Baroona Physio, Brisbane's Physiotherapists
Explanation of Musculoskeletal Injury and Pain...
The information below covers:
How many people are suffering musculoskeletal injury & pain** and why?
Did you know?
- Literature articles report that between 25% and 45% of our [western] population is presently experiencing significant musculoskeletal pain. This is between 440,000 and 790,000 pain sufferers in Brisbane right now.
- 80% of us suffer at least one significant episode of Low Back Pain at some time in our lives.
- More than 10% of our population experience significant musculoskeletal pain every day.
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, are often better in less than three months and can be much improved in less than a week 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?
Let’s start to answer that question by looking at the possible cause of musculoskeletal pain and injury in two categories:
1. Accumulative strain or Cumulative Trauma – published journal articles¹ explain that this 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 fibers and this can weaken the structure. It doesn't take much force [just slouching 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 your brain perceives the damage becoming dangerous. Protective spasm and pain is the result.
2. Non-accumulative strain – a) 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.
b) More rarely, diseases cause musculoskeletal pain, for example different types of arthritis, infection, and genetic diseases.
It is not commonly known that great physiotherapy can relieve the strain to the vast majority of musculoskeletal conditions in both the categories above, very quickly. You don’t have to wait for 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 analyze 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 likey the many times it had been performed in the past without adequate muscle control.
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'.
Model of Musculoskeletal Health
Common activities that produce the kind of accumulative strain shown above are where pain occurs that are most likely the result of accumulative strain:
- 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 the 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 we have a unique system that allows us to solve the cause very efficiently.
You are in good hands with the for rapid problem solving and confidence the actual cause is resolved and prevented from recurring.
The graph below describes the typical results achieve with the Ridgway Method for the vast majority of conditions.
Each improvement made with treatment is represented by a downward slope of the graph. In this example below the treatments achieve a pain-free state in three sessions. The norm is for this method to achieve pain-free, full range, in three to six visits. 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.
Musculoskeletal Recovery Model
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).
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!
The information above means that, in the vast majority of cases, not only can the strain be quickly relieved with great physiotherapy but the underlying cause of the problem can be solved with learning to control your body parts well.
You don’t have to wait until you’ve suffered pain to get this help! At Baroona Physiotherapy we are leading the musculoskeletal health industry with developing methods and courses that teach you all the good muscle control techniques to avoid these problems in the first place! Baroona Physios teach this method to practitioners Australia-wide.
The great news is that applying these methods for improved muscle control not only decreases the risk of injury they also result in performance enhancement! Thousands of our clients have participated in our injury prevention and performance enhancement workshops. The most common feedback is their amazement at immediate changes and ease of self monitoring for practice.
These performance enhancement methods allow athletes, workers, and home-bodies to be more efficient. Going back to the analogy of the door hinges positioned poorly, imagine the extra force required to move the door while it’s rubbing on its frame. You know it would be much more efficient, faster, and take less energy if the hinges [muscles] held the door correctly during the movement [your sport, work or play].
Let's think about the analogy of the repetitive or sustain forces that weaken ligament fibres, like an elastic band; with resulting protective spasm. This spasm builds gradually over time and stiffens a body part even before you know that there is a problem. Have you heard of someone getting a ‘stiff neck’ over time? It’s not the time that causes the stiffness; it’s the ‘strain’ and protective spasm developing due to poor [postural] muscle control. Another example is tight hamstrings [back of the thigh muscles]; one common method for the body to protect strain developing in the back is for hamstring muscles to tighten. This stiffening causes compensation in other body parts that usually reinforces the damaging strain that causes it. And no amount of stretching or massage to your hamstring muscles will help in this case, as this does not get to the cause of the tightness.
It’s not all doom and gloom, these resulting problems of spasm, stiffness and pain can be relieved rapidly with great physiotherapy care.
There’s a world full of habits that can change for the better by learning good muscle control!
The skills needed for good muscle control are not easy unless taught by physiotherapy advanced methods that we perfect.
There are two answers to this question:
a) 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 still places strain on the tissues between the vertebrae. So, again it's the way the sitting-up is done that matters. Optimal deep muscle action to hold the neutral curves is best.
b) 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.
The best answer to both of these dilemas is rapidly gaining ideal movement with great tissue de-loading, hands-on physiotherapy and then learning our advanced skills for activating the ideal muscles for supporting good positions [good posture]. To learn more see our 'Is sitting up straight good for you' answer in our FAQ page.
For Traumatic and Accumulative injury, the Ridgway Method solves what kind of muscle control is required for long term solution.
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; but the principle is simple when a good practitioner knows why and how to do it.
Taught to physiotherapists in Brisbane and throughout Australia!
Some musculoskeletal conditions have significant factors which are best treated with other professionals along with great physiotherapy.
- Fitness professionals – Are you happy with your exercise routine? Exercise Physiologists, Personal Trainers and Fitness Therapists are ideal support for long term maintenance of your strength and fitness levels.
- Psychologists – Do you notice how you are feeling as a result of experiencing pain? Can you identify if those feelings add to your pain intensity? Stress is one of the four major factors contributing to musculoskeletal pain and great psychological strategies exist to modify stress and its perpetuation of pain.
- Acupuncturists - For some musculoskeletal conditions the combination of physiotherapy and acupuncture can provide swift, long term relief more effectively than either modality alone.
- Surgeons – Some conditions are best treated surgery and many conditions are best managed with trialing great physiotherapy before committing to surgery. We can quickly help you get to your best course of action.
Great communication with each professional caring for your condition is our forte. We understand the importance of everyone working together for achieving your goals. We know many trusted professionals for your complete care, see our trusted links page.
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 visit our ‘Ask Your Physiotherapist’ page.
Please note: Your situation may vary from the explanation above. If you are not sure, please ask your physiotherapist to confirm your individual condition.
¹Published journal article: Marras Wm S: The case for cumulative trauma in low back disorders. The Spine Journal 3 (2003) 177.
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