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acute traumatic injury or chronic repetitive injury: which is worse?


“We also need to consider the difference between treating pain and treating the condition. Virtually nothing is known about using medication to stop or reverse tissue degeneration. Medication for Repetitive Stress Injuries is almost always just about symptom relief.  The specific cause of Repetitive Stress Injury pain is largely a mystery, and its comings and goings even more so.

So it’s hardly surprising that the collective track record of anti-inflammatory meds in this context is generally shabby and unpredictable, neither completely useless nor remotely reliable. If they worked well and consistently, obviously no one would ever need to read this. To whatever extent they do work for some people, some of the time, is due to unknown and variable chemistry.” Cherry picked from Paul Ingrahm’s article over at PainScience, Repetitive Strain Injuries Tutorial

When it comes to injuries, whether we are talking SPORTS INJURIES, industrial / work injuries, CAR WRECKS, horse accidents, or a potentially unlimited number of others —- which is worse; having one big injury, or thousands (maybe millions) of tiny ones?  Why am I asking this question?  Because in my clinic I’m constantly told (I heard it just yesterday from a person who was covered in SCAR TISSUE), “But doc; I’ve never had any sort of injury.”  It’s very important to remember that there are any number of reasons people get Scar Tissue or FASCIAL ADHESIONS that have absolutely nothing to do with acute trauma.  Today I am going to give you my top three.

  • YOUR INJURY IS REPETITIVE:  I use a simple analogy with my patients.  In each of my treatment rooms are small oak cabinets with counter tops for me to set my tablet computer.  I tell people that if I were tearing out the cabinets to replace them, I could go get my cast-iron antique 16lb post maul and smash it off the wall with one huge blow.  Or I could go get my trusty 16 oz standard household claw hammer and tap at it for years — even decades.  Eventually I’ll accomplish the task, and the cabinet is off the wall either way you slice it.  The only difference — at least on the surface — is time.  These sorts of injuries are known as Cumulative Trauma Disorders (CTD’s) and involve any number of the problems mentioned on THIS PAGE.  For a variety of reasons I will cover in a future post, I feel that all variables equal, Repetitive Stress Injuries tend to be a bigger deal than trauma.  While certainly not always the case, more often than not it is.
  • YOUR INJURY IS COMPENSATORY:  I’ll give you an example of what I’m talking about here.  A person sprains their ankle multiple times while growing up, later discovering that the leg with said ankle is slightly shorter than the other (an anatomical difference as opposed to functional).  The end result is that patient’s gait has been altered (rolling his ankle out and pushing off the lateral portion of the foot with every step).  This abnormal mechanical stress eventually wore down the ability of his buttock and hip muscle’s ability to control this aberrant motion.  The end result of decades of this mechanical compensation was chronic foot pain and chronic hip buttock pain.  Fortunately the worst of this pain has been effectively dealt with.  The constant supination / inversion of the foot and resulting varus (bow-legged) tendencies of the knee have been largely controlled by orthotics, a built in heel lift, and lace up work boots that must be replaced every six months.  But the resulting damage from decades of athletics and powerlifting still limit his ability to do certain kinds of exercise (lower body weightlifting, ride a bike, play basketball, etc, etc).  This person is thrilled to have his life back and be able to walk and hike again (over a decade of chronic pain exacerbated by every step), but bummed that he can’t (at least yet) do the things he used to do.
  • YOUR INJURY IS INFLAMMATORY:  As someone struggling to cope with CHRONIC PAIN, you have to realize that in most cases, not only is inflammation a huge part of the equation, it always (I repeat; always) leads to the Scar Tissue that the medical community refers to as Fibrosis (HERE).  It should not be lost on you that the number one most prescribed medication of the BIG FIVE for the kind of injuries we are discussing today is NSAIDS (Nonsteroidal Anti-inflammatory Medications).  It’s not that these drugs don’t work; they often work like magic.  It’s that they have such a brutal (and UNDERREPORTED) side effect profile.  The cool thing is, rather than always trying to mop up the inflammation being spilled by your inflamed body, many (probably most of you) have the potential to dry it up at its source.  Ask yourself this question; would it be better / easier / more cost effective in the long run to turn off the faucet that’s perpetually overflowing onto your floor, or constantly trying to mop up the mess after the fact — a mess that you can never get ahead of?  And even if your problem is not really considered ‘inflammatory’ (TENDINOSIS, TENOSYNOVITIS, CARPAL TUNNEL, FASCIAL ADHESION, etc, etc, etc), an ANTI-INFLAMMATORY DIET will usually make a huge systemic difference that translates to virtually all areas of physiology.  A perfect example of this can be found HERE.

The truth is, most of the time the pain we deal with is caused by a combination of the four topics mentioned above (trauma plus the three bullet points).  Part of the problem is that even if the underlying mechanical cause of your pain is discovered and effectively treated, the injury may require significant time to heal.  In other words, if you’ve repetitively injured your wrists, hands, and forearms from practicing the piano 6-10 hours a day (HERE), there is no telling how long it might take for you to heal to the point where you could get back to playing just one hour a day.


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