How did that happen?

How did that happen?

People often wonder how their pain came on, without having necessarily injured themselves. Actually, most musculo-skeletal conditions do not have an actual cause or associated injury. So one might ask how these musculo-skeletal conditions actually occur, then?

Injuries DO cause musculo-skeletal pains, but these are actually less common than many people realise. To understand this better, we shall use a well accepted medical model (graph) to explain how musculo-skeletal conditions occur.

In the graph (please see below), where Time is along the x-axis, and Pain is along the y-axis, pain is only felt after the Threshold has been reached (the stipled line across the graph).

Point 1 on the graph demonstrates that over a very short period of time, the pain threshold may be reached quickly. This type of injury occurs when individuals have been involved in bad car accidents or fallen hard down stairs. These people immediately feel or develop their back or neck pain/stiffness, which is typically severe in nature.

More commonly, Point 2 on the graph demonstrates how pain ‘simmers’ like boiling water, which brews until it reaches boiling point. This ‘boiling point’ for musculo-skeletal conditions is the Threshold after which symptoms are felt. This is how repetitive strain (or overuse injuries) occur. They happen due to people spending long hours at the computer, or sleeping in poor positions, amongst other activities.

Prior to the ‘boiling point’ of feeling pain or stiffness being reached, there may have been a ‘tweak’ or a ‘twinge’ (point 3), but nothing that makes the person get to the doctor. Until one day, one wakes up having slept awkwardly or one moves awkwardly, and immediately develops pain/stiffness. It actually isn’t “sudden”. It’s the accumulation of weeks or months of ‘brewing’ over time (point 4). Only a minor incident is required to bring it to the Threshold, where one starts to feel the symptoms (point 5). That’s usually when we see most patients presenting with their musculo-skeletal aches and pains.

So our primary goal as health practitioners is to return the patient to below the Threshold of pain (point 6). Once achieved, one would assume that the problem has been resolved. However, although the pain or stiffness may have gone away, the problem hasn’t necessarily disappeared!

The analogy here would be like saying that once the heart attack has been managed, that the patient’s problem has vanished. We all know that isn’t true for cardiovascular disease, and indeed it isn’t true for musculo-skeletal conditions as well.

So what happens? Daily and weekly activities cause these problems to re-occur, sometimes weeks or months later (point 7). Studies suggest that 2 out of every 3 patients experiencing back or neck pain will have a recurrence within 1 year.

So it becomes important for health practitioners and patients to identify all possible aggravators (point 8). These factors include poor sleep and work postures, carrying weekly shopping bags/laptops, and stress, amongst other things.

This also has implications regarding how to manage chronic musculo-skeletal conditions (ie: lasting for longer than 3-6 months). However, that will be discussed in our next blog post.