Introduction into painful conditions and what causes them
Before individualizing specific painful conditions that many of us will suffer at some stage in our lifetimes, I wanted to write a brief introduction on what pain is and the issues it causes. Physiologically, pain is nothing more than an electric signal caused by a chemical reaction within the body whereby chemical mediators are released due to some form of micro- or macro- trauma, whether it be acute or chronic, that signals a type of warning response from the brain.
Considering pain from our primitive existence, it was a learning tool that taught of dangers and perils. While the majority of the risks since then have changed, the response mechanism is the same. The majority of painful soft tissue conditions in the developed world are caused by non-traumatic incidents where poor posture and/or faulty movement mechanics are to blame. Typically these are related to work and/or sedentary lifestyle choices because the body will adapt to activities or lack of activities that it does most.
Muscles, which are the active stabilizers of the body and are responsible for simultaneously providing movement and stability, are unable to correctly activate or fire under load or during movement. Each jointʼs opposing musculature should be evenly balanced with flexibility and strength so that optimum and efficient range of movement and motion can be achieved, respectively. Even in a simple single movement, this happens many times around the body in joints near and far to the one being moved, as well as the spine. However, faulty adaptation(s) jeopardize correct movement mechanics. For example, sitting or standing for long periods of time causes specific muscles to lengthen and shorten, respectively, as the body manages these external stressors. However, when it comes time to move, muscles that have shortened (tightened) require accessory movements from other joints and other areas of the body to complete the desired action. This also occurs because depending on the nature of your activities, muscles will atrophy or weaken most commonly in stabilizing muscles whose importance is often underestimated. When this happens muscles that are designed for movement also have to provide stabilization to the joint, which causes it to fatigue easily. Ultimately, this alters the loading pattern(s) of the body and leads to overuse injury from muscle and tendon breakdown and/or damage to supporting passive stabilizing structures like ligaments, bone, menisci, fascia, vertebral discs, etc. These micro-traumas can cause swelling in the body that cannot be seen, but still pressurizes internal cavities or structures and manifests as pain; and will continue to do so until movement deficiencies are corrected. Pain in soft tissue structures can also arise from gross trauma to a body part or joint (ie. sprains, strains, contusions, fractures, lacerations). However, it is often at these times that the injury is most cared for with the use of healing aids, topical relief, immobilization techniques, medication, etc. And there is nothing wrong with these methods. Where we often let ourselves down is after we think we are healed. We can see evidence of healing with the reduction of swelling, through x-rays and the removal of a cast, or diminishing of bruising and it is thought that all is back to normal because function has slightly increased and the majority of the pain that was once felt in relation to the injury has vanished. However, where the hard work should just be beginning, is often where some therapists, insurance companies, and you stop. In the words of Gray Cook, “Pain changes everything.” When the body is injured, it is able to maintain relative functional movement through compensatory patterns that avoid stressing the injured area, which manifests as a limp or reduction of range of movement. While these compensations are paramount to maintain function, they become learned behaviors and do not just disappear after injury. For example, one of the first goals of a therapist after a lower limb injury is the retraining of normal gait. Common failure to manage these issues will then have identical implications as those discussed in non-traumatic injuries despite the initial traumatic injury having been healed weeks, months, or years prior.
Each jointʼs opposing musculature should be evenly balanced with flexibility and strength so that optimum and efficient range of movement and motion can be achieved.
It is common to view pain as the problem. In reality, pain is still the same warning mechanism that indicates something internally is wrong or has become stressed. Using assessment tools and previous research, painful conditions have been “mapped” and can provide answers to underlying issues. Just because the reason for the pain cannot be seen with the eye or manifests itself as a measurable entity, it becomes easy to account pain as the problem when in reality it originates from previous, often repetitive, actions that have altered the way the human body moves and manages physical stressors. Ignoring it, using medication, or even seeking basic therapeutic care will only cause the injury, and therefore pain to become cyclical because in fact the “true” problem remains and will return. The only cure is to change the way one moves and manages external load(s). In this series of articles we will discuss common painful conditions of the joints and how they can be managed through exercise. By using exercise as an intervention, the pain/injury cycle can be stopped and quality movement can once again be achieved as our bodies were designed to do.