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Over 30 years ago, the World Health Organization (WHO), made it a goal to have all healthcare providers take on a biopsychosocial approach to health. Unfortunately, most of the world including the United States has been slow to adopt this modern scientific approach to helping people with their health. The biopsychosocial model addresses 3 factors: biology, psychology, and sociology.

Biology includes your anatomy, physiology, and biomechanics. It’s important to be very thorough to rule out more serious issues.

Psychology includes your mood, what you think and feel, and how you hold yourself. All these factors influence the state of your body and how you recover from injury and pain.

Sociology includes your relationships with family, friends, your work and communities. These relationships have a dramatic impact on your biology and mental health.

With a completed picture we are better able to understand the complex series of influences that could be causing or prolonging your condition. Only then can we develop a recovery plan to overcome your pain and movement challenges.

To learn more about how we use the Biopsychosocial framework, watch our video here:

MYTH: I should be worried about seeing osteoarthritis on my X-Ray or MRI reports.

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FACT:

Joints change over time just like the rest of your body. These joint changes are called osteoarthritis. They are poorly related to pain.

MYTH: Osteoarthritis is a sign of wear and tear.

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FACT:

Osteoarthritis should not be considered wear and tear. In fact, quite the opposite. Osteoarthritis is an indication of wear and REPAIR. Joints get bigger due to thicker bones. This is why visible joints with osteoarthritis such as fingers or knees get bigger with age!

MYTH: Osteoarthritis means that I will have to get a joint replacement.

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FACT:

If there is not enough room for a joint to move, a joint replacement may be helpful to restore motion. However, many people experience normal age-related osteoarthritis, including joints that are BONE-ON-BONE, without the need for joint replacement!

MYTH: It’s bad if my joint becomes inflamed or swollen in an area of osteoarthritis. Osteoarthritis means that I will have to get a joint replacement.

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FACT:

Joint swelling and inflammation is an indication that the body is actively doing some work in that area, which creates a chemical soup that is visible and squishy. While we might not need the body to be doing that additional work, it does not mean that we will experience harm or pain from this process.

Think about your joints as construction sites during these times; there’s lots of activity going on when there is active construction. Don’t completely rest it, but take it easy until the construction site clears up!

MYTH: My joint hurts because of the osteoarthritis in it.

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FACT:

Joint pain and changes of the joint osteoarthritis are not closely related. People with significant changes of the joint can have no pain (including bone-on-bone!), whereas people with mild changes can have severe pain. Additionally, joint replacements are not a guarantee of pain improvement. In fact, over 40% of people who have joint replacements continue to have joint pain, sometimes even worsening pain, after their joint is replaced.

Pain is complex; find a movement healthcare provider who is well educated in pain to help you with your joint pain! (Tip: To find one, show them this list of myths and facts, they should understand the facts on this page well!)

MYTH: Running and other high-impact exercises are harmful to osteoarthritis.

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FACT:

Running has been shown to both improve joint osteoarthritis and reduce pain. As an added bonus, it helps strengthen your spine!

MYTH: I should not exercise a joint with osteoarthritis.

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FACT:

Exercise helps to reduce the progression of joint-space loss with osteoarthritis! It even helps with pain, as long as you work WITH the pain, rather than push through it. Be sure to have a good exercise plan developed by a movement recovery professional to maximize your success and help you reduce pain further!


Scientific Evidence

Halilaj, Eni, et al. “Modeling and predicting osteoarthritis progression: data from the osteoarthritis initiative.” Osteoarthritis and cartilage 26.12 (2018): 1643-1650.

Perrot, Serge. “Osteoarthritis pain.” Best practice & research Clinical rheumatology 29.1 (2015): 90-97.

Brinjikji, W., et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” American Journal of Neuroradiology 36.4 (2015): 811-816.

Bedson, John, and Peter R. Croft. “The discordance between clinical and radiographic knee osteoarthritis: a systematic search and summary of the literature.” BMC musculoskeletal disorders 9.1 (2008): 116.

Brinjikji, W., et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” American Journal of Neuroradiology 36.4 (2015): 811-816.

Williams, Paul T. “Effects of running and walking on osteoarthritis and hip replacement risk.” Medicine and science in sports and exercise 45.7 (2013): 1292.

Hyldahl, Robert D., et al. “Running decreases knee intra-articular cytokine and cartilage oligomeric matrix concentrations: a pilot study.” European journal of applied physiology 116.11-12 (2016): 2305-2314.

Lo, Grace H., et al. “Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative.” Clinical rheumatology (2018): 1-8.

Belavý, Daniel L., et al. “Running exercise strengthens the intervertebral disc.” Scientific reports 7 (2017): 45975.

Ding, Changhai, et al. “Knee cartilage defects: association with early radiographic osteoarthritis, decreased cartilage volume, increased joint surface area and type II collagen breakdown.” Osteoarthritis and cartilage 13.3 (2005): 198-205.

Hunter, David J., et al. “Structural correlates of pain in joints with osteoarthritis.” Osteoarthritis and cartilage 21.9 (2013): 1170-1178.

Wylde, Vikki, et al. “Persistent pain after joint replacement: prevalence, sensory qualities, and postoperative determinants.” PAIN® 152.3 (2011): 566-572.

SPINAL DEGENERATION sounds scary but it’s just a technical word for NORMAL AGING!

The spine begins to undergo completely normal, age-related changes at around age 13, and by our 40’s, our spine has already gone through a LOT of changes that we may not even be aware of.

Normal age-related changes of the spine include disc height loss, disc bulges and protrusions, and many other terms that sound bad, but generally aren’t.

Check out all these normal changes that the spine will undergo over time without pain or other symptoms!

In extremely rare cases (less than 10% chance!), these changes can take up too much free space around the nerve and surgery may be helpful to clear some space for the nerve to breath better.

Occasionally, there are minor injuries that may occur with these spinal changes that may result in an inflammatory “chemical soup” in the space around the nerves of the spine. These “soups” may sometimes cause problems, including pain, but they will typically resolve themselves all on their own.

Healthcare professionals who specialize in pain and movement can help you through the recovery process if you need backup.


Scientific References

Tonosu, Juichi, et al. “The associations between magnetic resonance imaging findings and low back pain: A 10-year longitudinal analysis.” PloS one 12.11 (2017): e0188057.

Brinjikji, W., et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” American Journal of Neuroradiology 36.4 (2015): 811-816

Suri, Pradeep, et al. “Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK).” BMC musculoskeletal disorders 15.1 (2014): 152.

Tertti, M. O., et al. “Low-back pain and disk degeneration in children: a case-control MR imaging study.” Radiology 180.2 (1991): 503-507.

When it comes to treating pain in athletes, the world-wide consensus is that we are not treating it appropriately with the current healthcare model.

Organizations ranging from the International Olympic Committee (IOC), the National Collegiate Athletic Association (NCAA), and US Military have put out official statements that athletes in pain, in particular elite athletes, should be treated by sports medicine clinicians who have a thorough understanding of the Biopsychosocial Model. Specific to physical therapy, the IOC recommends that physical therapists who treat athletes should be trained to “identify and address inaccurate conceptualisations of pain and injury plus psychosocial and contextual influences on pain” and be able to educate “the athlete regarding the role of the central nervous system in pain, especially in chronic pain“.

DMR meets, and exceeds, international standards for the treatment of pain in athletes.

Our Movement and Pain Specialists are trained in the current science of pain and movement, as well as, education and treatment strategies related to this knowledge. In addition, our facility is fully equipped to provide the appropriate physical stresses needed for athletes to meet the demands of their sport.

Learn more about what the International Olympic Committee and US Military expects of sports medicine clinicians below

Skilled physical therapy services are provided by licensed physical therapists for the treatment of illness or injury to help you recover from pain and functional limitations. Our licensed physical therapists can provide physical therapy services both, with or without, physician referral in the state of Michigan. We can evaluate and treat illness and injury for 10 visits or 21 days without physician consultation.

During, or after this time, we can re-assess and determine whether your condition has improved enough that you could continue with our Movement and Wellness programs, or whether we would need to consult with a physician for continuing treatment.

If your physician has already referred you for physical therapy services, we do not have to worry about these time limits and will work closely with your physician in ensuring your treatment is appropriate and uninterrupted.

It is commonly believed that  stretching could physically “lengthen” muscles and other soft tissues (such as tendons and fascia) by holding a stretch for an extended period of time or through all sorts of stretching techniques with fancy names. It is easy to believe this is the case because the muscle that is stretched feels looser and has an improved range of motion after you stretch it! However, it turns out it is a bit more complicated than this, scientific research has looked very closely at the ability of muscles and soft tissues in both humans and animals and found that even after hours of held stretching, muscles and soft tissues do not physically become “longer”, instead they only become more willing to be stretched. This scientific term for this is called “Stretch tolerance” and is primarily function of your nervous system.

It turns out what makes the body prevent a muscle from stretching is that the muscle has a set programmed limit of available length and motion that is maintained by the nervous system to prevent the muscle from overstretching and potentially causing an injury. The same “danger” sensors and nerve pathways related to monitoring injury, strictly regulate how long muscles and soft tissues can move. We can override these set programs with our stretching or mobilization exercises immediately, as well as in the long term with regular frequent stretching, to allow the muscle to move more readily and feel less tight/tense.

By understanding this science, we have learned there are a number of other ways to get the nervous system to allow a muscle or a body region to move a little easier without having to do intense or frequent stretches/mobilization exercises. We can do this by playing with movement and even imagining your movement. These movement experiments can make some very quick improvements in range of motion and movement quality without too much effort. See some examples of this in the videos below. Be on the look out for more of these!

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