Being an orthopedic specialized physical therapist, my intent is to educate you on pain of musculoskeletal origin which can vary from an ankle sprain to a headache originating from your neck (Cervicogenic headache). Pain is very complex in nature and is the driving force for one to consult a healthcare professional. An individual’s response to pain varies depending upon numerous factors like past experiences, attitude, beliefs, personality and other social factors. So, pain is not a mere physical sensation rather a state of mental and physical well being.
Consider yourself hurting your back while shoveling or pulling weeds. The inability of your back to handle the stressful force exerted while doing that activity (in a forward bend posture) resulted in injury. The compromised structure would be a muscle, tendon, ligament, disc or sometimes a joint itself. For injury of any origin the body’s protective response is through inflammation. The cardinal features of inflammation are heat, redness, pain, swelling and lack of function (Evans 1980). Swelling, heat and redness in the area are products of increased circulation, while the pain results from the presence of accumulated chemicals and heightened mechanical sensitivity even to non-injured surrounding tissues. This will manifest as aching pain even at rest, tenderness and exaggerated pain to touch and movements. Rest and relative rest are imperative at this stage and this acute inflammatory process can last for 3-5 days depending upon the extent of injury.
The next phase of healing is the repair process and this is the stage when early mobilization is warranted to optimize the correct healing. It is also the time individuals identify pain arising movements and postures and start avoiding them. If this habit is prolonged and ‘fear avoidances’ are learned, the repair processes will be retarded, remodelling of the healing tissues will not happen which will lead to limited range of movements and function (McKenzie 2003). Everytime the individual moves in the opposite direction of the injured structure, pain generates. This pain is not from the initial injury but from improper healing or bad tissue which was not mobilized to take up the normal day to day strain they are exposed to. Some people learn to ‘work around’ their pain and chances of re-injury are high. They adopt various ways to accomplish function which will strain the joint leading them to fail as they are not designed to work in that manner. ‘Derangements’ as we call these, are more painful in nature and can be more pronounced and debilitating.
Pain medications at this stage will merely mask your symptoms by deceiving the pain receptors in your brain. Anti-inflammatories are of no use or limited use as your symptoms are not from inflammation, but from an ill-joint or a poorly healed soft tissue. Only a clinician of mechanical background can differentiate between pain of chemical or mechanical origin and treat accordingly. Through a detailed assessment with Mechanical Diagnosis and Therapy, a treatment plan can be established by identifying the pathological structure and a preferred direction of movement. Patient has an active role as they are responsible for remodelling the bad tissue and recover the lost function through repeated movements in the direction of preference. Any further detailed investigation at this stage is unnecessary and has little to no effect in the treatment process.
Pain of mechanical origin are often treated as a systemic diseases like diabetes or high blood pressure where the patient has to go for ‘frequent’ follow ups to the health care provider to get better. This dependency is not a ‘right’ practice and once a treatment plan is established the patient should be equipped to self manage their symptoms and prevent recurrences. Understanding the pathology, pain behavior and following the ‘Right treatment’ when symptoms arise will bring your confidence back and help you enjoy your life to the fullest.
- McKenzie R, May S (2003). The Lumbar Spine Mechanical Diagnosis & Therapy. Volume 1. Spinal Publications New Zealand Ltd, Waikanae, New Zealand.
- Evans P (1980). The Healing process at cellular level: a review. Physiotherapy 66.256-259
Sinju Thomas PT, DPT, OCS, Cert. MDT
CEO & Senior Physical Therapist