The Case for Exercise Therapy to Primarily Resolve Musculoskeletal Pain and Injuries

1. The Case for Exercise Therapy to Primarily Resolve Musculoskeletal Pain and Injuries What Are Musculoskeletal Injuries. When we think of muscles we automatically picture joints moving and the ability to move with purpose to accomplish a task (for example: lifting a dumbbell to perform a bicep curl or groceries out of the trunk of a car). Recently Andy Galpin, Professor of Kinesiology at Cal State Fullerton, expressed on his podcast, Perform, that the largest organ system by volume of the human body were muscles. To be considered an organ system there has to be interdependence with other systems to allow the body to function optimally. What Dr. Galpin expressed was that in the last 20 years, research has shed light on the importance of skeletal muscle in helping to regulate other systems in our body. Our muscles are stimulated through exercise that releases signaling molecules called exerkines, from working muscle fibers to provide information and regulate other organs such as the kidneys (controls blood pressure, blood glucose levels, and bone density), liver (detoxifies our blood and metabolizes our food to give us energy), lungs and brain (keeps us breathing and alive); to name a few. In addition, the muscle mass of our bodies serves as the largest protein reservoir to provide maintenance for our immune system. White blood cells that fight off diseases, cannot be produced in our bone marrow without the presence of protein and more protein cannot be achieved without stimulating muscles to grow more through exercise. It can be argued that muscle may be the most important organ that we have. It allows us to move optimally, to live fully to enjoy life, and is an organ we have the most direct control over in making a difference in longevity, injury prevention, and pain relief. Exercise for Longevity Research has shown four physical components of longevity that have been linked to all-cause mortality (death due to any reason). To no surprise, the amount of lean body mass (body weight excluding fat tissue that causes inflammation and leads to disease) is one of the major components. Leg strength is another which allows us to stay actively engaged with our world both mentally and physically by being able to travel in different environments easily. If we are not able to move then we are limiting ourselves in the experiences that keep us going (being present physically for family and friends, exploring new places, and achieving new milestones). The third, foot speed, being able to cover a certain amount of distance in a sufficient amount of time is also reliant on how well our muscles are working. Without sufficient foot speed, we are more likely to lose our balance and fall. That may not be a problem for the younger population but certainly can be disconcerting for the older population which we will all eventually reach. Lastly, VO2 max, a measure of how well our body can use oxygen for high-intensity activities which is a measure of our cardiovascular fitness, can only be achieved through exercise. While it’s not a surprise that exercise helps us live longer, exercise being the go-to treatment option for pain and injury may be a surprise for some. Exercise for Treating Pain and Injuries In 2023 I had an unfortunate year. I had suffered a left foot injury training for the Los Angeles Marathon increasing my training volume too quickly. For weeks I could not do a single leg heel raise without sharp pain and discomfort at my 1st metatarsal. This put me out of commission for three months

2. as I was allowing my tissues to heal and build up bulk and tolerance. During those three months, I was still working and treating patients. Towards the end, I must have unknowingly compensated poorly when loading and unloading equipment from the work vehicle and I ended up injuring my lower back. I had sharp searing pain that traveled down from my lower back to both outside parts of my legs and into the big toes. The pain would sometimes switch sides or occur at the same time. Needless to say, I was not a happy camper! MRI results displayed two herniated discs at L4 and L5 disc levels. It was hard to get up each morning and I was not able to resume my marathon training. Fortunately, as a physical therapist, I knew what needed to be done. What got me through was making sure that my body was receiving the right exercises on the day-to-day. I made sure to buffer the injured area by building the muscles of the left foot to protect against the forces of impact when I was on my feet. I proactively practiced good lower back hygiene by not putting myself in positions and activities that made the pain worse. Improving hip flexibility in the sagittal plane, strengthening the core and hips in a spinal neutral position, and walking, allowed me to get through the day and still make progress toward healing. I was able to walk the entire Los Angeles 2024 Marathon in just a shade under 8 hours and followed that by resuming training for my next Marathon a month later with no limitations. In total, I was out of training commission for 9 months for two combined injuries and didn’t skip a day of work. What could have turned into an 18-month or longer ordeal, epidural injections, or potential surgery, was resolved with exercise, an ice pack, and a lumbar roll to protect my spine when I sat. I had received no other treatment of any kind. I am proof that the body is very resilient and can heal itself if given the proper care, exercises, and guidance. Convincing Reasons Why Exercise Should Be Your Go-To Treatment By prioritizing exercise in treating musculoskeletal injuries, we’re not only addressing the immediate issue but also enhancing the body’s overall resilience and health. Exercise interventions have shown remarkable benefits across various musculoskeletal conditions by: *Improving overall muscle strength and endurance *Enhancing flexibility and range of motion *Boosting cardiovascular health *Releasing endorphins, natural pain-relievers *Improving sleep quality *Reducing stress and anxiety Passive modalities (electrical stimulation, massage, manipulation, dry needling, acupuncture) have their respective benefits. However, none encompass all the benefits that exercise provides. Exercise empowers patients to take an active role in their recovery and this prevents the formation of chronic pain conditions. It equips individuals with tools they can use independently, promoting self-efficacy and long- term pain free health management. By embracing exercise as the primary treatment for musculoskeletal injuries, we’re not just treating symptoms, we’re optimizing the function of our body’s most crucial organ system, our muscles. While other modalities may have their place in a comprehensive treatment plan, exercise should be at the forefront, offering a powerful, sustainable, and holistic approach to healing and maintaining function for life.

3. Sources: Galpin, A (2024, June 19). Perform. [Podcast] Retrieved from Cheung CL, Lee GK, Au PC, Li GH, Chan M, Li HL, Cheung BM, Wong IC, Lee VH, Mok J, Yip BH, Cheng KK, Wu CH. Systematic review and meta-analysis of lean mass and mortality: Rationale and study description. Osteoporos Sarcopenia. 2021 Mar;7(Suppl 1):S3-S12. doi: 10.1016/j.afos.2021.01.001. Epub 2021 Feb 11. PMID: 33997303; PMCID: PMC8088993. Momma H, Kawakami R, Honda T, et al. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies British Journal of Sports Medicine 2022;56:755-763. Salier Eriksson, J., Ekblom, B., Andersson, G., Wallin, P., Ekblom-Bak, E., 2021. Scaling VO 2 max to body size differences to evaluate associations to CVD incidence and all-cause mortality risk. BMJ Open Sport Exerc Med 7, e000854. https://doi.org/10.1136/bmjsem- 2020-000854 Studenski, S., 2011. Gait Speed and Survival in Older Adults. JAMA 305, 50. https://doi.org/10.1001/jama.2010.1923