Musculoskeletal injury or disorders can affect muscles, joints, tendons and ligaments in all parts of the body. These issues can happen at any time during the lifetime, in the active and inactive, and can seemingly occur for no known reason. There may be an obvious trauma or injury that is responsible for the disorder, but more likely than not the pain or dysfunction comes on without trauma. Injury, it may be sudden, in that you awoke with it, or it may be a slowly worsening niggle that will not go away.
If you currently have such a problem, you are not alone. Musculoskeletal injury is widespread, with lower back pain being the most common condition, affecting nearly everyone at some point in his or her life. Estimates suggest that in developed countries 33% of the population at any given time will experience lower back pain. In some countries, musculoskeletal disorders make up around 40% of work-related illness, suggesting that you are more likely to develop a musculoskeletal problem through your daily routine rather than through any kind of sports injury. It is therefore very likely that at some point in your life, probably in the not-too-distant future, this book may be of great use to you. In this first chapter we will briefly look at the soft- tissue repair process after injury, differentiate chronic from acute musculoskeletal problems, and outline general types of chronic musculoskeletal injury.
Soft-tissue Injury and Repair
If at any point a force is applied to the musculoskeletal structures that exceeds their ability to withstand that force, there will be disruption to the normal structure and function of that tissue. This may be minor and give you nothing more than a dull ache for a day or two. If you are no stranger to exercise or physical work, you may recognise this as muscle soreness, where there has been minor damage to the muscle tissue. With adequate rest and nutrition, this ache will subside as the inflammatory process passes and the muscle fibres are repaired and perhaps even made thicker and stronger. All of this is a normal process and happens on a daily basis as our musculoskeletal systems respond to the dynamic ebb and flow of forces applied to our bodies.
Injury. This article will focus on musculoskeletal injury problems more troublesome than muscle soreness, and more specifically on problems that have arisen when internal or external forces applied to body tissues have exceeded their tolerance and led to injury. We will take a broad look at the process of repair that many musculoskeletal structures undergo when injured, and discuss the reasons why some injuries do not fully resolve in the expected timescales. These are referred to as chronic injuries, and this article will offer targeted body-weight exercises to rehabilitate and build resilience to these types of injury.
Key Point: Soft tissue and bone breakdown and repair happens on a daily basis; it is a normal process that takes place in response to the forces acting on your body.
Injury and Inflammation
The injury may take many forms, from the obvious stretching trauma of an ankle sprain to the prolonged excessive loading of spinal ligaments and discs. Ultimately, a force has been applied that exceeds the strength of the musculoskeletal structure, causing it to deform or break.
Injury. Damage may occur to cells, muscle fibres, connective tissue fibres, bone tissue or blood vessels passing through the area. If the trauma is extreme, several of these structures may be disrupted. If blood vessels are damaged, you will develop swelling, which may appear as bruising. Damage to cells and fibres will trigger the inflammatory process; this can also result in swelling, but is usually more delayed and can take several hours or days to develop.
Inflammatory chemicals irritate your nerve endings to cause pain, reminding you that you have an injured body part that needs rest. These chemicals can open blood vessels and make them leaky, leaving the injured area swollen, red and warm. The common advice in these circumstances is PRICE Protect the injured area, Rest from further aggravating movements, apply Ice, Compress the area to limit inflammatory fluid, and Elevate where possible to allow gravity to aid in the drainage of the swelling. A fuller explanation of this method is not the focus of this book, and so we recommend in such cases that you see a qualified health or medical professional for further advice. Injury.
Key Point: Inflammatory chemicals irritate your nerve endings to cause pain, reminding you that you have an injured body part that may need a period of relative rest.
The Repair Process
Inflammation following injury can last from a few hours to several weeks, depending on the severity of the injury. The inflammatory process is essential in order to kick-start the repair process that begins alongside the inflammatory phase. During this repair process, new material is laid down to replace or bridge the original damaged tissue. In bone, joint lining and skeletal muscle, the new tissue is the same as that lost: it is like-for-like. In connective tissue, however, such as tendons, ligaments and the fibres around muscles, the original tissue is replaced: the makeshift material is commonly known as scar tissue. Scar tissue is made of collagen fibres, and this material is the structural foundation of much of the body. Eventually the scar tissue may come to resemble the tissue around it, but it will never be the same. This may lead to ongoing injuries such as a niggling hamstring strain or an ankle ligament sprain.
Injury. After a while, the newly laid collagen begins to mature; this may start at around three weeks after injury and last for many months. Links develop between the collagen fibres to strengthen the healing tissue, and the fibres begin to shrink. These last two stages indicate why sometimes the healing process is never fully resolved.
Key Point: When connective tissue, such as tendons, ligaments and the fibres around muscles, is damaged, the original tissue is replaced by scar tissue made of collagen.
When Repair Fails
As the collagen fibres in the healing breach begin to shrink and form strong bonds between themselves, you may be left with an area of scar tissue that is not fit for purpose within an otherwise healthy muscle, ligament or tendon. The fibres of these surrounding tissues will be lined up along the direction of stress, meaning that they can glide and extend under stretch and be able to take up the pull. When scar tissue is laid down, it is done so in a haphazard way, running in all directions. If the healing wound does not undergo gradual loading and movement, the fibres are not remodelled to align with surrounding fibres. The result is that you return to normal movement after a period of rest only to pull the area again, creating more inflammation and more scar tissue. As the healing fibres shrink and strengthen, this also makes the area of injury less able to respond to stress and strain, leading to re- injury, inflammation and scar tissue formation. This cycle can become an ongoing process, as an excess amount of poorly constructed scar tissue is unable to replicate the original tissue. Such a cycle can form the basis of a chronic, ongoing or recurrent musculoskeletal disorder. Injury.
Differentiating Musculoskeletal Injury
When referring to an illness or injury, the term chronic by definition means to persist for long periods or to constantly recur. This is the basis of our discussion above when looking at scar tissue repair and the dangers of inadequate rehabilitation. Chronic injuries may also be referred to as overuse injuries, to distinguish them from injuries that come on quickly after obvious trauma, known as acute injuries.
Chronic overuse injury are seen and experienced more often than acute traumatic injuries, and can easily arise from occupational, sporting or leisure activities. They tend not to be instantly disabling, and their onset is more gradual, with varying degrees of pain and dysfunction. The problem area may worsen with repeated exposure to the aggravating activity; this could be a gym or sporting movement, or more likely the result of sitting for long periods or repeating a manual task for work or leisure. Injury.
Chronic overuse injury often result from a prolonged stress that exceeds the ability of the tissue to withstand that stress. This issue can occur in deconditioned and conditioned bodies, and can depend on the amount of stress, its duration and the nature of its application. Ultimately, we can look at three potential causes:
- The tissue/body is poorly conditioned in relation to the demands of the task. In this book we focus on developing physical resilience in multiple body areas through functional exercises.
- The environment has contributed to the injury. Look at the environment, such as desk set-up, driving position or any gym/sporting equipment, to see where changes can be made to ease stress to the body.
- The activity creates excessive stress. When otherwise fit and healthy people develop lower back pain from sitting, they often want to know what is wrong with their spines. The answer is usually nothing. The human spine is not built for sitting long hours in a position of spinal flexion (bending). Modify the activity.
Types of Chronic Musculoskeletal Injury
In this article we cover specific body areas and outline some commonly seen musculoskeletal problems affecting these regions. Many of the disorders discussed are chronic/overuse injuries or were once acute injuries but have failed to reach full repair. Such musculoskeletal disorders can affect muscles, joints, tendons and ligaments in all parts of the body. We will briefly outline here the types of problems that will be explored further in later chapters.
Injury. Muscle strains can occur throughout the body, but are most common in long muscles that cross two joints; this is because there are multiple demands on the muscle to move or control more than one joint at any one time. Such injuries are often seen in the hamstrings and the calf muscle, both of which are heavily loaded muscles and play an essential role in slowing movement and absorbing force. In the relevant chapters we provide specific exercises to target the function of these muscles in order to create resilience to everyday loads. Strains to both the hamstrings and the calf can become chronic when the scar tissue is not properly rehabilitated. Again, recommended targeted exercises to complete the rehabilitation process will be given.
Tendon problems were once considered to be an inflammatory problem, but as you explore the body chapters in this book, you will see that we attribute them more to degeneration of the tendons. This notion is based on current thinking and research in this area, and we offer targeted exercises to help rehabilitate tendinopathies or to develop resilience to developing tendon disorders. Common problematic tendons include those at the shoulder, the elbow, the knee and the ankle. Injury.
Ligament sprains can become chronic if not fully rehabilitated. The scar tissue within the healing ligament may be of poor quality if you have not developed a gradual load through the ligament. When stress is suddenly applied, even with normal activities, you may find that the area swells and becomes painful. Such a problem is commonly seen in the ankle after an inversion sprain. There may even be some instability in the area following ligament injury, and so it is essential that the muscles can react adequately and provide additional support to the joint. We offer targeted exercises to develop resilience and rehabilitation for ligament stability injuries to the shoulder, the knee and the ankle.
Finally, it is worth considering joint-related problems. Especially, but not exclusively, in weight-bearing joints, osteoarthritis can develop; this is a relatively common disease in older joints but it is not just an affliction of the elderly. Age may be one factor in joint osteoarthritis, but there are many other contributing factors, such as genetics, obesity and prior injury. Nutrition and hydration may also play a part. Many people hold the notion that osteoarthritis is a condition that will just get worse, or that movement will aggravate it. Neither of these ideas is necessarily true, and we offer targeted exercise as an evidence-supported form of managing pain and dysfunction from osteoarthritis.
Ross Clifford & Ashley KalymA Four-Inch-Long Penis Is More Than Adequate