Without joints, moving around would be impossible. That's why classes of animal give up bones on the inside and develop shells to defend themselves from attack. We have developed and refined our system of joints and they allow us the big physical activities of walking and running, alongside the delicate movements of the hands and other limbs. When everything is working well, this gives us the chance to be the most adaptable creature on the planet. When the joints seize up, it's like the oil runs out of the engine in our vehicle and leaves us stranded. Why does this happen? Putting aside the longer term diseases like arthritis, the most common causes are overuse and injury. Whenever you have a job which requires repetitive movements, or you play a sport which depends on you always moving in the same basic way, you risk micro-trauma injuries, i.e. you stress or strain the ligaments, tendons and muscles that hold the joints together and give them strength. This can take several years to show itself. For example, operating a particular machine in the same way can slowly tear muscles through overuse. We only recognize the problem as the tears grow larger and interfere with movement.

Overuse injuries arise from a number of different factors. If the movements are not "natural", i.e. they involve us moving the body in ways we were not designed to move, this is an example of poor biomechanics. Other causes come from poor muscle strength or inadequate control over the movements. In the long term, the cure is either to stop moving in this way or relearn the movements. Sometimes, you avoid further injury by improving the coordination and toning the muscles to give better strength. This is always possible with sporting injuries. There are always coaches around to show you how to hit or throw the ball more efficiently and with a smaller risk of injury. At work, it may come down to redesigning the work. This involves, changing chairs to give you better posture, or changing the machine so the movements are more natural, or allowing longer breaks, or rotating people between different machines, etc. Since this may cost your employer money, none of these changes may happen unless a run of court cases awards damages and changes the calculation of cost.

If this is an injury or the first signs of longer terms problems, the first step should be to rest, reduce any swelling with an ice pack, and change your sleeping position. If necessary, an anti-inflammatory may be useful, but the real benefit will come from an exercise program. It will start with massage or manipulation of the joint to ease the problems with the tendons, ligaments and muscles. Then move on to a series of specially designed exercises to improve mobility and build up strength. If movement is painful, you should use Ultram to get through the initial stages. But as your body grows used to moving in the right way, the pain should ease naturally. You should stop using the painkiller as soon as possible. This prevents you developing tolerance for the drug. Should the pain flare up again, Ultram in short bursts should bring it back under control.