Musculoskeletal pain and injuries, cumulatively referred to as musculoskeletal disorders (MSD’s) are often multifactorial in nature, and a primary focus of my initial visit is determining these factors so that I can address the cause(s) of the injury through in-office care, lifestyle modifications, and goal setting. First, it is important to differentiate musculoskeletal pain from a musculoskeletal injury. Pain is defined by the International Association for the Study of Pain (IASP) to be an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain can be caused by inflammation and can be present even without an injury. For example, joint pain/arthralgia may be caused by high stress or illness. An injury is a change to the physical structure of the body. An example includes a muscle strain, which is microscopic or macroscopic tearing of the muscle or tendon. The following factors can play a role in the development of MSD’s:
Intrinsic factors are biomechanical, structural, pathologic, or genetic. They are determined through my physical examination and used to develop active and passive treatment plan goals. Examples include:
- Alignment/symmetry
- Arthrokinematics
- Osteokinematics
- Flexibility
- Myofascial tissue texture/tone
Extrinsic factors are modifiable/controllable to some degree lifestyle changes. They are determined through this history and used to develop health maintenance and promotion goals. Examples include:
- Physical: repetitive overuse (ADL’s and/or occupational); exercise training errors; lifting technique; ergonomics; footwear
- Nutritional: macronutrient composition; micronutrient intake; caloric balance; antioxidant intake; fast food; processed food; toxins
- Hydration: water intake (ounces/day); sweetened beverage intake (type and number/day)
- Substance use: alcohol; tobacco
- Mental/Emotional: anxiety; depression; stress
- Sleep: amount; quality; position
- Pharmaceuticals: inappropriate or long-term use of OTC or prescription pain medications, prescription drugs with musculoskeletal side effects
While MSD’s have an intrinsic component, in my clinical experience extrinsic factors typically play more of a causative role. One of the main examples of this that I see in practice are exercise training errors. Examples of this include lifting heavy weight with improper technique or increasing training volume or intensity too quickly.
Through in-office care focused on addressing the intrinsic factors and out-of-office care involving SMART goals and data tracking through my interactive EHR system, my hope is to help you return to pain-free living without limitations!
Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., Keefe, F. J., Mogil, J. S., Ringkamp, M., Sluka, K. A., Song, X. J., Stevens, B., Sullivan, M. D., Tutelman, P. R., Ushida, T., & Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939