Bone & Joint Expert Care

Musculoskeletal Pain

From time to time we all suffer with what doctors call musculoskeletal problems: that is aches, pains and twinges in our muscles and joints. These have literally dozens of causes, and while some problems are minor and short-lived others are more serious and, unfortunately, lifelong. Many of them result from the knocks, bumps and strains that our bodies suffer in the course of our normal activities or exercise, while others are due to mild rheumatic conditions, and we can take care of these ourselves with advice and medication when necessary from a pharmacy. This article is intended to; help you to decide what you can look after for yourself; how to do it; what may need medical investigation and treatment, and some of the most common causes and symptoms of musculoskeletal pain and treatment.

Pain that attacks the muscles, ligaments, tendons and the bones is known as musculoskeletal pain. In many cases, the body's response to injury is to tense the injured area, which restricts blood flow. An increase in pain can result in increased tension and a pain-tension cycle that could be hard to overcome. Incorrect body mechanics and posture, coupled with stress, may also cause increased muscle tension and pain. People often reduce activity because of pain, may lead to gradual muscle weakness and de-conditioning, resulting in further pain.

Causes

There are many causes of musculoskeletal pain. Daily activities can cause wear and tear to muscle tissue. Trauma, such as jerking movements, auto accidents, falls, fractures, sprains, dislocations, and direct blows to the muscle, may also lead to musculoskeletal pain. Posture changes or poor body mechanics may cause spinal alignment problems and muscle shortening, this can lead to the misuse of other muscles.

Other possible causes of pain include:

• Postural strain
• Repetitive movements
• Overuse
• Prolonged immobilization.

Acute and Chronic Pain

• Acute pain usually begins suddenly and may be intense. It often triggers visible bodily reactions such as sweating, an increase in blood pressure, and more. Acute pain is generally a signal of injury to the body, recent surgery or medical illness; and it resolves when pain relief is given and/or the injury is treated. In more serious cases of pain, however, a pain medicine doctor may be necessary to help manage the pain and offer patients relief.
• Chronic pain persists, and pain is often considered chronic when it lasts beyond the normal time expected for an injury to heal or an illness to resolve. Chronic pain, also known as persistent pain, can be stressful for both the body and the soul, and usually requires careful, ongoing attention to be treated appropriately.

Common Types of Musculoskeletal Pain

Neck Pain

Like back strain, neck strain is an irritation to tendons, muscles and ligaments in the upper back and neck area. Whiplash is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion, such as in a car accident.

Back Pain

Back strain is a fairly broad category called “soft tissue injury,” which covers muscles, tendons and ligaments. About 80% of back and neck pain is muscle-related.

The stomach muscles, or abdominals, enable the back to bend forward. They also assist in lifting. The abdominals work with the buttock muscles to support the spine. The oblique muscles go around the side of the body to provide additional support to the spine.

Another type of strain relates to spinal ligaments that run in front and in back of the vertebral bodies. Tendons, which also connect muscles in the spine, can develop inflammation, or tendonitis.

Some people believe that part of what makes the back muscles more prone to strain is that they are shorter than other big muscles in the body. The muscles in our thighs that enable us to walk, run and jump are longer and less prone to strain. It’s very unusual to strain a thigh muscle.

Shoulder Pain

The shoulder can be described as several joints that combine with tendons and muscles to allow a full range of motion to the arm, from scratching your back to throwing the perfect pitch. Mobility may come with a price, however. The shoulder movement can lead to increasing problems with instability or impingement of soft tissue resulting in pain. Pain may be felt only when the shoulder is moved, or all of the time. The pain may be acute and disappear in a short time, or it may continue and require medical diagnosis and treatment.

Arm & Hand Pain

One of the only physical liabilities of having an office job is a hand injury in the form of carpal tunnel. Hands, arms and shoulders can also be hurt from sports injuries, arthritis, congenital deformities, and repetitive stress. The most common types of injuries are:

• Fractures and sprains
• Carpal tunnel syndrome
• Tendonitis
• Arthritis
• Nerve and tendon injuries or lacerations
• Rotator cuff tear
• Shoulder pain and instability
• Ganglion cysts
• Tennis elbow

Hip Pain

The primary cause of hip pain is arthritis, specifically osteoarthritis. Arthritis is the most common chronic condition and is characterized by inflammation of the joints. Common causes of arthritis include wear and tear on the bones and joint cartilage, most often when the body has too much weight to support. This can be caused by carrying heavy loads consistently for years but is more commonly a byproduct of being overweight.

Knee Pain

The most common knee problems include the following:

• Knee cap pain - the pain usually becomes most noticeable when walking up stairs, going down stairs, running or sitting.
• Pain from a torn meniscus - the meniscus is the cartilage that keeps the femur (the thigh bone) and the tibia (the shin bone) from hurting or grinding when they rub against each other. If the meniscus is torn, stretched or out of place, pain may occur when the joint is moved.
• Pain from ligament problems - there are four ligaments in the knee: the anterior cruciate ligament, the posterior cruciate ligament, the medial collateral ligament, and the lateral collateral ligament. When the ACL is torn, it is often because the leg rotates while the foot stays planted on the ground. Often times an ACL tear is accompanied by a loud popping sound from the knee and the support of the knee gives way. A posterior cruciate injury happens when the knee is forced backwards or when it receives a hard impact. A medial collateral ligament injury most commonly occurs when the knee is hit from the outside while a lateral collateral ligament injury occurs when the knee is impacted from the inside.
• Pain from tendon problems - inflamed tendons that connect the knee cap to the shin bone can cause pain.

Foot & Ankle Pain

Our feet and ankles bear the brunt of every step we take. Women in particular wear uncomfortable, jarring yet fashionable shoes that can do damage to the structure of the foot over time. Athletes are at risk of foot problems from traumatic injury, joint, tendon, or ligament problems.

The most common foot problems are:

• Foot and ankle trauma/fractures
• Ligament sprains/tendonitis
• Achilles tendon problems
• Heel pain/plantar fasciitis
• Bunions, hammertoes or claw toes
• Ankle or foot arthritis
• Flat feet deformities

Symptoms

Often times, sufferers of musculoskeletal pain complain that their entire bodies ache. The muscles may feel like they have been pulled or overworked. The muscles may twitch or burn. Symptoms vary from patient to patient, but the common symptoms are:

• Pain
• Fatigue
• Restlessness & Reduced sleep

Diagnosis

Outlined below are some of the diagnostic tools that your physician may use to gain insight into your condition and determine the best treatment plan for your condition.

1. Medical history: Conducting a detailed medical history helps the doctor better understand the possible causes of your pain which can help outline the most appropriate treatment.
2. Physical exam: During the physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted.
3. X-rays are usually the first step in diagnostic testing methods. X-rays show bones and the space between bones. They are of limited value, however, since they do not show muscles and ligaments.
4. MRI (magnetic resonance imaging) uses a magnetic field and radio waves to generate highly detailed pictures of the inside of your body. Since X-rays only show bones, MRIs are needed to visualize soft tissues like discs in the spine. This type of imaging is very safe and usually pain-free.
5. CT scan/myelogram: A CT scan is similar to an MRI in that it provides diagnostic information about the internal structures of the spine. A myelogram is used to diagnose a bulging disc, tumor, or changes in the bones surrounding the spinal cord or nerves. A local anesthetic is injected into the low back to numb the area. A lumbar puncture (spinal tap) is then performed. A dye is injected into the spinal canal to reveal where problems lie.
6. Electrodiagnostics: Electrical testing of the nerves and spinal cord may be performed as part of a diagnostic workup. These tests, called electromyography (EMG) or somato sensory evoked potentials (SSEP), assist your doctor in understanding how your nerves or spinal cord are affected by your condition.
7. Bone scan: Bone imaging is used to detect infection, malignancy, fractures and arthritis in any part of the skeleton. Bone scans are also used for finding lesions for biopsy or excision.
8. Injections: Pain-relieving injections can relieve pain and give the physician important information about your problem, as well as provide a bridge therapy.

Treatment

With any muscle pain or injury, it’s natural for an individual to stop moving the injured area and wait for it to heal. Ironically, this is counter-productive. Restricting movement causes the muscle to weaken, become less flexible and receive less circulation. In fact, gentle stretching and exercise is the best way to resolve the injury by getting it moving and increasing circulation.
Exercise is an important factor in the treatment of chronic musculoskeletal pain. If alignment problems are not treated, muscle shortening or weakness may occur, this may contribute to alignment problems, as well as poor mechanics and body posture. The more support the muscles can offer, the less stress and therefore less pain. While running or stair climbing can be taxing to the body, the stationary bike and swimming are both excellent cardiovascular activities that put minimal pressure on the body.

For patients with spine, upper extremity or lower extremity pain or disorder, pain may be managed by prescribing low doses of medicine to increase the body's level of serotonin and norepinephrine. 

Other pain management options

• Injections with anesthetic or anti-inflammatory medicines in or around the painful sites
• Strengthening and conditioning
• Physical or occupational therapy
• Acupuncture or acupressure
• Relaxation/biofeedback techniques
• Osteopathic manipulation (a whole system of evaluation and treatment designed to achieve and maintain health by restoring normal function to the body)
• Therapeutic massage

Rheumatism and Arthritis
Rheumatism is a general description for any pain, soreness or stiffness in the muscles, joints or sinews that hold our bones together, which is long-term and not the result of a knock, injury or strain. Arthritis means literally "inflammation of the joints" and covers a wide range of medical conditions, all of which are long-term but with different causes and degrees of seriousness. Many over-the-counter medicines these days can be recommended for rheumatic and mild arthritic pain, so how do you know what you can use safely and effectively, and how do you know when you ought to be seeking your doctor's, rather than your pharmacist's advice? A look at the main rheumatic conditions will give you an idea.

Osteoarthritis (OA) Osteoarthritis is due to the wearing out of the cartilage between the bones that stops them rubbing together and damaging each other. This causes the bones to become hardened and deformed and bony projections form, particularly on the finger joints, knees, hips and spine, causing pain, often severe, and joint stiffness that restricts movement. OA is very common and an almost natural result of getting older. Cartilage wear starts in our teens and we nearly all have some joint damage, but usually without symptoms, by our forties. Overuse or misuse of joints through work or sport, and injury, obesity or poor posture can all speed up the process. By the age of 60 about 20 per cent of people have developed symptoms painful enough to need treatment. Mild symptoms can be treated with over-the-counter pain relieving medicines (see below), but more serious pain will need prescription drugs. Various types of exercise and physiotherapy can help relieve stiffness and immobility, but sometimes joint replacement surgery is the only answer to OA.

Rheumatoid arthritis (RA) This condition is due to inflammation of the lining of the joints, and can lead to damage and deformity of the joints, tendons and ligaments which hold our skeletons together and keep them flexible. RA is an auto-immune disease, where the body is attacked by its own cells that normally defend it against attack by outside agents such as bacteria. The main symptoms are inflammation and swelling and pain in the hands, wrists and knees, and stiffness on getting up in the morning. Symptoms can affect the whole body, and include tiredness, depression, fever, poor circulation and dry eyes. The condition can fluctuate through phases of improving and getting worse. Except in the very mildest cases treatment is with prescription drugs to reduce inflammation, ease pain and to try to stop the condition worsening.

Muscular rheumatism (fibromyalgia, fibrositis) This is a condition of aching and pain involving muscles, tendons and ligaments, but not joints. The cause is unknown, but seems to be connected with poor sleeping, and may start following an injury, accident or viral infection. There may be a connection with ME (myalgic encephalomyelitis, also known as chronic fatigue syndrome). Pain and soreness can occur anywhere in the body, with shoulders, neck, elbows, chest, knees and lower back most commonly affected. There may also be general feelings of tiredness and depression. Unlike OA and RA, this condition can go away completely.

Treatment is with non-prescription pain relieving medication to start with, going on to stronger prescription drugs if necessary. Antidepressants are sometimes prescribed. Relaxation techniques and regular exercise are often helpful in relieving the condition.

Sprains, strains and injuries
Pain and inflammation in the muscles, joints and tendons are often the result of over-exertion or injury from physical activity, be it sport, gardening, decorating or a hundred and one other things. Most can be self-treated, although medical advice should be sought if there is severe pain that does not ease off after a short time, or if the area affected cannot move. The following are the most common conditions.

Sprains
A sprain occurs when a ligament or the capsule of tissue surrounding and holding a joint together gets overstretched, and surrounding muscle tissue may also be torn. There may be some blood leakage from the torn tissues, giving the affected area a bluish look, and fluid oozes from damaged cells causing swelling . Ankles, knees and wrists are often damaged in this way. Treatment is with RICE , and pain-relieving, anti-inflammatory medication.

Strains
Strains are injuries to muscle tissue only. If the muscle sheath is torn there will be some internal bleeding. Strains can occur anywhere around the body, including the neck and shoulders. If care is not taken during healing permanent scar tissue can form which shortens the muscle, reducing its efficiency and leaving it prone to further injury. Treatment is as for sprains.

Back pain
lumbago and sciatica Most of us will get pain in the lower back at some time. Muscular pain is called lumbago and it is usually caused by over-exertion, lifting heavy objects or twisting awkwardly. The pain is felt across the lower back, and it may radiate to the buttocks, groin and thighs. There may be stiffness, spasm in the muscles and tilting of the back to one side. With rest and self-treatment lumbago will normally ease off within a few days. Back pain may also be due to a cartilage separating bones in the spine (vertebrae) slipping out of place and allowing the vertebrae to rub together and trap a nerve. This condition is known as sciatica and it causes sharp pain that that spreads down the thighs; there may also be a tingling feeling or numbness. Any back pain that does not improve in a week with rest and self-treatment requires medical attention.

Repetitive strain injuries (RSI's) When muscles and joints are overworked by repeated use, strain or inflammation may occur that can become a long-term problem if proper attention is not paid to them. Sports-related conditions such as 'tennis elbow' is a well-known example and, in these days of increasing computer use, RSI's involving the hands, wrists, arms, neck and shoulders are becoming increasingly common. These can be avoided by not working for too long at a stretch and taking regular breaks, and by ensuring that the equipment used, including chairs, is set up for comfortable use. If left to develop for too long, RSI's can lead to permanent disablement.