Chemo and MSK pain: how cancer treatment affects your body

Why chemo causes joint pain

Not all joint pain during cancer treatment comes from chemotherapy. Hormone therapy, immunotherapy, changes in activity, existing health conditions, and other causes may contribute. Possible causes include:

• Chemotherapy medications. Certain drugs, particularly taxanes such as paclitaxel and docetaxel, can cause temporary muscle and joint pain. This is sometimes called taxane-associated acute pain syndrome (TAPS). In a 2017 study of patients receiving docetaxel for breast cancer, nearly 75% experienced episodes of increased joint pain, while about 78% reported increased muscle pain over three treatment cycles. Keep in mind these findings are specific to docetaxel—not all chemotherapy drugs have this effect.

• Hormone therapy. Some cancer treatments lower estrogen levels or block estrogen’s effects. These changes can contribute to joint pain and stiffness, particularly in people taking aromatase inhibitors for hormone-sensitive breast cancer. Note: Hormone therapy is different from chemotherapy, although it’s possible to receive both.

• Immunotherapy. Treatments that help the immune system recognize and attack cancer cells can sometimes cause immune-related side effects, including joint pain or inflammatory arthritis. These symptoms usually require medical evaluation because they may need specific treatment and, in some cases, changes to cancer therapy.

• Changes in activity levels. Fatigue, nausea, and other treatment side effects can make it harder to stay active. Reduced activity can contribute to muscle weakness, stiffness, and lower endurance, which may make everyday activities feel more difficult, Dr. Mercer says.

Chemotherapy and some other cancer treatments can also cause peripheral neuropathy, which affects the nerves outside your brain and spinal cord. 

Neuropathy may cause tingling, numbness, burning, altered sensation, or nerve pain, often in the hands and feet. Neuropathy is different from joint pain: it results from nerve dysfunction rather than pain arising primarily from a joint, although both can occur at the same time.

Because cancer-related pain has several possible causes, be sure to inform your oncology team about any new or worsening symptoms rather than assuming they are an expected side effect.

Chemo body aches and joint pain: what it feels like

Treatment-related muscle and joint pain can vary depending on the therapy you are receiving. Some people experience a dull ache or stiffness, while others notice more widespread soreness or discomfort that makes movement harder. Symptoms may include:

• Aching or stiffness in the knees, hips, shoulders, hands, or other joints

• Muscle soreness, tenderness, or a heavy feeling in the arms and legs

• Discomfort after sitting or lying down for long periods

• Pain that makes walking, climbing stairs, or other daily activities more difficult

• Tingling, numbness, burning, or altered sensation in the hands and feet, which may indicate peripheral neuropathy rather than joint pain

• Fatigue that makes it harder to stay active or manage discomfort

Some people feel especially stiff after a period of inactivity, such as first thing in the morning, Dr. Mercer says. Gentle movement may help some people feel more comfortable, but persistent or significant morning stiffness should be discussed with your care team.

How long does chemo joint pain last?

It depends on the treatment, the cause of your pain, and how your body responds. For example, with taxane-associated acute pain syndrome, muscle and joint aches often develop within the first few days after treatment. 

“In general, we tend to see people have more pain two to five days after treatment, and then it begins to improve,” says Dr. Mercer.

But that timing doesn’t apply to every chemotherapy medication or every person. Some people experience symptoms throughout treatment, while others continue to have discomfort afterward.

If your pain is not improving, becomes more intense, or changes unexpectedly, tell your oncology team as soon as possible.

Exercise after chemotherapy: what's safe?

Movement can be a helpful part of managing cancer-related muscle and joint symptoms, but the right amount and type of exercise depend on your treatment, symptoms, medical history, and current health.

“Exercise raises levels of certain mood-boosting hormones in your brain like endorphins, and also strengthens all your muscles to better support your joints,” says Dr. Mercer.

Regular physical activity can help maintain muscle strength, improve physical function, and reduce cancer-related fatigue. In fact, guidelines from the American Society of Clinical Oncology (ASCO) recommend aerobic and resistance exercise during active cancer treatment when appropriate.

Exercise may also help with certain treatment-related symptoms. For example, a 2023 study involving 134 people treated for ovarian cancer found that a six-month aerobic exercise program improved self-reported symptoms of chemotherapy-induced peripheral neuropathy, including numbness, tingling, and other nerve-related discomfort.

“In general, the more active you are, the better you’ll feel, as exercise reduces inflammation in your nervous system that makes you less sensitive to pain,” explains Dr. Mercer. You can use a program like Hinge Health, where you may access a PT via telehealth/video visit.

However, that doesn’t mean exercise has been shown to relieve every type of chemotherapy-related joint or muscle pain. The benefits depend on the underlying cause, the exercise program, and your health and treatment needs.

Also, you don’t need to push through a strenuous workout to benefit. Walking around your home, doing gentle stretches, or practicing a few strengthening exercises may be a reasonable place to start for some people.

A physical therapist with experience in cancer rehabilitation can help you choose activities that match your symptoms, treatment schedule, and goals. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. If you have severe weakness or substantial balance or neurologic symptoms, an in-person assessment may be especially important.

Always check with your oncology team before beginning or changing your exercise routine, especially if you have:

• Low blood counts

• Significant fatigue

• Dizziness

• Balance problems 

• Peripheral neuropathy 

• Bone metastases

• Recent surgery

• Heart or lung problems

• Other treatment complications

Ways to manage cancer treatment body pain

Managing joint and muscle pain during cancer treatment may involve a combination of simple, at-home treatments including gentle movement, physical therapy, symptom-relief strategies, and medical care. Here are some approaches that may help:

• Try physical therapy and targeted exercises. Targeted exercises, such as the ones above, can help strengthen and stretch the muscles around your joints, which can help ease pain. You can do exercise therapy at home or work with a physical therapist who can guide you through movements tailored to your needs. You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit.

• Stay active in manageable ways. You do not need a formal workout every day. Short walks, gentle stretches, and light household activities may help you keep moving. On days when symptoms are more intense, even a few minutes of comfortable movement may be enough. Activity should not be used to push through severe pain or significant fatigue.

• Ask about heat or cold therapy. A warm compress or cool pack may provide temporary relief from certain muscle or joint aches. Check with your oncology team first, particularly if you have neuropathy, reduced sensation, skin changes, poor circulation, an affected treatment area, or an implanted device. Use a protective layer, avoid extreme temperatures, and limit the duration according to your care team’s advice.

• Use support when you need it. A cane, walker, shower chair, or other assistive device may help you conserve energy and move more confidently on difficult days. “It prevents you from being stuck in bed all day, which can actually worsen chemo body aches,” says Dr. Mercer. A physical therapist can help you choose and use the right support. Assistive devices do not treat the underlying cause of pain, but they may improve safety and function.

• Get advice on complementary treatments. Talk to your provider if you’re interested in trying alternative treatments for chemo joint pain relief, such as massage or acupuncture. They have both been shown to help relieve cancer-related muscle and joint aches and pains.

• Discuss pain relief with your oncology team. Depending on the cause of your symptoms, your care team may recommend medications or other treatments. Do not start over-the-counter pain relievers without checking first, since some can increase bleeding risk, affect kidney function, interact with other medicines, or mask a fever during chemotherapy.

Tips for staying active during chemo

Your energy, strength, and symptoms may change from one day to the next during cancer treatment, and that’s normal. Rather than following a rigid exercise schedule, aim for a flexible routine that you can adjust throughout treatment.

• Make small, practical adjustments. “Try to set up your environment so that you can minimize extra steps on days where you have a lot of pain and fatigue: for example, set up your exercise space by a wall so that you can use it for support during your workout,” says Dr. Mercer. Keep water and a sturdy chair nearby, too.

• Plan around your treatment cycle. If you tend to feel more tired or achy after an infusion, schedule lighter activities for those days and save more challenging exercises for when you feel better. Some people notice symptoms a few days after treatment, but everyone’s pattern is different.

• Ease into movement after resting. Gentle ankle pumps, wrist circles, or other comfortable movements can help you get moving after spending time in bed or sitting. Start slowly, especially if you feel weak or lightheaded.

• Track your symptoms. Note when pain or fatigue occurs, how intense it feels, and which activities seem to help or aggravate it. “Everyone is different, so an individual journal helps your medical team and physical therapist work around chemo joint pain,” explains Dr. Mercer.

When to see a doctor

Some muscle and joint aches are expected with certain cancer treatments, but new or worsening pain should be discussed with your oncology team.

Contact your care team if you experience:

• Joint or muscle pain that is severe, persistent, or interfering with everyday activities

• New or worsening numbness, tingling, burning, or weakness

• Pain that becomes progressively worse between treatment cycles

• New swelling, redness, or warmth around a joint

• Pain in a specific bone, particularly if it is new, persistent, or worsening

• New difficulty walking, repeated falls, or worsening balance

• Symptoms that begin after immunotherapy, especially joint swelling, prolonged morning stiffness, or reduced range of motion

Seek emergency care for symptoms such as chest pain, severe shortness of breath, sudden inability to bear weight, severe pain after a fall, sudden severe weakness, or new loss of bladder or bowel control. Tell the medical team that you are receiving cancer treatment.

PT tip: Be flexible

Your exercise routine does not have to look the same every day, especially during cancer treatment. “Chemo joint pain requires a different PT approach than typical musculoskeletal pain,” says Dr. Mercer. “There may be some sessions where you can easily do an hour’s worth of exercise, and some where you can barely move at all. Work with your PT to find a mix that addresses where you are at the moment.”

How Hinge Health can help you

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.