Muscle or Joint Pain?

I typically hear this same question each week, "Is my pain from the muscle or joint?" I usually answer, "Probably a little of both." This always seems to put a perplexing looking on most patients faces.

The musculoskeletal system is composed of your bones, joints, muscles, ligaments and tendons. Each of which has its own specific function but together to create stability and function. The ligaments attach the bones together to form joints while the muscles attach to the bones by tendons to make an anchor for locomotion. A "joint complex" consists of the union of two or more bones and all the surrounding muscles, ligaments and tendons.

Joint sprains are injuries that occur when a joint is suddenly moved or forced beyond its normal range of motion and the ligaments are severely stretched or torn. Ligaments connect adjacent bones together to give support and stability to joints. Sprains cause the injured joint to become weak and unstable. How badly the ligaments are damaged defines the degree of injury. A first-degree sprain is a minor stretch of the ligament while the integrity of the joint remains intact. Usual symptoms include mild pain and swelling. With a second degree sprain the ligament stretch is more severe causing a partial tear of the ligament. This will result in increased pain, swelling and bleeding at the site of injury causing an ecchymosis at the site of the injury. Third degree sprains occur when the ligament is completely torn or ruptured. Ruptures are joint injuries in which the fibers of the supporting ligaments become torn but the ligament does not remain in tact.

Muscular sprain/strains or "pulls" are injuries to the muscles and tendons from stretching or exerting some part the muscle beyond its normal length. Muscles are attached to bones by tendons and the tendons are what allow the contraction of the muscles. When there is an injury to the muscle it can become stretched or torn and muscular strains are graded according to their severity. First degree sprains are a mild injury to the tendon and or muscle and will cause pain, swelling and muscular spasm. Second-degree muscle strains involve more tearing of muscle or tendon fibers and along with above symptoms, there will be a loss of muscular strength and a bleeding of the muscle that will result in an ecchymosis (black and blue) at the site of injury. Third degree strains are a complete rupture of the muscle or tendon from the bone. In this case, there will be a complete loss of muscle function.

In the majority of injury cases, whether it is an ongoing condition or an acute injury, there is usually a muscular and a joint component. Granted, I am not saying that there are not true joint injuries (a ligament tear in the knee) or muscular injury (a strain of back muscle) because initially this is true. However, with either a joint or a muscle injury, both can lead to adverse effects on the other. The bones of the body are the frame and provide muscles attachment points for which to cause motion in the joints. This synergy enables the muscles to create movement. The big question when evaluating injury is to determine which is the primary cause of pain and then deal with any other additional issues as well.

When the normal joint mechanics become altered, as with the joint and muscle injuries above, the function of all the components of the joint complex are altered as well. For the majority of cases, it is never as simple as "just a muscle strain, or just a joint sprain." Musculoskeletal injuries, whether is begins in the joint or begins in the muscles, will lead to detrimental effects on the other. It is important to note that even though the pain from muscle or joint injury has "gone away" that does not mean that normal function was been restored. Many times we suffer the effects of injuries many months or years after the initial event. That is why it is important to get things looked at when you have had an injury. Another important component of the injury process that most people miss is the rehabilitation phase. For all significant injuries it is necessary to re-strengthen the injured area to prevent the injury from reoccurring.

For all acute injuries, I recommend to act immediately and aggressively. Treating the injury immediately can greatly reduce the recovery time greatly. It is best to always remember this acronym: P.R.I.C.E.S.: PROTECTION, REST, ICE, COMPRESSION, ELEVATION & SUPPORT. Immediately Ice the injured area to reduce swelling and any bleeding. Use a compressive bandage to wrap the area thus reducing more swelling, giving the area support and protecting it from re-injury. Rest the area and avoid activity that will put stress on the injury site. Then elevate the area above the level of the heart to assisting the reduction of the inflammation. Another question that is frequently asked is about the use of ice or heat. For all acute injuries use ice for the first 48-72 hours. For muscular injuries I recommend implementing heat after about 72 hours. For joint injuries continue to use ice until the swelling resolves (like in the case of ankle sprains). And lastly, if a mild injury does not improve with in a few days or the injury appears severe enough to seek care, don't hesitate to call some you trust and get treatment.

Dr Jim Hendricks is a doctor of chiropractic at Freeport Integrated Health Center in Freeport. His undergraduate education is in Sports Medicine and he is Certified Strength and Conditioning Coach. For more information or questions you can e-mail at drjah@suscom-maine.net or go to www.freeporthealth.com