Bodies in Motion Stay in Motion: Staying Active with Chronic Musculoskeletal Problems
By Yani C. Zinis, D.O., Orthopedic Associates, East Denver LIVING WELL Magazine
The age old physics algorithm first discovered by Sir Isaac Newton has very appropriate applications for our everyday lives as we all attempt to “age gracefully.”
As a physician who sees a wide range of patients with sports related and general musculoskeletal injuries, it is clear that people who have learned to function within their limitations yet remain active clearly stay on the path of wellness! The guidance of a physician who is progressive in the evaluation and management of various injuries and chronic problems is paramount. This includes a thorough review of evaluating the mechanisms of injury as well as any predisposing factors, which may be causing chronic or persistent symptoms. Various arthritic conditions are extremely common, and typically this is a manifestation of either previous injury to an affected area or predisposing genetic factors. Conservative treatment of such problems almost always is indicated, particularly if diagnostic studies do not yield an acute process such as a fracture. Essentially, the goal after accurate diagnosis and evaluation is to maximize function.
Take for example, a chronic recurrent low back problem. There are very strong statistics that show that 80% of all people at some point will experience low back pain to a varying degree in their lifetime. Even though there may be a disk herniation or other significant pathology, these problems almost always can be treated non-operatively, if recognized in an appropriate time frame and do not result in more long-term damage such as neurologic injury. In fact, pain is not necessarily a predictor of the severity of a problem, particularly when discussing issues of the spine. Often, more acute symptoms are related to spasm or other pain generating factors and, if diagnosed and treated appropriately, even in the presence of disk pathology, the majority of the time surgical intervention can be avoided. Many studies have indicated that back pain is frequently self-remitting, but left undiagnosed and untreated often becomes a chronic recurring problem. Although the underlying disk herniation is not “cured” or reversed, the problems that have developed accommodating for such an injury are frequently more debilitating and limiting. Even to the most educated and experienced physicians, identifying the pain generating structures is frequently challenging when treating spine problems.
Rehabilitation of such conditions and injuries is vitally important, both in assisting in resolution of symptoms as well as in the prevention of recurrence. The primary focus is on preserving and improving function, whether in regards to daily activities or returning to sports. It is important early in the evaluation process to set realistic short term and long term goals.
There are vast differences in each individual’s ability to cope with limitations from an injury or chronic condition, and patients are frequently at different stages of their life when they present for evaluation. Physical limitations can have a cascading effect, particularly when patients get extremely discouraged or depressed due to limitations in daily activities or athletic endeavors, which have become increasingly difficult. Encouraging a person not to ignore their symptoms or strictly mask their symptoms with medications is important, but also there are options to effectively treat various musculoskeletal pain conditions in an effort to improve activity and restore function. This often includes passive and active treatment regimens, while at the same time making efforts to improve strength, endurance and stability. This can be accomplished through the treatment and guidance of a physician and physical therapist, and gradually incorporate work through stability exercises and flexibility in programs such as Pilates and yoga, or even warm water pool exercise.
As a result, this treatment philosophy helps to maintain and improve a person’s overall state of wellness especially from a cardiovascular standpoint. Establishing realistic expectations is important, but there almost never is a situation where the patient cannot have an active role in their recovery process, while the physician assists in pain management.
There is a concept that I frequently discuss with patients: “there are things frequently that we cannot change, but focus and work on the things that we can.” I also ask patients to follow the premise that pain is unavoidable, suffering is optional. Helping patients get out of the cycle of recurrent pain leading to limitations in function is something that we do on a daily basis. It is up to you to take the first step in seeking care for your problems and become an active participant on the road to recovery. This applies whether the goal is to continue skiing or golfing well into your 70s or 80s, or simply walk across the parking lot with more stability and less pain. We all have to start somewhere, and working through limitations but never giving in will help us all age gracefully.
Yani C. Zinis, D.O. is board certified in Physical Medicine & Rehabilitation. He is an assistant team physician for the Colorado Avalanche, consulting physician to The Denver Nuggets, Olympic Team Physician with USA Hockey, and a volunteer physician for the USOC Paralympic teams. You may reach Orthopedic Associates at 303-321-6600.