Musculoskeletal Pain and Injury Explained

Did you know?

1. Literature articles report that up to 58% of our [western] population is presently experiencing significant musculoskeletal pain.(Urwin et al, Ann Rheum Dis. 1998 Nov).
   
2. 80% of us suffer at least one significant episode of Low Back Pain at some time in our lives.(Deyo et al, NEngl J Med, 2001, Anderson G et al, The Adult Spine: Principles in Practice,1997).
   
3. More than 10% of our population experiences debilitating Low Back Pain every day(Walker et al, J Manipulative Physiotherapy; 2004).
   

    

If you have suffered, or are suffering pain and injury then you can rest assured you are not alone. The good news is that the vast majority of these painful problems are not permanent, and can be much improved very quickly with great physiotherapy.

Why would the incidence of musculoskeletal injury & pain be so high? What are we doing that brings on so many problems to so many people?

There are generally 2 classifications of musculoskeletal pain and injury:

1. Accumulative strain or Cumulative Trauma
2. Non-accumulative strain

Accumulative strain or Cumulative Trauma

A number of published journal articles explain the detrimental effects of accumulative strain on the musculoskeletal system leading to pain and disability (WS Marras, The Spine Journal, 2003; Village J et al, App Erg, 2005; Kumar S Spine 1990.)

Accumulative strain is the process of minor forces repetitively acting on ligaments, joints, muscles or nerves due to a lack of good control [poor position] of the body parts involved. A simple analogy can be if you imagine a door with its hinges positioned incorrectly and the corner rubbing against the frame every time it moves – eventually the structure of the edge of the door breaks down. Our bones are like the frame and door and the hinges are like our muscles controlling the door.

Also, some tissues suffer accumulative strain through sustained tension over time. Another simple analogy is if you imagine a rubber band that has been held in a stretched position for a long time (e.g. a year); its structure is weakened and requires very little force to snap the band. A similar process occurs to tissues in the body such as the ligament tissues; for example the annulus fibres that make up ‘discs’ between our spinal vertebrae. These ligaments are quite elastic, like a rubber band, and if your muscles don’t hold a good position of the vertebral bones [i.e. poor posture] then sustained or repetitive tension is applied to the ligament fibres and this can weaken the structure. It doesn’t take much force [slouching, or sitting up too straight, is enough], or time [just twenty minutes or more each time repeated frequently over months or years] for the fibres to ‘strain’ to the point that negative signals are sent to the brain warning of the damage becoming dangerous. Protective mechanisms and pain are the result.

Non-accumulative strain

1. A one-off incident with high force causes the injury and pain. For example; a motor vehicle accident, falling from a height, slipping and falling, being tackled or hit etc.
2. More rarely, diseases cause musculoskeletal pain, for example different types of arthritis, infection, and genetic diseases.

Physiotherapy is widely used to relieve the strain to the vast majority of musculoskeletal conditions in both the categories above, very quickly. In our experience, you don’t have to wait for full anatomical healing to occur to be able to be pain free and back to full function!

Getting back to the cause of pain and injury…

Which of the above is the major cause of most musculoskeletal problems?

1. Accumulative or 
2. Trauma and disease?

You might be surprised to learn that it is by far the Accumulative Strain that is the major underlying cause of most injuries and pain that most of us experience. Often when the pain onset seems to occur suddenly it is actually the movement which was the ‘straw that broke the camel’s back’.

Another way to analyse if the cause of a problem is accumulative is to look at whether the same, or similar, activity when the pain occurred had been performed previously. If so, then it is unlikely that the activity itself was the cause, but more likely the many times it had been performed in the past without adequate muscle control.

Ridgway Method Model of Musculoskeletal Health

The graph below summarises:

• ‘Optimal’ with the blue line showing minimal strain with well balanced ‘hinges’ (muscles and joints) during daily life.
• ‘Subclinical’ strain that build up over time, the maroon area, and not enough to require conscious warning with the brain creating pain.
• ‘Clinical’ is shown by the yellow area, where the brain’s guarding protection and warning signal creating pain turns into a vicious cycle that does not quickly settle by itself. The point where the Strain Line hits the Pain Threshold is the point where the “straw breaks the camel’s back.”

Common activities that produce the kind of accumulative strain shown above are:

• Pushing beyond normal ranges, and-or prolonged fatiguing positions
• Turning your head to reverse the car
• Bending over to put on shoes
• Bending over to pick up a heavy object such as a pot plant
• Using a computer for many hours each day
• Sitting for many hours each day
• Driving for many hours
• Repetitive tasks without many breaks and variation (painting, cleaning, manual work)
• Repetitive actions in sport … and many more (basically, anything performed for long periods or repetitively)

Is it any wonder that so many people in our society suffer musculoskeletal pain? But, remember, it’s not the activity that leads to accumulative strain; it’s the way the activity is performed with your muscle control.

Sometimes the body part in which the brain creates pain is the area that suffered the injury. And… of great interest, most commonly the area you experience your pain is different to the body part that suffered accumulative strain. We term this “referred pain”.

You might imagine it can be tricky to solve the cause of a condition if the pain is in a different area. It is a big challenge… and Ridgway Method Certified Practitioners, such as the  team at NWPG, have a unique system that allows us to solve the cause very efficiently.

The Ridgway Method provides a reliable system for rapid problem solving and confidence to resolve the actual cause of a condition(in the vast majority of cases).

The RM Progress Graph below describes the typical results achieved with the Ridgway Method.
Each improvement made with RM treatment is represented by a downward slope of the graph. In this example below the treatments achieve a pain-free state in 120-minutes (four sessions). The norm is for this method to achieve pain-free, full range in 60-240 minutes of assessment and treatment (2-8 visits) within 2-4 weeks. If the results are not coming this quickly we may not be the right practitioners for the job! In these cases we will help you find the right practitioner.

Ridgway Method Musculoskeletal Recovery Model: RM Progress Graph

This accumulative strain description is true for every body part; your back, neck, jaw [TMJ], rib cage and your limbs. Including all kinds of conditions from spinal disc strain, sciatica, neck-headaches, tennis elbow, shoulder impingement, carpal tunnel, muscle ‘tears’… and many more.

For optimal results prevention of recurrence is the key. For this reason it is important to note that increasingly less frequent sessions are needed after achieving the pain-free stage (X, Y & Z above) – These sessions are referred to as Tune-up sessions, and are part of the Prevention and Optimisation Stage of management at NWPG. They generally occur after the Diagnosis and Treatment Phases of management have been completed.

Prevention is better than cure, and the Prevention and Optimisation stage is for us to assist you manage your condition in the most optimal way. There are 3 main reasons you want this type of service:

1. To test how well you are managing the condition on your own.
2. To progress your skills for achieving better movement patterns that will further prevent recurrence of your condition.
3. To treat any re-accumulation of strain that has occurred through simply living!

The average frequency of POP treatments for non-elite athletes is graduated to 30 minutes every 1-3 months.

The very positive side-effect of this kind of treatment is that performance enhancement also occurs, as optimal muscle control to prevent recurrence is the same muscle control required for best performance!

A Common Question – Why can’t I just ‘sit up straight’ to hold good posture and prevent pain?

There are two answers to this question:

1. Most commonly when we ‘sit up straight’ our automatic action doesn’t position the spine into its ideal curves. While a ‘straight’ spine looks good, it can still place excessive strain on the tissues between the vertebrae. It’s the way the sitting-up is done that matters.
2. Once we have developed a habit of less-than-ideal posture, the gradual stiffening of the joints actually makes it harder to get into the ideal positions when we try.

Correcting this common problem most rapidly requires a good problem solving system as each individual is different.

For Traumatic and Accumulative injury, the Ridgway Method solves what kind of muscle control is required for long term solution for each individual. This problem solving process for pain requires a lot of technical skill, a lot of individual personal attention, including advanced problem solving and advanced testing methods. RMCPs have advanced training and advanced assessment skills to achieve the Ridgway Method technical problem solving process. 

Teamwork

We understand the importance of everyone working together for achieving your goals.This is why RMCPs work hard at helping people that support you – instructors, coaches, personal trainers, parents of younger clients, group leaders, therapists, GPs etc.

Please consider sending the link to this page to someone you think would be interested to learn this forward-thinking information.

If you have questions please contact us and ask.

Please note: Your situation may vary from the explanation above. If you are not sure, please ask your physiotherapist to confirm your individual condition. We offer our unique injury prevention services in one-on-one, hands-on consultations ready for your booking for today, or you can express your interest in our group workshops.