October 12 marks World Arthritis Day and the beginning of Bone and Joint Action Week, making it a good time to talk about one of the most common questions we hear from patients:

“Why does this joint keep hurting?”

Sometimes the answer is actually sitting just outside the joint.

Joint Pain and Tendon Pain Can Feel Very Similar

A tendon is the strong connective tissue that attaches muscle to bone.

Because tendons often attach very close to joints, tendon pain can easily feel as though it is coming directly from the joint.

For example:

• Pain on the outside of the elbow may involve the tendons commonly associated with tennis elbow.

• Pain near the front or side of the shoulder may involve the rotator cuff tendons.

• Pain just below the kneecap may involve the patellar tendon.

• Pain at the back of the ankle may involve the Achilles tendon.

• Heel pain may involve the plantar fascia, another connective tissue structure that can become irritated with repetitive stress.

That is one reason simply saying, “My elbow hurts,” does not necessarily tell us what is actually wrong.

How Does Tendon Pain Usually Develop?

Some tendon injuries happen suddenly, but many develop gradually.

Repeated loading can eventually exceed the tissue's ability to recover.

You might notice that the area initially hurts only during a particular activity.

Maybe your elbow bothers you after playing pickleball.

Your shoulder hurts when you lift weights overhead.

Your Achilles feels stiff when you start running.

Or your knee becomes painful after repeated squats or lunges.

At first, the discomfort may disappear quickly.

Then you begin noticing it more often.

Eventually, the same area may become uncomfortable during normal daily activities.

This type of pattern is especially common in active adults who continue training or working through the early stages of irritation.

Why Rest Alone Doesn't Always Solve the Problem

When something hurts, taking a temporary break from the aggravating activity can certainly be helpful.

But simply resting until the pain disappears does not always address why the tissue became overloaded in the first place.

If you return to exactly the same activity, at the same intensity, with the same movement pattern, the symptoms may return.

That is why treatment may need to address more than the painful spot.

We may also need to look at:

• Joint mobility

• Muscle strength

• Flexibility

• Movement mechanics

• Training volume

• Workstation ergonomics

• Repetitive daily activities

• Recovery between activities

The goal is not simply to make an area temporarily feel better.

It is to help the body tolerate the activities you actually want or need to perform.

Clues That Your Pain May Involve a Tendon

You cannot reliably diagnose a tendon problem based on symptoms alone, but certain patterns can raise suspicion.

Tendon-related pain is often associated with specific loading activities.

For example, you might feel pain when:

• Gripping or lifting something with an irritated elbow

• Raising the arm or reaching overhead with a painful shoulder

• Jumping, running, or squatting with an irritated knee

• Pushing off the ground with Achilles pain

• Taking your first few steps after rest with persistent heel pain

Some tendon problems also cause localized tenderness near where the tendon attaches to the bone.

However, several different conditions can create similar symptoms, which is why a musculoskeletal examination can be helpful when pain continues.

What About Arthritis?

Arthritis is different.

The term describes inflammation or degeneration involving a joint, and there are many different forms of arthritis.

Osteoarthritis, for example, involves changes within a joint that can occur over time and may be associated with pain, stiffness, and changes in mobility.

But not every painful knee, hip, shoulder, or other joint is automatically arthritis.

Likewise, finding arthritis on an X-ray does not necessarily mean every symptom a person feels is coming from that arthritis.

A person can have changes within a joint while also having irritated muscles, tendons, or other surrounding tissues.

That is why the location of pain is only one piece of the puzzle.

The Examination Matters

At TULA Mobile Chiropractic, evaluating musculoskeletal pain involves looking at how the area moves and how it responds to different types of stress.

Depending on the complaint, an examination may include checking:

• Joint range of motion

• Muscle strength

• Tenderness

• Flexibility

• Movement patterns

• Orthopedic tests

• Activities that reproduce the symptoms

• Nearby joints or muscles that may be contributing

Sometimes the area that hurts is the primary problem.

Other times, limitations elsewhere in the body are contributing to increased stress on that area.

The goal is to understand the pattern rather than simply treating the location of the pain.

Treating More Than the Painful Spot

Treatment depends on the individual condition.

At TULA Mobile Chiropractic, musculoskeletal care may include chiropractic adjustments, therapeutic manual therapy, targeted mobility and strengthening exercises, dry needling, myofascial cupping, therapeutic ultrasound, electrical stimulation, and other approaches based on the patient's examination and needs.

For certain persistent tendon and soft-tissue conditions, shockwave therapy may also be an option.

Shockwave is particularly interesting in cases where a tendon has remained painful despite time, activity modification, and more traditional conservative treatment.

We will be talking much more about that later this month.

When Should You Have Persistent Joint-Area Pain Evaluated?

You do not need to seek treatment for every temporary ache after a workout.

But it may be time for an evaluation if pain:

• Keeps returning with the same activity

• Has lasted several weeks

• Is limiting exercise or everyday activities

• Causes you to change the way you walk or move

• Is getting progressively worse

• Is accompanied by significant weakness or loss of motion

Sudden severe pain, substantial swelling, inability to bear weight, significant trauma, fever, redness or warmth around a joint, or new neurological symptoms may require more immediate medical evaluation.

This Bone and Joint Action Week, Pay Attention to the Pattern

If your elbow, shoulder, knee, hip, ankle, or another joint has been bothering you, ask yourself a few questions.

When does it hurt?

What movement brings it on?

Does it hurt during activity, afterward, or when you first start moving again?

Those details can tell us a lot.

Pain near a joint does not always mean the joint itself is the problem.

Understanding the difference can help guide more appropriate treatment—and help you get back to the activities that matter to you.

TULA Mobile Chiropractic provides personalized chiropractic and musculoskeletal care in the comfort of your home or office throughout Cooper City and surrounding Broward County communities.

If a stubborn joint, tendon, or soft-tissue problem is interfering with your normal activities, contact TULA Mobile Chiropractic to schedule an evaluation.

Dr. Nancy Gomez, DC
TULA Mobile Chiropractic