If you fix a medical problem by eating well for a month, it's silly to expect the improvement to stick if you return to eating crap. The same applies to mechanical, or orthopedic, problems. Consider movement (and sustained positions) your “diet” when it comes to mechanical problems. There are certainly some mechanical problems that never have to pay attention to diet again. But for most, it matters. There’s no hard and fast rule; each patient’s case is unique, and is understood during the treatment process.
If nothing in a person’s life changed except she bought a new sports car, used it a lot, noticed lumbar stiffness getting out of the car she never had before, and a week later she had an L5 radiculopathy to her big toe, there’s a great chance that position is a factor. Let’s say that point is confirmed during treatment. Meaning, sitting in the sports car now exacerbates leg symptoms and/or obstructs low back movement. After resolving the patient’s low back derangement, does that mean she can never use that car again? Probably not. But it’s likely she’ll do much better long-term if she adjusts the car’s seat, or does her corrective exercise before and after car rides over 30 minutes, or makes sure to check her low back motion after being in the car. In this scenario, resuming her old “diet” of just hopping in her sports car - and adopting that specific mechanical seated position - without thinking twice will likely lead to recurrence. -- Laura
How often are patients seeking care for something they’ve had before? Learning about the nature of a problem, which lends itself to recurrence prevention is - in addition to resolving the problem - extremely valuable. If you understand the basic concepts and have a prevention plan to minimize chances it happens again, you’re much better off than a person whose problem just resolved.
Are there inexplicable things that happen to our bodies? Of course! Your hip is killing you one day and then the next day it’s like nothing happened. We can’t pretend to know everything. But for the problems we can diagnose (and fix), learning strategies to prevent recurrence is a close second to getting better in my book in terms of goals. It’s about getting better and staying better. -- Laura
The term “muscle memory” is familiar, but I think “joint memory” also exists. Muscle memory refers to engrained changes in the muscle as well as in the brain. Muscle and joint memory are often inextricably linked; for instance, when repeating pull-ups, both get habituated to that pattern.
However, what I want to highlight is the positional aspect of joints versus the pattern aspect. Whether it’s due to lifestyle, an event, or obvious injury, an altered resting position can be established for a joint. In the face of irreconcilable injury, this demonstrates the body’s resilience, as the body accommodates, creating a new normal. (Think of the historical images of a new acetabulum being formed due to a fractured hip.)
Subtler changes are more likely. If your neck always looks down, it makes sense that subtle changes are occurring at the joint level (not the obvious manifestation of "horns" written about in the news recently). If you have a fall jarring your low back that resolves on its own with time, it’s possible you have altered joint alignment. (That’s why having an expert check your musculoskeletal system after an injury is important if you want to ensure things are working normally, even in the absence of pain.)
This phenomenon does not preclude resolution of this positioning or of symptoms. But when I encounter patients who have had longstanding symptoms, it enters my mind that their joints may be accustomed to positions that are not purely anatomical. If a patient has had a subtle lumbar shift for 20 years, doesn’t it make sense the joints are accustomed to that position?
Put simply, if a joint problem has been there for a long time, once fixed, I find patients need to be more on top of motion checks ad infinitum to ensure the joint stays fixed and doesn’t “remember” its old ways. For short-term problems in which the joint has only been impacted for weeks/months, patients can usually get away with less in terms of lifetime prevention strategies. -- Laura
The perfect position is the position that reduces, abolishes, or prevents symptoms. And if a lumbar roll doesn’t reduce, abolish, or prevent symptoms, then it is not indicated. A roll may make symptoms worse initially, but, as therapy progresses, it becomes helpful. Or it may only be tolerated for 20 mins but eventually is useful for long stretches. Its use should always be assessed, not recommended without reasoning.
When it comes to prevention, often that looks like a person who doesn’t have symptoms in sitting but has trouble rising, especially with straightening his low back. Or it may look like a person who has no pain all day sitting at work but then pain in the evenings at the gym. If using a lumbar roll all day prevents pain later at the gym, then it is indicated.
Lumbar rolls can be extremely effective as can any decent lumbar support built into a chair. The point is usually to reduce prolonged spinal flexion or enhance extension. Lumbar rolls can be easily added, adjusted, and removed. They can come in the form of a rolled up sweatshirt, household pillow, or something purchased. I’ve had patients support their low backs with water bottles and purses. I myself used my wallet while driving once. Their low cost and ease of use make them potent tools for helping those with musculoskeletal complaints. -- Laura
We wash our hands to prevent infections, wear helmets to minimize head injury, and brush our teeth to reduce disease and decay. There are tips to preventing musculoskeletal problems as well. I put it succinctly recently: Move your joints. In all directions. Quite often.
Learning the basic tenets of prevention goes a long way. My goal is to help patients with their current problem and, just as importantly, to teach them what is occurring so that they can minimize or prevent recurrence. Advice to stay active, flexible, and strong to prevent injury is valid. What is lacking in my experience, however, is nuanced advice on maintaining joint balance and health. If people had a basic understanding of how joints worked, and some daily or weekly prevention strategies, a lot of aches, pains, and “injuries” that come on for no reason could be avoided. (Most musculoskeletal complaints, after all, cannot be blamed on major, or even minor, trauma.) -- Laura
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