Saturday 17 December 2011

Is it muscle, joint, ligament, nerve or tendon problem.

Where is the problem coming from? 
    A very common question I am ask, Is it a joint problem? is it a muscle problem? is it a ligament problem? are just some examples. This attempts to clarify the question, and looks at the difficulties in answering it.

Which is more serious?
    Before continuing it is useful to look at which is more serious, a joint problem, muscle problem or ligament. The reason I bring this up is people often have their own idea which they think it is. It is commonly perceived  for instance that a joint is worse than say a muscle problem. This is mistaken belief. In fact they are all equal, mostly it depends on the level of tissue damage.

What is a joint, muscle or ligament problem?
    Unless there is arthritis or some internal derangement of the joint, describing "what is joint a problem" is not always as straight forward as one thinks. Joints are held together by ligaments and moved by muscles and tendons. All these can then be involved. For instance if there is a muscle  imbalance round a joint, the joint can come under strain. The strain then effects the ligaments holding the joint together and produce pain. It is now a ligament and muscle problem as well. This is one reason people can get a "different diagnosis" from different Osteopaths and Physiotherapists. In an attempt to describe the problem in a simple coherent form that a patient can understand Osteopaths and Physiotherapists will often describe either "tissues causing symptoms" (standard diagnosis) or "causal and contributing factors" as the diagnosis. Therefore, it is possible to have two diagnosis from practitioner, and both be right.

Example
     Take for an example a shoulder problem. Give it a medical diagnosis "supraspinatus tendonitis". This is inflammation of the supraspinatus muscle tendon. However, though it may be a "correct diagnosis" it does not tell us any more than the name of the tendon which is inflamed. As such the diagnosis does not in itself help with the formulation of any treatment. The real issue and question is "why is the tendon inflamed in the first place" Once this is worked out a treatment plan can be formulated and the "diagnosis" it self is of little help. In this example it is the tissue causing symptoms (supraspinatus tendon) which is used as the diagnosis.
     If one where to now look at causal factors it get much more varied, as there can be quite a number, often different in each person. If for instance some scapular muscle are weak (lower trapesius, serratus anterior) and some are tight (upper traps, pectorals), the imbalance may result in the shoulder girdle not functioning as it should and this leading to the supraspinatus tendon getting inflamed. The situation could then be correctly described as a "muscle problem". If there was a problem in the neck that had a bearing on the supraspinatus tendon (these can be various but may including nerve supply) one might call it a "nerve irritation". If the spine was stiff (for instance the thoracic spine), because of loss of movement here the shoulder has to move extra resulting in strain at the shoulder joint, one could call it a "spinal problem". If one where to look at  functional problems, such as improper movement patterns, ( initiating reaching the arm forward by lifting the shoulder girdle first) this could also be seen as a diagnosis.
 
    All the above can be a "correct diagnosis" and in fact more helpful than the diagnosis of supraspinatus tendonitis.

Chris Reynolds Osteopathy & Physiotherapy




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