How You Can Help Prevent and Treat Musculoskeletal Injuries.
July 23, 2018
WHETHER IT'S A NEW ACHE or nagging pain, you're not alone: 1 in 2 Americans reported some limitation in their normal activity due to a musculoskeletal condition, according to a national health interview survey performed by the Centers for Disease Control and Prevention.
As a physiatrist with sub-specialization in sports medicine, I take care of people of all ages and abilities. Common complaints are shoulder, knee, neck and back pain. We each come from a different background, but pain doesn't discriminate. It doesn't matter if you're an athlete who wants to get back to competition, an employee whose job includes physical labor or a retiree who wants to play with your grandkids – injuries can significantly impact your lifestyle.
Injuries can happen in an instant, such as a sprain or strain, or they can occur over time, as is the case with osteoarthritis. While each condition is diagnosed and treated differently, there are general principles we can all apply, no matter what the underlying cause may be, to help prevent injury and rehabilitate ourselves.
Biomechanics are the key. There are four factors each of us is in control of that directly impact our bodies: strength, flexibility, technique and load. What are these and why do they matter?
Strength training has been consistently shown in studies to be effective in injury prevention. Although a well-balanced strengthening program is best, two muscle groups that almost everyone can improve on are the upper back and the core.
The scapulae (shoulder blades) are important for proper shoulder biomechanics. That is, they allow for proper shoulder motion. Abnormal biomechanics can affect muscles and tendons like the rotator cuff.
A simple exercise you can do to stabilize your scapulae is a wall slide.
1. Stand with your back against a wall.
2. Try to push the wall with your shoulder blades and head (without looking up).
3. Place your hands against the wall (or as close as you can) at shoulder height.
4. Slowly raise your arms up until your hands touch each other. Be sure to continue pushing against the wall.
5. Slowly lower your arms down, and repeat for 1 minute.
6. For advanced training, do the above while face-down on a mat.
The core consists of your abdominal and buttock muscles, and these are essential for everything from normal activity to generating the power for a home run swing or the velocity to hit the slant between defenders. Of the core muscles, the hip abductors, which raise the leg out to the side, are most consistently weak. To assess your hip abductor strength, do a single-legged squat in front of the mirror. If your knee moves side-to-side instead of going straight up-and-down, that muscle group is weak.
To strengthen the hip abductors, perform a side leg raise.
1. Lay down on your side.
2. Bend your bottom knee.
3. Try to keep the rest of your body as straight as possible.
4. Slowly raise your top leg as high as you can, without wobbling your hips.
5. Slowly lower your leg, and repeat for 1 minute.
6. For advanced training, do the above while performing a side-plank.
While stretching hasn't been definitively shown to prevent injuries in sports, most experts still agree on the importance of flexibility. Tightness across a joint can put excessive strain on another part of the body.
Two common techniques for stretching are dynamic and static stretching. Dynamic stretching is essentially "going through the motions" at a lighter pace. An example is high-knee skipping. Static stretching, on the other hand, is what most of us are familiar with. It involves holding a stretch for a set amount of time without moving. For the most effective and efficient stretching program, I recommend dynamic stretching before exercise, and static stretching afterwards.
Most of us suffer from tight pectoralis (chest) muscles. With our modern-day reliance on computers, our frequent sitting posture only exacerbates this.
1. Stand in a doorway.
2. Place your hands on the door frame at just above shoulder height.
3. Lean forward for 30 seconds.
Another muscle group that's often tight is the hip flexors and quadriceps (front thigh muscles). For best results, static stretches should be held for at least 30 seconds.
Hip flexor/quadriceps stretch
1. Lay down on your side.
2. Grab your top ankle. If you cannot reach it, wrap a towel around it and hold onto that.
3. Try to pull your ankle as far back and as high up as you can.
4. Do not raise your hip.
5. Hold for 30 seconds.
Proper technique is essential for maximizing performance as well as preventing injuries. For sport-specific movements, such as throwing, simple adjustments in technique can yield significant improvements in performance, as well as decreasing the already excessive stress across joints. A common injury for both athletes and non-athletes alike is low back pain – but this can be prevented by bending and lifting correctly.
Proper lifting technique:
1. Stand close to the object you want to lift.
2. Spread your feet at least shoulder width apart.
3. Keep your weight on your heels.
4. Squat while bending your knees.
5. Keep your chest up.
6. Grab the object and use your legs to lift it up.
Neck and arm pain also commonly affect everyone from esports athletes to my minimally invasive surgical colleagues, but applying correct ergonomics can help prevent associated injuries.
Proper monitor/computer ergonomics:
1. Keep the monitor and keyboard directly in front of you and in line with each other.
2. Monitor distance should be at about arm's length.
3. The top of the monitor should be at or just below eye level.
4. Use an adjustable chair with armrests, and adjust so your elbows are in line with keyboard and wrists are flat.
5. Sit upright.
The load our joints experience is another factor for injuries that is within our control. Contrary to popular belief, running is not a risk factor for developing knee osteoarthritis. The main risk factor is body weight, which is directly proportional. In fact, with normal walking, the load across the knee joint can be three times your body weight. So for example, losing 5 pounds can mean taking 15 pounds off your knees.
There are many diets, and patients frequently ask which one is best. I tell everyone "the best diet is the one you'll stick with." It's important to keep a balanced diet, since completely cutting out something like fats or carbohydrates can be more harmful than helpful. With cultural and financial considerations in mind, my two biggest tips for dieting are eating smaller portions and drinking plenty of water. I guarantee that you'll be hungry when you start cutting back, but that's just because your body is used to a certain volume. This will adjust over time.
No matter what occupation or lifestyle we have, injuries can have significant detrimental effects. There are many small things each of us can do that can have a great impact on our overall health. I hope these tips enlighten and empower you. If you suffer from a musculoskeletal condition or feel any pain from doing any of the suggested exercises, consult a physical medicine and rehabilitation or sports medicine specialist.