Understanding “Good” vs. “Bad” Joint Pain, and When to See a Doctor

By Nick Ehrhardt, MD and Sharon Brock, MS, MEd

Pain is essential for survival—it exists to protect us, promote healing, and signal when something’s wrong. However, it becomes a problem if it lingers for too long or causes us to stop moving. In fact, nearly half of Americans over the age of 50 experience such severe joint pain that negatively impact daily activities. Stanford researcher and physical therapist Corey Rovzar, PhD, DPT offers practical tips and some hope for those with chronic joint pain.

“If you have joint pain, the first step to feeling better is to understand how pain is perceived, then you can start working with it,” says Dr. Rovzar.

How Does Pain “Work”?

The experience of pain begins with local tissue damage, such as from an injury or arthritis. This damage activates the nociceptor cells, which are sensory neurons that send “possible threat” signals to the spinal cord and the brain. The brain then interprets the stimulus as sensations such as hot or cold, achy or sharp. The brain also determines whether the stimulus is an actual threat and warrants an experience of pain. For example, if you have knee joint damage, the brain creates the sensation of pain to direct your attention to the knee so that you can address the “threat”. This process is called nociception.

Since pain is processed in the brain, research shows that lifestyle behaviors influencing brain health, such as how you eat, sleep, and think, can shape the way you experience pain. Therefore, Dr. Rovzar encourages her patients to adopt healthy lifestyle changes as a way to help reduce their pain.

“Since pain is processed in the brain, it’s influenced by our mental state, which we have some control over,” says Dr. Rovzar. “When we eat well, get better sleep, and lower our stress, the level of pain we experience sometimes decreases. For example, people with depression are two to three times more likely to develop chronic pain.”

Pain can also be exacerbated by local inflammatory mediators, known as cytokines. In the short term, these inflammatory mediators guide the body to clear our damaged tissues and promote healing. However, when they are present for too long, they may contribute to ongoing joint damage, stiffness, and pain.

Even if an injury has healed, the experience of pain can persist, a phenomenon known as phantom pain. This condition is more common when the brain remains in a state of protection and stress and offers evidence that pain levels are influenced by more than just tissue damage and cytokines.

“Because pain is processed in the brain, the experience of pain is subjective,” says Dr. Rovzar. “We can look at someone’s spine imaging and think, ‘This picture looks terrible,’ but they might not have any pain at all. Conversely, someone with mild changes in the spine might be experiencing a lot of pain.”

How to Tell the Difference Between “Good” and “Bad” Pain

Whether you exercise on the weekends or train like a professional athlete, it’s important to know the difference between “good” pain that signals muscle growth and “bad” pain that may indicate harm.

“Good” Pain:

• “Good” pain is generally described as dull, sore, or achy muscle discomfort during or following exercise. This pain typically reduces after stretching, soft tissue massage (e.g. foam rolling), and/or applying heat, and gradually subsides over the course of a few days.

• When starting a new training regimen, it’s normal to feel some pain and stiffness 24 to 48 hours after the workout. This phenomenon is called delayed onset muscle soreness, or DOMS.

• These symptoms are signs that you’re challenging your body appropriately and building muscle strength and endurance. Increased muscle mass often results in less joint pain because stronger muscles can take on more of the load of our movements, reducing strain on our joints.

“Bad” Pain: 

• “Bad” pain is described as sharp, stabbing, electric, or throbbing. Generally, it appears suddenly or during specific movements.

• “Bad” pain is more commonly felt in joints, bones, and tendons. Be aware of new “popping” or “clicking” sensations that appear suddenly with pain. Long-standing, painless clicking or cracking, however, is generally not a cause for concern.

• If you experience these symptoms, stop the activity and rest, as they may signal injury or overuse. If the pain persists or worsens, consult a medical provider.

“‘Good’ pain tends to be diffuse, mild to moderate, and associated with activity. ‘Bad’ pain is sharp, point-specific, and may include other symptoms like clicking, swelling, or reduced range of motion,” says Dr. Rovzar.

When to See a Doctor for Joint Pain

It is advised to seek medical attention if:

• Pain is sharp, sudden, or intense, or accompanied by fever, nausea, swelling, warmth, or redness.

• Pain occurs after a physical trauma or is associated with weakness or numbness.

• Pain lasts longer than one to two weeks, worsens over time, or disrupts sleep.

When in doubt, consult your primary care physician or a local urgent care facility for their expert opinion.

“If someone has an acute injury and hasn’t had imaging, I definitely send them to see an orthopedist to rule out something major,” says Dr. Rovzar.

Overcoming the Fear of Pain

Pain is not always a sign of damage. Understanding your pain, tracking it over time, and safely staying active can be key parts of long-term relief from joint pain.

As medicine continues to evolve, so do the treatments for pain. Various non-surgical procedures, such as joint injections and local nerve blocks, have transformed the way we combat pain. Also, strong evidence is emerging that supports the use of lifestyle treatments, which not only offer benefits for pain but can also enhance overall health and quality of life.

“Many people are afraid of pain and stop moving to avoid it. But it’s important to remember that soreness is part of the process of making their muscles stronger, which, in turn, reduces joint pain,” says Dr. Rovzar. “As a physical therapist, a lot of my job is helping people get over the fear of pain, giving them permission to move. Especially for those with chronic pain, movement is medicine.”