Have you ever wondered why you seem to be in pain without a clear cause? Or perhaps the doctor has been unable to identify the cause on a scan and you’ve left your appointment thinking it’s all in your head? Well, that’s because, unfortunately, or perhaps fortunately musculoskeletal pain is complex and this gives us a great opportunity to modulate it.

Musculoskeletal pain can originate from bones, joints, ligaments, muscles, nerves, and tendons.

Chronic musculoskeletal pain however can be experienced in one particular area of the body or throughout the body, and may not be derived from one specific structure.

Causes of Musculoskeletal Pain

I could write an endless list of its root causes and you still wouldn’t be prepared for some surprise visits. Referred pain for example, can emanate from other organ systems such as the heart, kidneys, lungs, pancreas, and spleen may also lead to musculoskeletal pain. For example, a person who suffers a heart attack may experience pain that radiates down to the arm.

There are over 150 documented musculoskeletal disorders, some with underlying systemic causes and many without - but don’t worry.

Don’t fret though, it’s the job of your physiotherapist and the healthcare team to help screen for these, before hopefully re-assuring you and beginning to modulate and treat the things we can change. Much of the time in fact, the pain is not sourced just from a specific structure or caused by specific disease and this is when things get really interesting. We will discuss this in just a second.

Clinical Signs and Symptoms

There are many ways to identify musculoskeletal pain so that when it rears its ugly head, you can treat it rather than retreat. Here are common some signs and symptoms to look out for:

Aching and stiffness.
Burning sensations in the muscles.
Muscle twitches.
Sleep disturbances.
Fatigue.

The quality of pain will differ depending on the cause and location of the pain, but there’s no cause for alarm. The good news is that these symptoms can be properly diagnosed by a physiotherapist and treated accordingly.

Diagnosis of Musculoskeletal Pain

Firstly, stop searching Google for remedies! The internet is great, but can be incredibly confusing, misleading and may oftentimes contribute to more fear. A trained professional such as an experienced physiotherapist will begin with a detailed medical history since the causes of musculoskeletal pain vary widely.

A physiotherapist is able to do so much as predict the outcomes of your diagnosis not just by a specific injury, but also a whole lot of other factors such as moods, belief in ability to improve, general levels of activity, etc. Besides getting answers from the patient about when the pain started, how it feels, areas that hurt, and other associated symptoms, we may refer you for imaging such as x-rays, MRI’s or refer you briefly to a General Practitioner or appropriate specialist for further diagnostic work up.

NOW THE INTERESTING BIT! …

Your Recovery May Have Nothing To Do With Your Injury

A major study exploring novel approaches has identified five distinct musculoskeletal groups based on prognostic factors. The researchers used 11 different indicators that are broadly classified in four main domains to score and identify the musculoskeletal patient groups. In addition, four active covariates – age, BMI, gender, and education – were used to meaningfully classify patients.

Figure 1: Overview of groups and indicator variables

Groups I and 2 had the lowest scores across the four domains – pain, thoughts and beliefs, psychological, and activity & lifestyle. The distinctive characteristics for group 2 were the increased number of symptoms across the domains. Group 3 and 4 could be differentiated by opposite scoring patterns in the psychological domain. Patients in group 3 exhibited lower mental distress and higher fear of avoidance and the reverse was true for group 4. Lastly, group 5 patients showed more symptoms across all the four domains with symptoms worsening in the pain and activity & lifestyle domains. Patients with obesity and lower education had higher group affiliation.

This study clearly reveals why it's important for physiotherapists to consider the whole patient and not just focus on the painful body structures and areas. That’s why our staff will ask a broad range of questions regarding your health and lifestyle at our first appointment to help design personalized treatment to improve function and quality of life.

Could you have gone through physiotherapy sessions and your pain persisted? Absolutely. It’s never been unheard of.

Previous treatment approaches were confined to a specific pain diagnosis, pain dimension, or a sub-grouping variable that led to ineffective treatments. Integrative Physio has always explored new transformative treatments to ensure the best possible treatment outcomes for our patients.

The desire of every patient is to be out of misery and back to optimal health. Our holistic approach covers all the factors used to describe and diagnose chronic musculoskeletal pain. We understand the problem as a composite of pain intensity, impact on daily function, pain-related distress, psychological and social factors, and temporary characteristics. Taking into account these multidimensional factors, we understand the complex interplay of factors that lead to musculoskeletal pain and design effective treatments.

Treatment

We offer a full range of treatments to address the root cause of your problem, promote enhanced healing, and restore the range of motion in muscles and joints. You no longer have to worry about “quick fixes'' that only last for a second and perhaps worsen the situation, or myths like, “if there’s no visible joint damage, it can’t be that bad”. Treatments for musculoskeletal conditions have come a long way, so we don’t often see obvious outward signs. However they still cause significant pain, fatigue and disability. It can also impact family, work, social life, finances, etc.

The first step is education. It’s natural to focus on the physical causes of pain. You may be more attuned than most people to thinking of the musculoskeletal structure, how we move, and how we could move better. While pain can be caused by a physical injury, research shows that pain involves our brain and nervous system, too. If you focus only on the physical contributors to pain, you are failing to address the bigger, more complex picture and the body as a whole.

Plausible additional treatment options for musculoskeletal pain though include dry needling, manual therapy, recovery systems, shockwave therapy, and lifestyle changes.

Having read this article, hopefully, you will understand that we may guide you through thorough, ethical and professional help that may aid your recovery.

Get in touch with our friendly staff to learn more about targeted musculoskeletal physiotherapy. We’ll be happy to help you come back strong, empowered and in control of your own health destiny.

References

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Babatunde, O. O., Jordan, J. L., Van der Windt, D. A., Hill, J. C., Foster, N. E., & Protheroe, J. (2017). Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. PLoS ONE, 12(6), e0178621.

Lacey, R. J., Belcher, J., Rathod, T., Wilkie, R., Thomas, E., & McBeth, J. (2014). Pain at multiple body sites and health-related quality of life in older adults: Results from the North Staffordshire Osteoarthritis Project. Rheumatology, 53(11), 2071– 2079. https://doi.org/10.1093/rheumatology/keu240.

Mallen, C. D., Peat, G., Thomas, E., Dunn, K. M., & Croft, P. R. (2007). Prognostic factors for musculoskeletal pain in primary care: A systematic review. British Journal of General Practice, 57(541), 655– 661.

Murphy, S. L., Lyden, A. K., Phillips, K., Clauw, D. J., & Williams, D. A. (2011). Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanisms. Arthritis Research & Therapy, 13(4), R135. https://doi.org/10.1186/ar3449.

Nielsen, A. M., Kent, P., Hestbaek, L., Vach, W., & Kongsted, A. (2017). Identifying subgroups of patients using latent class analysis: Should we use a single-stage or a two-stage approach? A methodological study using a cohort of patients with low back pain. BMC Musculoskeletal Disorders, 18(1), 57. https://doi.org/10.1186/s12891-017-1411-x.

Rabey, M., Smith, A., Beales, D., Slater, H., & O'Sullivan, P. (2016). Differing psychologically derived clusters in people with chronic low back pain are associated with different multidimensional profiles. Clinical Journal of Pain, 32(12), 1015– 1027. https://doi.org/10.1097/ajp.0000000000000363

Synnott, A., O'Keeffe, M., Bunzli, S., Dankaerts, W., O'Sullivan, P., & O'Sullivan, K. (2015). Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: A systematic review. Journal of Physiotherapy, 61(2), 68– 76. https://doi.org/10.1016/j.jphys.2015.02.016.

Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., … Wang, S.-J. (2019). Chronic pain as a symptom or a disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19– 27. https://doi.org/10.1097/j.pain.0000000000001384

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Engebretsen, K.B, Glette, M., Overas, C.K., Nordstoga, A.L., Evensen, K.A.I., & Skarpsno, E.S. (2020) Novel approach towards musculoskeletal phenotypes. Eur J Pain. 2020; 24: 921– 932. https://doi.org/10.1002/ejp.1541

Musculoskeletal Pain: Causes, Symptoms & Treatment