Have you ever woken up one day with a pain and thought how the heck did this injury occur? It’s a common question I get in my clinic. People say to me, doctor I didn’t do anything I swear, I just woke up and it hurt, how did that happen? I would say about 50% of the patients I see have a mechanism similar to this as opposed to direct trauma to an area. The cumulative injury cycle explains how this type of injury can occur.
The cumulative injury cycle, pictured above, explains that injuries can occur in 3 manners: 1. Acute 2. Repetitive Injury 3. Constant Pressure/Tension. If left uncorrected these can lead to 1. Inflammation 2. Adhesions/Fibrosis 3. Weak and Tight Tissues 4. Decreased Circulation. And, if nothing is done about those, it can lead to loss of function/strength/range of motion, pain, etc. Relating to our above scenario, a repetitive injury or constant pressure/tension are the cause of the injuries that present without trauma. An example would be someone who works at a desk job where they constantly sit with poor posture all day. They put constant pressure/tension on their upper back/shoulders by sitting with poor posture which can lead to the next step of decreased circulation which leads to adhesions which lead to weak and tight muscles. When a patient comes in, my job is to find where the issue is and correct the issue, it’s as simple as that!
To correct for these issues, my tool of choice is Active Release Technique (ART) and specific rehabilitation exercises. I find that ART works fantastic for breaking down adhesions but if you don’t correct the biomechanical issues, the cycle can start again and you’ll be back to square one. How many times have you heard of someone getting treatment or going to rehabilitation for an injury and they get better but then in time, the problem comes back? What that means is that they have re-entered the cumulative injury cycle. I spend a lot of time with my patients to try to make sure that I take care of the problem and keep it from coming back. Hopefully this helps to explain how some injuries can just come out of the blue and why some injuries seem to never go away.
-Dr. Brian Damhoff