What is a musculoskeletal injury (MSI)?

So you've heard about musculoskeletal disorders and injury from your doctor or from a quick Google search. Let's start by defining it to understand what musculoskeletal injuries are.

A musculoskeletal injury (or disorders) is an injury that affects the muscles, bones, joints, ligaments, nerves, tendons, and spinal discs. These parts of the body make up the musculoskeletal system that supports your body weight and helps you move through space. When we injure this part of the body, like in a car or sports accident, we can feel pain and stiffness, as well as be limited in our day-to-day function. (CDC, 2020, Cleveland Clinic, 2022)

Types of Musculoskeletal Injuries

There are two common types of injuries that affect the musculoskeletal system, both with very similar names!

  • A sprain is a stretch or tear of a ligament, which connects two bones together. They are very stiff and fibrous which help them stabilize and support your body's joints when you move. For example, ligaments you may have heard of are ACL, MCL and PCL (anterior cruciate, medial collateral, and posterior cruciate ligaments) which are all part of the knee joint. (University of Rochester Medical Center, n.d.)
  • Strains differ from a sprain because they are a twist, pull, or tear of a muscle and sometimes a tendon. Tendons are similar to ligaments in terms of structure, however they connect a muscle to bone, rather than bone to bone.

Sprain and strains often feel similar. These musculoskeletal injuries may feel painful, stiff, or sore, and include bruising or swelling in the affected area. Both could cause a loss of function, and/or range of motion.

What is the difference between an acute and chronic injury?

An acute injury is present with an injury such as a fall, sprain, dislocation, or direct blow to the area (this is called a contusion and can cause bruising). With acute musculoskeletal injuries we can pin-point the physiological trauma that is causing pain, swelling, and discomfort.

A chronic injury is caused by repeated small traumas over a longer period of time that are being subjected to your body's system. This leads to inflammation and irritation in the muscles you are using and can develop into an 'itis' which will be explained more below. This is also known as a repetitive strain injury.

Chronic pain is pain experienced longer than 3 months. This can be due to a chronic or acute injury.

What makes you more likely to get an injury?

Here is a comprehensive list of what would make you more likely to get a musculoskeletal injury:

- previous injury

- muscle imbalances and weakness

- poor warm-up, overstretching

- faulty biomechanics and malalignment of bones and joints

- excessive muscle tightness

- poor motor control/balance

- fatigue, overuse, not enough rest

- poor equipment or movement techniques

- sudden increase in load/volume 

N.B. these are preventable with proper training and support from your health and safety team at work (e.g.: education, better ergonomics).

Can musculoskeletal injuries be work-related?

Yes.

Work activities often include frequent and repetitive movements such as sorting mail, packaging products, or lifting boxes. Your risk of musculoskeletal injury will vary depending on the work you are performing—you don't only injure yourself from doing very physical work like heavy lifting! A certain posture (which can be awkward in nature) sustained for long periods of time can also cause musculoskeletal injuries. This may include sitting at a poorly set-up desk all day or doing overhead work such as painting.

Some common musculoskeletal injuries that are work-related are:

-Thoracic outlet syndrome

-Carpal tunnel syndrome

-Tendonitis

-Tension neck syndrome 

The health and safety team at your workplace can help with injury prevention by making your work environment more ergonomic and providing tools such as carts and machines to help with lifting tasks. Management can also help make common work practices safer by providing education programs for lifting and workplace health.

‘Itis’  vs. ‘osis'

Names of certain musculoskeletal disorders can help you decipher what type they are. If you see 'itis' at the end of the word, this means a diagnosis of inflammation. An example of this is arthritis, which can be related to but not caused by aging, genetics, stress on the joint, injury, or certain diseases. It is important to note however that rheumatoid arthritis is an autoimmune disease, however osteoarthritis is degenerative, i.e. breakdown of the tissues. Swelling is a common feature of inflammation in the body. 'Osis'/'oses' at the end of the diagnosis, for example, tendinosis, means there is a diagnosis of degeneration of the tissue. 

Why this is important is that the distinction between “itis” and “osis” changes the treatment protocol. For example, tendonitis would take much less time to heal, whereas tendinosis would require prolonged care with rest, gentle movement, and progressive loading of the tissue.

Q: how long does a muscle take to heal?

Muscle tissue repair has a general progression that it goes through before the muscle is healed. It is important to note however that everyone’s recovery time can vary, based on how you support healing of your body’s muscles and ligaments. Whether you exercise with a kinesiologist, see a physiotherapist or massage therapist, and/or you have a gradual return to activity can affect how well you recover. There are additional factors that change the length of time that it takes to recover from an injury such as age, genetics, stress, nutrition, infection, and sex hormones.

Tissue Response to injury:

  1. Muscle degeneration and inflammation

Inflammation at the site of injury peaks at 2-3 days and will last for a couple of weeks. Blood flow will increase to the area bringing important clotting factors, anti-infection materials and processes, and stimulate proliferation of building cells like fibroblasts. Inflammation is usually a localized, beneficial response to tissue injury.

  1. Muscle regeneration

This stage lasts for several months and peaks 2-4 weeks post injury. Your body will create more permanent tissue called granulation tissue that replaces clots in healing wounds. 

  1. Remodeling and Functional repair

This is also known as the maturation phase that lasts 10-12 months that focuses on reorganization and alignment of collagen fibers (assisted with movement). This stage is particularly important for continuing your rehab exercises even when the injury isn’t painful anymore because it helps with reducing the risk of re-injury.

I’m sore after a hard workout, does that mean I’ve injured myself?

Maybe.

Delayed-onset muscular soreness (DOMS), the sensation of pain and stiffness in the muscles that occurs from 1 to 5 days following unaccustomed exercise. When we submit our muscles to high tensions, our muscles undergo structural damage. When this happens, muscle cells rupture and the contents build up along with cleaner cells called macrophages. This stimulates our free nerve endings in our muscles leading to the sensation of soreness. 

In short, feeling sore after a hard workout comes from inflammation from microtears in the connective tissue in your muscles. Exercising while experiencing DOMS does not adversely affect muscle repair or damage your muscles more, however it may limit you from working as hard or exercising with proper form.

DOMS doesn’t usually necessitate seeking medical help—in fact, having a light form of DOMS can be a good thing! DOMS at an intensity of 2/10 for 2 days or less means you’ve challenged your body appropriately to cause a change in the muscle tissue which stimulates muscle growth, i.e. you get stronger.

If you experience intense muscle or joint pain, inflammation, or swelling longer than a week, it is recommended to see your doctor or physiotherapist. 

Common Injuries by Body Part

Neck:

Whiplash associated disorder (WAD)

A disorder that covers a collection of symptoms relating to an accident that involves acceleration and deceleration like a motor vehicle accident. Parts of the body affected can be different, depending on which way the movement happens- side to side or forward to back. Body parts affected can include the neck as well as the shoulder and upper and lower back

Postural Syndrome

This syndrome includes neck tension, headaches, upper and middle shoulder and back pain. Characteristics include a slouched posture, increased neck and upper back curves, and forward head postures. With postural syndrome you lose biomechanically advantageous posture. 

Shoulder:

Impingement

This is when the top of the humerus (the upper arm bone) and tendons of the rotator cuff are repetitively pinched and irritated against the underside of the coracoacromial arch, the bones that are made of the shoulder blade and collar bone (clavicle). This can occur with repetitive overhead tasks such as painting overhead, or due to poor biomechanics/a loss of stability in the shoulder blade and trunk. 

Biceps Tendinopathy

Irritation of long head of biceps in the bicipital groove, which involves feeling pain at the front of the shoulder or the top of the upper arm. This can be caused by trauma to the area or repetitive use of the shoulder, often in overhead motions. 

Elbow/forearm/wrist:

Tennis/Golfer’s Elbow

Pain on or near the lateral epicondyle of the elbow. This is classified as a tendinopathy and may be caused by trauma from a direct blow, sudden forced lengthening of the muscles in the forearm, by repetitive strain/movements, or by overuse (not taking enough rest days in the season while playing tennis for example).

Hip:

Lateral Hip Pain (Bursitis or Tendinopathy)

Pain at the greater trochanter, the bony part of the hip where the upper leg meets your pelvis. This can be diagnosed as trochanteric bursitis or gluteus medius tendinopathy. This injury occurs with general activities such as walking or running when there are leg length discrepancies, muscle imbalances in the lower extremities or malalignment of the knees or hips, loss of advantageous biomechanics at the hip, knee, or spine (loss of stability).

Muscle Strains (most commonly hip flexor or adductor)

Muscle strains are generally traumatic in origin, such as a quick movement or catching a fall.  These can be identified when you feel pain with contraction of the strained muscles. Muscle imbalances and/or weakness, malalignment of joints, or just not warming up properly before activity can predispose you to muscle strains.

Back:

Back Strains/sprains 

The area around an overstretched muscle or ligament in the upper or lower back becomes inflamed and painful. Injured muscles can spasm and limit range of motion of the back, often with bending forward, leaning back, and lifting tasks.

Herniated Discs

Symptoms from herniated discs happen when the discs between your vertebrae start to protrude and compress or irritate nearby nerves. This can lead to pain at the site as well as numbness, tingling or muscle weakness in the buttocks or legs.

back injury

More advanced neurological symptoms that may occur include changes in bladder/bowel function and loss of control in the legs. At advanced stages this injury is a medical emergency.

Knee:

Patellofemoral Pain Syndrome

Refers to pain around and/or under the patella, also known as your knee cap. This is mainly caused by the patella not tracking properly over the knee joint. Symptoms can get worse with going up or down stairs, running, or jumping. Improper tracking can be due to muscle weakness at the thigh (quads) or hip (glutes), altered ankle alignment or fallen arches. 

Iliotibial Band Syndrome

This is characterized by pain at the side of the thigh closer to the knee. This happens when the Illiotibial band, a thick band of tissue that runs from your hip to your knee, rubs against muscles of your lower thigh with the bending and straightening of your knee, irritating nearby tissues. This is commonly experienced by runners. 

Ankle:

Ankle sprains

By far the most common injury at the ankle, ankle sprains are caused when someone ‘rolls’ their ankle forcing a ligament to be suddenly forcibly stretched. Usually ankle sprains involve the foot rotating/inverting inwards due to different bone lengths on either side of the ankle, however spraining the ankle outward also is possible. Sometimes the muscles on the side of the ankle (peroneals) can also be strained.

Plantar Fasciitis

This is where the plantar fascia, on the bottom of the foot, becomes inflamed and painful. This happens when sudden cumulative or repetitive force like jogging is placed on the plantar fascia causing the attachment to the heel to be weakened or possibly frayed. 

Achilles Tendinopathy

This is characterized by pain in the achilles tendon before or at where it attaches at the heel. This is most often caused by repetitive forces being applied to the tendon however it can also be a result of alignment problems of the lower extremities, muscle stiffness or weakness in the leg/ankle/foot or weak hip stabilizers. 

How can I prevent injuries from happening?

Training your body to be more agile and developing better balance and stronger muscles helps you ward off potential injuries. This will also help you recover faster when injuries do occur. 

Many musculoskeletal injuries can be prevented by applying ergonomic principles to your daily actions or workspace. This can include adding more movement into your day, taking frequent breaks if you are seated long hours or performing repetitive tasks, and using proper lifting techniques.

References:

Centers for Disease Control and Prevention. (2020, February 12). Work-related Musculoskeletal Disorders & Ergonomics. Centers for Disease Control and Prevention. Retrieved July 21, 2022

Government of Canada, C. C. for O. H. and S. (2022, July 21). Work-related musculoskeletal disorders (wmsds) : Osh answers. Canadian Centre for Occupational Health and Safety. Retrieved July 5, 2022

Guo, S., & Dipietro, L. A. (2010, March). Factors affecting wound healing. Journal of dental research. Retrieved July 10, 2022

HUNT, T. I. M. (2021). Specialized exercises for injury rehabilitation: A Manual for Health Professionals. TELLWELL TALENT.

Laumonier, T., & Menetrey, J. (2016, December). Muscle injuries and strategies for improving their repair. Journal of experimental orthopaedics. Retrieved June 30, 2022

Muscle injuries. Physiopedia. (n.d.). Retrieved June 15, 2022

Musculoskeletal system: Arthritis, lower back pain, bones, Muscles. Cleveland Clinic. (n.d.). Retrieved July 21, 2022

O'Connor, F. G., Sobel, J. R., & Nirschl, R. P. (1992). Five-step treatment for overuse injuries. The Physician and Sportsmedicine, 20(10), 128–142.

RB;, A. (n.d.). Mechanisms of exercise-induced delayed onset muscular soreness: A brief review. Medicine and science in sports and exercise. Retrieved July 21, 2022

Sprains, strains, breaks: What's the difference? Sprains, Strains, Breaks: What's the Difference? - Health Encyclopedia - University of Rochester Medical Center. (n.d.). Retrieved July 21, 2022

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