I have been a physical therapist for thirty-seven years with my focus on treating musculoskeletal pain and inflammation. Recently, there have been more articles published about the negative side effects of a group of medicines called n-saids that are used by many of my clients to manage their musculoskeletal pain and inflammation. Over the years, my clients have asked so many questions about musculoskeletal pain, inflammation, and n-saids, that I felt it was time to clear the air and help them make sense of it all.
First, “What is musculoskeletal pain?” Musculoskeletal pain is unavoidable because everybody will experience it at one time in their life. It has three main causes: 1) Activities of daily living that put unusual or repetitive strains on your muscular, fascial, neural, and skeletal systems. 2) Acute or traumatic events causing injury to these tissues. 3) Musculoskeletal diseases
Musculoskeletal pain affects your bones, muscles, ligaments, bursae, tendons, fascia, and nerves. All of these tissues that allow you to perform your activities of daily living. Musculoskeletal pain can be “acute” having a rapid onset with severe, intense symptoms or it can be “chronic” with a slow, insidious onset over time. The pain can be localized in one area of the body or referred or widespread.
Lower back pain of course is the most common type of musculoskeletal pain experienced. Other common types of musculoskeletal pain include myalgia or muscle pain, myositis or muscle inflammation, sprains of ligaments, fascitis, tendonitis, bursitis, neuritis, and stress fractures. Just a reminder, anything that has the suffix “itis” means inflammation.
Musculoskeletal pain has various symptoms and causes, but the most common include: 1) Bone pain which is described as deep, penetrating, or dull. Usually, it is the result of a traumatic event or overuse. 2) Muscle pain is often described as less intense than bone pain, but can still be debilitating. It can be caused by an acute, traumatic, event or overuse causing a muscle strain, an autoimmune response, loss of blood flow to the muscle, infection, or a tumor. Muscle as well as bone pain can be accompanied by muscle cramping and spasms. 3) Tendon and ligament pain are also caused by traumatic, acute injuries or overuse. 4) Fibromyalgia is a condition that may cause pain in the muscles, tendons, fascia, or ligaments and is usually in multiple locations as well as difficult to describe. It is usually accompanied by other symptoms. 5) Joint pain, injuries, and diseases usually are described as a stiff, aching, “arthritic” type of pain. The pain may range from mild to severe in intensity and worsens with movement. Swelling of the joint may also occur. 6) Tunnel syndromes refers to musculoskeletal disorders that cause pain due to nerve compression or entrapment. These disorders include carpal tunnel syndrome of the wrist, cubital tunnel syndrome of the elbow, and tarsal tunnel syndrome of the ankle. 7) Neuritis is described as pain from the inflammation of a peripheral nerve caused by entrapment, compression, or any other physical irritation of the nerve. The irritation is usually caused by the surrounding soft tissue which may include the muscle, tendon, fascia, ligament, or even bone. The pain experienced usually travels along the path of the irritated nerve and is often described as a burning sensation. The sciatic nerve may become entrapped by the piriformis muscle as an example. 8) Bursitis is a condition when the bursae, a small fluid-filled sac near the joint, gets irritated and swollen. The purpose of the bursae is to help the joints move more smoothly and efficiently. When working right, they cushion certain bones, tendons, and ligaments especially at the hip and shoulder joints as they move on each other.
As already mentioned, anyone can experience musculoskeletal pain. It does not discriminate being experienced by the young and old. It is most often caused by an acute, traumatic injury to the bones, joints, muscles, tendons, ligaments, fascia, and nerves. This can be caused by quick, jerking movements, car accidents, falls, fractures, sprains, dislocations, and direct blows to the joints or muscles.
However, musculoskeletal pain can also be caused by chronic overuse as well as poor postural habits or prolonged immobilization. Pain from chronic overuse affects about 33% of the adults in the U.S with lower back pain being the most common area of pain. Lower back pain is also the most common work-related diagnosis in our Western society.
So, “What is the cause of musculoskeletal pain?” The answer is “inflammation.” Inflammation is an essential and dynamic tissue response by the cells of the muscles, fascia, tendons, ligaments, cartilage, bones, and nerves to damage. It is an extension of the cellular and metabolic involvement of these tissues. In fact, it is actually a protective response by these tissues with the aim of restoring their structural and functional integrity after being damaged. Simply put, it is a defense mechanism or self-protective reaction by the body in which the immune system recognizes damaged cells and begins the healing process.
However, if this inflammatory response by the body becomes chronic and goes on for a long time, it can become problematic. Chronic inflammation has now even been linked to other systemic diseases like heart disease, stroke, and may lead to auto-immune disorders like lupus and rheumatoid arthritis.
So as you can see, chronic inflammation can have long-term and whole body, systemic effects if untreated. Chronic inflammation is also referred to as low-grade inflammation because it produces a steady, low-level of inflammation throughout the body and this type of systemic inflammation over time can contribute to the development of disease. The reason being that when these inflammatory cells stay too long in the blood vessels, they promote the build up of plaque and we all know what it can do to our health and well-being.
Acute inflammation on the other hand, like with a sprained ankle, is a short-term response having a localized effect, meaning it works at the precise place where the tissue damage occurred. The tell tale signs of acute inflammation include redness, swelling, heat, and sometimes pain and loss of function. In the case of acute inflammation, blood vessels dilate, blood flow increases, and white blood cells swarm the injured area to promote healing.
That brings us to, “What can you do to manage inflammation?” The most common answers I give all my clients daily is by improving your skeletal or structural alignment, good exercise habits, good sleeping habits, good postural habits, and good eating habits. However, the most often asked question by my clients is, “What can I take now for the pain?” Invariably, most of my clients say they take ibuprofen, advil, or motrin all of which are a group of medicines referred to n-saids or non-steroidal anti-inflammatory drugs. Most of my clients over the years would agree that these medicines are a significant help in managing their pain. The problem with these medications is that most people exceed the suggested daily dosage and they have side effects.
Recently in a New York Post article that was written on the unexpected side effects of popular pain killers, they wrote that in a study of 1,326 ibuprofen users, 1 out of 10 people exceeded the daily suggested limit. The author of this study, Professor David Kaufman stated, “The biggest pattern was people taking too much at once.” Kaufman went on to say, “Gastrointestinal bleeding and heart attacks are the two biggest concerns with ibuprofen and other n-saids.” Finally he states, “It’s always a good idea to take as little as possible.”
Well then, the final question has to be, “What is my alternative to taking n-saids?” The answer is “turmeric or curcumin.” In various studies that I have read on the efficacy of turmeric compared to ibuprofen, the results consistently showed that turmeric was just as effective as ibuprofen.
So while you are managing your musculoskeletal pain by changing your alignment, your sleeping habits, your exercise habits, your postural habits, and your eating habits, why not include a daily dosage of turmeric. Give your body all the tools it needs to manage inflammation and reduce your musculoskeletal pain. Just a reminder, before doing this it is always good to check with your pharmacist or doctor if you take other medications. Be well.