In this paper I will discuss musculoskeletal disorders (MSD) and some of the science behind these disorders, how people can better alleviate the symptoms of MSD and prevent them from happening. I will gain this knowledge through the pursuit of recent research from the online collegiate library database using the world wide web, class text books, also speaking with others who are experienced in this particular field.
MSD are largely preventable but common. “MSDs are the single largest category of workplace injuries and are responsible for almost 30% of all worker’s compensation costs” (CDC, 2017). Common musculoskeletal disorders are Carpal Tunnel Syndrome, Tendonitis, Muscle / Tendon strain, Ligament Sprain, Tension Neck Syndrome, Thoracic Outlet Compression, Rotator Cuff Tendonitis, Epicondylitis, Radial Tunnel Syndrome, Digital Neuritis, Trigger Finger / Thumb, DeQuervain’s Syndrome, Mechanical Back Syndrome, Degenerative Disc Disease, Ruptured / Herniated Disc, and many more! Essentially, these are repetitive motion injuries, but also happen from trauma like auto accident and falls.
Health care providers are at risk for MSD, while helping other bodies, they must look out for their own bodies health and safety. Occupational ergonomic risk factors to consider are high task repetition, forceful exertions, and repetitive or sustained awkward postures, while individual risk factors are poor work practices, poor fitness, poor health habits (Middlesworth, 2016). Its important to stay vigilant on the workplace and in life overall, to prevent MSD from occurring, through ergonomic awareness and proper body mechanics. Staying strong and fit may prevent MSD from happening, I assume a strong back prevents back injuries. Body workers and health care providers must practice proper body mechanics through the use of joint stacking, this conveys power in best balance structurally sound ergonomic ways (Moran, 2017). Practicing safer movement and body mechanics on the job will prevent wear and tear and ultimately prevent MSD. Because this is exactly the reason health care providers experience more MSD’s than other groups.
What causes MSD? A few things like car accidents, poor posture, over use, and neglect to maintain the body in a healthy condition. As I type this, my head is hunched forward, I have a knot in my neck/shoulder region, I sit up a little taller and drop my shoulders down and back, I realize the importance of posture to prevent MSD. Lack of posture creates more restrictions, imminently more micro tears, scar tissue, and lesions to release and heal from. This is the epitome of myofacial release philosophy which I will discuss more later. ‘Restrictions’ can exert force of up to 2000 pounds per square inch on the body’s sensitive tissues and organs. This amount of force can literally crush your vital structures that are near it, or wreak havoc on your tissues. Since the fascial system runs throughout your entire body, these restrictions can cause pain anywhere in the body and compromise any system. Therefore, facial release, proper body mechanics, and receiving regular acupuncture will benefit those suffering from MSD.
Friction can cause MSD because of wear and tear to the bodies tissues, ligaments, joints. Friction is when two body parts are rubbing together and the tissues begin to wear out, a good example is in the thumb joint from constant texting, carpal tunnel in the wrist joint from repetitively sleeping with the hand bent a certain way. Degenerative disease of spine is another example of wear and tear, when the discs between each vertebra degrade or become much thinner, causing a pinched nerve and numbness tingling of the extremities. There are also accidents that occur, we fall on our butts in MN on the ice, we get whip lash from an automobile accident. These are examples of non wear and tear MSD. Disorders can happen anywhere in the body and at anytime in ones lifespan. It is more likely that an elderly person will fall and obtain an MSD because there are other factors involved like osteoporosis, heavy alcohol use, general dizziness, and lassitude. It is highly likely a competitive athlete will obtain an MSD during their sports career especially rotator cuff muscle in the base ball player, torn meniscus in the soccer player, and tendonitis in the tennis player. There are common injuries in Yoga as well, sciatica from over stretching the ham strings, cervical spine and lumbar spine compression fractures from head stands and wheel poses. Anytime theres micro trauma and injury to the soft tissues you have an MSD. Numerous micro traumas result in Cumulative Trauma Disorder. Trauma, repetitive motion, poor postures over time, surgery, and scar tissue are all causes for MSD. MSD can manifest in many ways such as broken bones, dislocations, fractures, pulled ligaments, sprains, strains, ruptures, subluxation, etc. It can be painful. Its best to prevent these things from happening. Always use your legs not your back to do heavy lifting! Use surgery as a last resort. Herniated discs do recover within 4-6 weeks (Robinson, 2007). There are numerous ways to treat an MSD.
Once MSD happens, it can take a short and sweet or long time to recover, this depends on the severity and duration of the injury. Right away, once an MSD injury happens, we have inflammation and its best to practice this injury protocol-PRICE: protection, rest, ice, compression, and elevation (Campagne, 2017). Swelling and edema occur around injuries, initially cold therapy will reduce swelling, after 24 hours use heat. Heat therapy for MSD is amazing at reducing inflammation and swelling and releasing heat and toxins. Other healing modalities are acupuncture, massage, hydrotherapy, tens unit, myofacial release, and whatever it takes to increase blood flow, decrease stiffness, pain, spasms, decrease inflammation.
Wound healing occurs in three overlapping phases, inflammation, granular formation, and matrix formation or remodeling (Marcus, 2017). Fibroblasts are what repair damaged tissues. Wound healing cannot occur without the proper functioning of these three phases and the function of the fibroblasts. During the healing process theres a condition called “denervation supersensitivity” which develops as the scar tissue forms and nerve endings grow into the fibrotic tissue. This causes super sensitivities by restricting the motion of the affected tissue and creating pain (Graham 2009). This may be a contributing cause of fibromyalgia, a disorder where people experience numerous symptoms and significant pain. There are ways to manage the pain during the healing process.
People with MSD can visit an immunologist, physiatrist, pain specialist, plastic surgeon, chiropractor, acupuncture practitioner, osteopath, podiatrist, massage therapist, and physical therapist to manage the symptoms of MSD. Time heals all wounds. I found compression to help around the knee after having a torn meniscus. Acupuncture releases pain relieving endorphins.
I take particular interest in Myofacial release for its gentle approach to healing MSD. Doctor Still, MD founded osteopathic medicine and he observed the fascial system, a quote by Dr. Still, (Still, 1910)
The fascia gives one of, if not the greatest problems
to solve as to the part it takes in life and
death. It belts each muscle, vein, nerve, and all
organs of the body. It is almost a network of
nerves, cells and tubes, running to and from it; it
is crossed and filled with, no doubt, millions of
nerve centers and fibers to carry on the work of
secreting and excreting fluid vital and destructive.
By its action we live, and by its failure we
shrink, or swell, and die. Each muscle plays its
part in active life. Each fiber of all muscles owes
its pliability to that yielding septum-washer, that
gives all muscles help to glide over and around
all adjacent muscles and ligaments, without friction
or jar. It not only lubricates the fibers but
gives nourishment to all parts of the body. Its
nerves are so abundant that no atom of flesh fails
to get nerve and fluid supply therefrom.
He states, “It not only lubricates the fibers but gives nourishment to all parts of the body. Its nerves are so abundant that no atom of flesh fails to get nerve and fluid supply therefrom”, this is very important to realize how crucial hydration and nutrition is to nourish all the bodies systems, bones, and muscles. Fluids bring vitality, life, and strength to the body. Without fluids the body becomes inflexible, rigid, there is disorder, and death is imminent. Massage moves the toxins from the tissues, and into the lymph system to be drained out the body through the urine or to the surface to be released through the pores as in sweat. Every massage therapist I know motivates others to hydrate! hydrate! hydrate!
Pioneer John. F. Barnes developed the innovative healing technique; myofacial release, to heal MSD among many other disorders of the human body, he’s been in practice since the 60’s. Let me explain what facia is. The facia is what binds the body together and nourishes the body with qi and blood. Kwong (2013) explains that all medical students are taught about various organ systems: cardiovascular, respiratory, gastrointestinal, musculoskeletal, and neurological systems and the fascia is part of all of these systems. Derrick Lundberg (2015) explains how myofacial release works. He stated that the facial network is super conductive and excitable, the meridians are a super highway for energy to transmit from one body system to another. Its clear to see that the facia connects all the body and all systems are interconnected and interdependent, and the superficial layers of the facia are a direct link to heal all organ systems of the body! This is TCM theory at its finest. Myofacial release is a widely employed direct manual therapy which utilizes specifically guided mechanical forces to manipulate and reduce myofascial restrictions of various somatic dysfunction (Bordoni, 2017). The healing of tissues is expedited through the release of tension and increased circulation. This is done through long holds and applying direct static pressure to the area that is damaged. The practitioner palpates the fascial restriction, applying pressure into the direction of the restriction, until resistance is felt, then the collagenous barrier is engaged for 90–120 seconds until a softening of the tissues happens. This brings great relief to the persons with MSD. Practitioners use slow manual force to tight fascial areas to break the fascial cross-links, a transition from gel to sol state in the extracellular matrix (Bordoni, 2016). Restrictions form in the fascial system creating lesions that can be found by the bodyworker. The fascial system stores memory from physical, mental, and emotional traumas. The body has ‘muscle memory’ and any traumatic pain injury can cause pain long into the future unless you move through the issue on a holistic level- mind, body, spirit.
Issues stay in the tissues. Just as the systems of the body are interconnected the body and mind influence each other dramatically. According to TCM wisdom, emotional pain manifest in the physical body and the physical pain can have long lasting effects on the persons state of mind, it goes both ways. Its of utmost importance to become aware of the body’s subtle energetic systems that alter the body mechanic as you go about your business, also as a way to manage pain and to become more aware of your stress threshold or how much your body can handle before you know its time to quit to prevent injury. Your body wears out, you can only abuse it so much before parts need replacing or you must modify your routine or adapt to the MSD you have acquired. Becoming a meditator, you become more expansive and can see the whole picture, you become mindful of the body and how it feels. Becoming present in the moment, people stress less, and have less accidents. Theres really no need to accept nor reject things in the world, this only adds to the stress. To contemplate, this practice gives the body time, space, and energy to heal from the physical, mental, spiritual ailments. All the constriction we create in our minds and bodies, over time, creates tightness, its a negative feedback loop. If not properly dealt with the help of an integrative health care provider, or through holistic means, the body will keep screaming for help and pain will be persistent. Its all about gaining some awareness and tuning into our bodies and getting the help when we need it and taking care of the self.
In conclusion, all functions of body have a relationship to the facia of the body, massage is very important part of wellbeing and healing MSD. Having better body mechanics in everyday life can prevent another MSD from occurring. Practices like Yoga, acupuncture, meditation, and myofacial release can do wonders to release years of tension.
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Department of Emergency Medicine, University of San Francisco – Fresno
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