If you experience persistent or long-lasting pain, you are not alone. America is in the midst of a pain epidemic, especially pain related to musculoskeletal problems. According to a study by the National Academy of Sciences, common chronic pain conditions affect approximately 100 million adults in the United States. That means nearly 1/3 of all adults in the US are struggling with on-going pain. No small problem, but the remedy may surprise you.
Most conditions which affect the musculoskeletal system involve gradual changes or repeated trauma over time. Even when it’s easy to recall the onset of pain, there’s still no smoking gun. Painful muscles and joints are only part of the problem. Remember the old rhyme; hip bone connected to the knee bone…. Well they should have taught us pectoralis connected to the deltoid or hamstring connected to the gluteal. Tough to make it rhyme but it’s closer to the truth. Just like the skeletal system where bones connect to bones, muscles are connected to muscles. In fact, nearly 80% of muscle connections involve other muscles and fascia. Too bad we don’t have a study demonstrating some evidence of this myofascial chain. Wait I just found one. A systematic review of 62 peer-reviewed research articles made the following determination: fascia connects the skeletal muscles forming a body-wide web of myofascial chains (28). The authors describe the existence of 5 myofascial chains in the human body. It was concluded that skeletal muscles of the human body are directly linked by connective tissue.
So what happens when portions of the chain develop weakness, instability or stiffness (WIS)? This is where we unravel the mystery of musculoskeletal pain. The presence of WIS in the myofascial chain means the painful area is not the site of the problem. Chain related problems develop over time and often without any pain. Eventually the chain problems (WIS) will create excessive tissue loads due to altered movement and awkward postures. Pain is not caused by tissue damage, it’s caused by tissue overload. Most of the tissue changes seen on imaging (MRI or Xray) develop over months and years. So why do some of these degenerative tissues become painful. It’s simply caused by tissue overload which triggers a cycle of pain and inflammation. If we fail to treat the chain related problem (WIS) then the pain will become more frequent and possibly more severe.
For instance, if weakness exists at the mid-portion of the chain (back and hip) than the chain must tighten to compensate. This will lead to tissue overload at the opposite shoulder and possibly cause shoulder pain. If we simply treat the painful area without addressing the weakness in the chain than we miss the chance to achieve long-lasting pain relief. Since human movement is dependent on the myofascial chain, pain is rarely at the site of the problem. All the more reason why we must treat the chain to trick the pain. Pain is a sign of imbalance, rather than injury. If we can identify and treat the WIS portions of the chain then it’s possible to avoid tissue overload and resolve pain.
The chain approach to treatment is not a new concept but it’s still poorly understood. It probably has something to do with the fact that chain problems (WIS) can’t be seen on imaging. You can’t MRI the spine and determine if it’s weak or stiff. Plus, there’s no prescription drug to resolve tissue overload. Chain limits can only be identified with chain events. The inability to perform coordinated or balanced movements with symmetry is the best sign of a chain problem. This requires detailed analysis of movement which uncovers dysfunctions which may exist well above or below the painful region. Not only is movement an indicator of chain related problems, it is also the remedy.
Movement is medicine. The musculoskeletal system craves variability in movement. If you struggle with persistent musculoskeletal pain than movement is your key to pain relief. How do you get moving again despite the pain. Pacing is the key to get moving with pain and eventually with less or no pain. Start with a simple 3/4/5 routine. Select 3 new movements which are safe challenges to the entire chain. Perform each of these movements for 4 minutes and repeat 5 times a day. This program would require you to dedicate 1 hour a day to variable movement. If you need some examples of movements to get the chain active and healthy check out the exercise videos on our free app (NEPT).
Pain can be the fuel that helps you change. It can guide you to make changes that create a healthy and balanced movement system. The first step is to get moving and do it frequently. Follow this up with simple steps to improve your wellness so your body and myofascial system work together for healing. Do not let your pain stop you from moving toward a better you. Remember, if seen in a proper light, pain can fuel positive changes in your life.
Dr. Keith Poorbaugh, owner & Physical Therapist, PT, ScD, OCS, CSCS, CMTPT, FAAOMPT, and Dr. Jimmy Sliwa, Physical Therapist PT, DPT, CMTPT