Pain is a complex and multifactorial experience, and understanding the mechanisms behind it is critical for effective management of musculoskeletal pain. Musculoskeletal pain is a significant burden on individuals, society, and the economy. In recent years, pain science has made significant advances in understanding the mechanisms and treatment of pain.
Traditionally, musculoskeletal pain has been attributed to mechanical dysfunction, such as poor posture, bad movement patterns, and structural abnormalities. However, the evidence supporting this view is weak. A systematic review of 11 studies found no evidence that poor posture causes musculoskeletal pain (Laird et al., 2016). Another systematic review of 21 studies found no evidence that poor movement patterns cause musculoskeletal pain (O’Sullivan et al., 2015). Furthermore, structural abnormalities, such as disc herniation or degeneration, are commonly found in people without pain and are therefore not always the cause of pain (Brinjikji et al., 2015).
Current evidence suggests that physical therapy and exercise are effective treatments for musculoskeletal pain. Exercise has been shown to reduce pain and improve function in a variety of musculoskeletal conditions, such as low back pain, knee osteoarthritis, and fibromyalgia (Häkkinen et al., 2020; Messier et al., 2004; Busch et al., 2016). Physical therapy, which includes exercise, manual therapy, education, and other interventions, has been shown to be effective for low back pain, neck pain, and osteoarthritis (Chou et al., 2017).
It is essential to recognize that musculoskeletal pain is a multifactorial experience that can be influenced by a wide range of factors beyond just mechanical dysfunction. Poor recovery, lack of sleep, a bad diet, and poor lifestyle choices can all contribute to the problem. For example, sleep disturbance has been shown to be a risk factor for musculoskeletal pain (Finan et al., 2013). In addition, dietary factors, such as low intake of omega-3 fatty acids and high intake of processed foods, have been associated with increased musculoskeletal pain (Griep et al., 2018).
Pain science provides solutions for musculoskeletal pain through cognitive-based rehabilitation approaches. These approaches focus on changing a person's beliefs and understanding of pain, rather than just treating the physical symptoms. For example, education about pain science can help individuals understand that pain does not always equal tissue damage and that it is often a protective response by the nervous system. This understanding can help reduce fear and anxiety about pain, which can contribute to the chronicity of pain (Louw et al., 2011).
Furthermore, movement is the best option for treating musculoskeletal pain because it is safe, inexpensive, and has numerous benefits beyond just reducing pain. Movement can improve strength, flexibility, and balance, which can help prevent future injuries. Additionally, movement can improve mental health and overall well-being (Stanton et al., 2018). Movement-based interventions, such as yoga, Pilates, and tai chi, have been shown to be effective for musculoskeletal pain (Wren et al., 2011; Holtzman et al., 2013; Wang et al., 2016).
Understanding the mechanisms and treatment of musculoskeletal pain is essential for effective management. While mechanical dysfunction has traditionally been blamed for musculoskeletal pain, the evidence supporting this view is weak. Current evidence suggests that physical therapy and exercise are effective treatments for musculoskeletal pain, but it is also essential to recognize that musculoskeletal pain is a multifactorial experience that can be influenced by a wide range of factors beyond just mechanical dysfunction. When in doubt, move.
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