We’ve all experienced it or at least heard of it, ‘I threw my back out’ or ‘I tweaked my shoulder, hip , knee etc.’
Musculoskeletal (MSK) injuries, whether they be acute such as a sprained ankle, or chronic such as long standing back or shoulder pain are incredibly common around the world. In fact A 2017 study published in the renowned British medical journal ‘The Lancet’ that included data from nearly 200 countries over 27 years found that low back pain is THE leading cause of Years of Disability 1 . Furthermore, in the US, a 2020 study published in JAMA 2 found that MSK conditions cost American health care system more than any other single group of ailments studied!
A simple first line treatment of most MSK injuries includes therapeutic exercises3, however relatively few people ever make it to formal physical therapy. The reasons for this are many, including cost of co-pays, missing work, and inconvenience of getting to a physical therapy clinic. Unfortunately these barriers make it difficult for a person suffering from a musculoskeletal injury to get the most basic treatment they need to overcome their pain.
What is the person do with that nagging back pain, sore shoulder, elbow or neck pain. What about recurrent injuries such as repeatedly twisting your ankle? Most people intuitively understand that there should be some exercises that they can do to help recover from their pain and perhaps eliminate these recurrent injuries, however it is often not clear to most people which exercises they should be doing.
It is sometimes helpful to think about the human body as a machine, every joint is designed for a specific motion; when the muscles activate in the appropriate sequence and with the correct force, a motion is smooth and painless. With inappropriate firing of muscles, pain patterns can be perpetuated, and what started out as a small amount of pain in one part of the hip can spread across the low back and even up the spine due to forces being transmitted inappropriately.
The key is to identify the underlying problem so that the best interventions can be implemented. This may include introducing gentle movement and mobility through muscles and joints that may have become overly stiff or tight, and usually includes targeted strengthening of specific muscles. Strengthening and training muscles in appropriate firing patterns results in joints that are supported and oriented correctly as they progress through the desired motions–ideally without pain.
In the shoulder key factors may include strengthening the rotator cuff muscles, along with scapular stabilization. In the knee, there is small group of muscles call the VMO (Vastus Medialis Oblique) that are critical to maintaining the appropriate position of your kneecap during walking, this is referred to as patellar tracking. In the hip, low back and spine there are many factors to consider, but often gluteal muscle function needs to be enhanced for pelvic stability during single limb stance, that is the portion of walking when you are on one foot; the gluteals also play a key role in hip extension and stabilizing the pelvis during lumbar extension.
These topics are explored in thousands of text books and artricles. There are thousands of sources from seeing your Doctor, a Physical Therapist, YouTube exercise videos or self-help books, the question is which exercises to perform for MY pain!??! Which exercises are best? will some exercises make my condition worse?
If you are reading this, then you are taking steps to enhance your own human body’s function. Join me in my ongoing exploration of how the body works and how to best improve the function of our bodies! Click through the videos where I address various causes of pain, and help you to implement simple exercises that will reduce pain and improve your bodies function for the decades to come!
- GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for Global Burden of Disease Study 2017, Lancet 2018:1789-858.
- Dieleman JL, Cau J, Chapin A, et al. US Health care spending by payer and health condition, 1998-2016. JAMA 2020; 323:863-84.
- Bichsel, Liechti, et al. Cross-sectional analysis of Recommendations for the treatment of hip and knee osteoarthritis in clinic guidelines. Archives of Physical Medicine and Rehabilitation 2022;103:559-69.