Our Current State of Pain and Injuries
The United States is el numero uno on the planet in reports of musculoskeletal pain. Currently, 43% of Americans report chronic pain. In order to combat this high level of pain we have developed a habit of obtaining and consuming opioids at alarming rates. In 2008 we consumed 80% of the world’s opioid supply while having 4.6% of the world’s population (Manchikanti).
The United States is also #1 in ACL tears (200,000/yr) and surgical reconstruction (150,000/yr), which costs our medical system $1 billion dollars (Joseph 2013). It is interesting to think about why we may be leading in these categories amongst other countries.
There are multiple reasons this has happened. One of the more overlooked and less understood by the general public is an over-reliance on imaging and poor screening by medical doctors. This compounded with poor diets, lack of physical activity, poor workplace ergonomics, low health literacy, and poor sleep habits creates a widespread state of unhealth in the United States. Physical therapists are also not free of blame as we have also contributed by underloading our patients. We can change this trend and it begins with educating yourself on the issues.
X-rays and MRIs are NOT the Whole Story
There is now overwhelming evidence that has demonstrated pathology seen on a medical image will not correlate to actual symptoms. This means the findings from the image you receive does not mean that is the source of your pain and symptoms.
Too often patients say they have a disc bulge, arthritis, are “bone on bone,” or have a partial tear and assume, or are informed, that they need to stop doing what they love. They have been told they can’t run again or squats are bad for their knees and this creates a negative ripple effect. It is important to understand that imaging is only a piece of the puzzle and that loading the system appropriately is almost always the correct prescription. You can still do what you love with the appropriate program.
A study in 2017 by Herzog et al found that when 10 different MRI centers looked at the same image of a 63 y.o. woman with Lower Back Pain there were 49 distinctly different findings! Imagine how confusing that would be for a patient and how it would affect her diagnosis, subsequent choice of treatment, and beliefs about the state of her body.
Studies on imaging have found that things like joint degeneration, disc bulges, tears, etc. are prevalent in people with or without pain. This means they are likely just a normal part of aging and do not need to be assumed to be the source of pain. They are the wrinkles on the inside.
Developing a smart and worthwhile plan of care involves thinking about the whole picture of health on an individual basis! We need to ask ourselves about the state of each aspect of our health. How are we doing with our diet, sleep, exercise, stress, and relationships?
Image of a lumbar spine with two disc herniations
Prescribe Exercise, because it is Medicine
If we think of ourselves as living machines that have evolved with musculoskeletal locomotion as a unique primary function, then we can see that too much REST can lead to RUST. This has become the case more and more often as our workplaces involve computer work and more digital integration. To combat this and stay healthy we need to move and load more often in specific ways that don’t compound the repetitive postures we are in on a daily basis..
According to Alnadi et al. those with non-specific knee pain showed 10-56% decrease in quadriceps strength compared to controls.
In 2018, Hewett found there was a reduction of 50- 67% in ACL tears after undergoing a strengthening program.
Youngstedt (1997), found exercise (in late morning/early afternoon) improves sleep quality, REM sleep, deep sleep, total sleep time, and self-reported energy levels.
If you are in pain and/or rehabilitating an injury it is especially important to appropriately load and practice movement patterns that will create robust tissue health.
As a physical therapist, our specialty is evaluating people’s health to determine what areas they need to focus on in order to return to doing what they love. We take the time to explain what their medical imaging may mean or if medical imaging is needed to get the outcome they desire.
Our desire as a physical therapy clinic is to empower patients so that they can learn to practice quality health habits that will eliminate their pain and dysfunction in a safe, yet aggressive, manner so that no time is wasted.
ABOUT THE AUTHOR
Dr. Steve Behm
Steve is a Doctor of Physical Therapy who believes in taking the time to understand each patient’s lifestyle and how that can impact their physical health. Steve is focused on getting patients back to their normal lives and doing the things they love.