DEAR MAYO CLINIC: I enjoy an active lifestyle, from gardening to playing golf, cross-country skiing and participating in water fitness. I also walk daily. My knees have begun to bother me, and I am noticing some other aches and pains. I don't want to have to cut back on the activities I love. What can I do to reduce joint issues and cope with joint pain?

ANSWER: Joint pain affects people at all stages of life from student athletes to seniors. Pain can be a big barrier to not only maintaining a regular exercise program, but also getting started.

Recognizing how important physical activity is in your life, I recommend these four strategies to help keep you active:

Assess your current functional movement.

A good first step, regardless of your activity level, is to set up an evaluation with your primary care provider, or see a sports medicine specialist who can assess your overall fitness level, general mobility, and if you have current injuries or pain.

Either of these experts also may conduct a functional movement screening to evaluate how you move and pinpoint specific issues. For example, you may have more pain in one knee than the other, you may have decreased range of motion in a hip or shoulder, or you may be stronger on one side than the other. This type of screening is valuable in that it can identify specific rehabilitative exercises that can be performed along with your regular exercise program. These exercises lessen pain, as well as help your body move more safely, perform exercises correctly, and reduce the risk for further injury or worsening symptoms.

The findings from a functional movement test also can be beneficial in building a program that's going to be safe and effective for you and let you exercise as pain-free as possible.

Build a successful exercise routine.

Whatever your level of fitness, a good exercise routine should be sustainable. Regular exercise provides a host of health-related benefits, including reducing risk of cardiovascular disease, managing weight, maintaining strength and flexibility, and supporting bone health.

It also should encompass a combination of activities, including:

• Cardio, which increases heart rate and improves your overall cardiovascular fitness. This includes vigorous walking, swimming, biking, playing pickleball, or taking a dance or water fitness class.
• Strength, which builds and strengthens muscles, improves overall function and improves performance in the gym, as well as activities of daily living. Strength activities include weight training; working with resistance bands; climbing stairs; and exercises such as pushups, situps and squats.
• Flexibility, which stretches muscles and ligaments and promotes range of motion. Stretching, yoga, tai chi and Pilates all focus on flexibility.

And, finally, regular exercise doesn't mean just going to the gym, taking a class or following an online exercise program. It also means moving throughout the day, especially to break up periods of sitting. This unstructured exercise may be sweeping the floor, walking in place by your desk or performing some simple stretches when you first get up or before you go to bed.

Customize exercise to you.

Sore muscles after exercising, especially if people are new to exercise and working on increasing their activity level, are normal. But sharp or ongoing pain may indicate an injury or chronic problem.

Some points to keep in mind are:

• Ease your way into a new exercise program. Try not to go from 0 to 100 overnight, since that may increase your risk of injury.
• Listen to your body. Don't overdo it. Take a break or tone down your activity for the rest of the day.
• Keep a small problem small. If you're feeling recurring pain, get it checked out.
• Build in time to recover between activity sessions. The body need this time to rebuild and repair.

Another strategy is to work with a physical therapist, sports medicine specialist or trainer to determine the right and wrong way to perform an exercise, or strengthen muscles to support a particular movement or joint.

For example:

• If you suffer from low back pain and are not able to perform a traditional barbell back squat exercise, you could do a modified version: either a split squat (one leg at a time) or rear-foot-elevated squat. These variations target the same muscle groups, but apply external resistance in the form of dumbbells or kettlebells at your side instead of on your back.
• If you have knee pain, using a reverse lunge or hex-bar squat reduces stress on your knees and allows you to target the same muscle groups.
• If you aren't able to perform pushups or variations of the bench press without pain in your upper body, switching to a neutral grip position can reduce stress on the shoulder. Make sure to align the arms in a 45-degree angle with your torso to reduce stress on the shoulder and minimize pain.

Working with an exercise specialist can help you develop a plan that is specific to you and your abilities.

When joint pain begins to restrict the activities you love, it's time to consult with an orthopedic specialist. Together, you'll map out a plan for treatment to keep you moving and enjoying life. Orthopedists have a wide variety of options in their treatment toolbox. These options range from the least invasive, such as physical therapy or medications, to more invasive, including injections or surgery. Their goal is to get patients back to the lives they want to lead.

Break down barriers.

Joint pain is just one barrier to regular exercise. Others include:

• Time
  To start and maintain regular exercise, people need to carve time out of their schedules. Recent research shows that even short five- to 15-minute workouts throughout the day can provide health and fitness benefits. Finding these little pockets of time and a consistent workout can go a long way.
• Knowing where to start
  Performing an online search for workout programs can yield overwhelming results. Once again, sports medicine specialists can provide guidance toward a program that best fits your goals. The choice of workouts should be ones you enjoy and can stick with.
• Motivation
  Whether it's getting started or keeping going, lack of motivation can sink workout resolutions. One successful strategy is to review goals as a reminder of why you want to exercise, whether it's to keep up with the grandkids, feel better or lose weight.
• Being realistic
  Build a foundation by setting goals that can be accomplished in small segments, with each building on the next. For example, if you're just starting, a walk around the block might be a first step — not signing up for a 5K.

The benefits of regular exercise are both physical and mental. Make sure you play the long game when it comes to your exercise program. Find a style of exercise that works for you long term and that you can incorporate into your daily life.

For more information on creating an exercise routine, the importance of a strong core and other topics, check out online videos. — Dr. Jacob Erickson and Dr. Andrew Jagim — both of Sports Medicine, Mayo Clinic Health System, Onalaska, Wisconsin

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