Musculoskeletal disorder - that nagging pain you can’t put your finger on

By Dr Robin Chatterjee, consultant in musculoskeletal, sport and exercise medicine at Chiswick Medical Centre.

The benefit of a trauma-based injury, although in an ideal world we would avoid them altogether, is the speed at which a diagnosis can be made. This allows for a more responsive and suitable treatment plan to be put in place.

The time-saving aspect for treating this type of musculoskeletal problem can therefore differ from those occurring through an unknown cause. This is in no small part due to the fact the injuries that seem to creep up on us more often than not result from deeper-lying health issues.

As a consultant doctor who specialises in musculoskeletal, sport and exercise medicine at Chiswick Medical Centre, I’ve seen many more patients affected by injuries caused by an unknown source, than those where the cause is easily identifiable. Unfortunately, there is no main cause of musculoskeletal disorders but there are common themes.

As I emphasise to all patients, these injuries are neither age, weight nor gender-specific. And, generally, require greater investigation to help determine the root cause. From irregular sleep patterns to stress and dietary habits, the common denominator normally sits within an individual’s day-to-day lifestyle – or, more aptly, how their lifestyle and dietary habits have become detrimental to their physical health.

When it comes to musculoskeletal injuries of an unknown cause, there are certainly some which are more common. It is important to consider everyday factors which can contribute to a far more rewarding, pain-free daily lifestyle.

When a patient visits me with shoulder pain, I will ask them about their lifestyle to better understand any specific areas which may, inadvertently, be causing the problem.

For example, if a person’s sleep schedule is irregular it can have an adverse effect on their shoulder area. This is because of the negative hormonal reaction which occurs within our body as a result of getting too little, or even too much, sleep. Yes, unfortunately it is true - excessive lie-ins can actually amplify musculoskeletal pain.

As mentioned, there is often more than one contributing factor to how an unhealthy lifestyle directly correlates with injuries of this nature. Perhaps the most common is diet, as being overweight has both direct and indirect consequences on our body as a whole. This is certainly true in relation to our shoulder area, where poor dietary habits – or related conditions such as diabetes, thyroid problems and high cholesterol can produce high deposits of calcium in the tendons in the shoulder, leading to inflammation (tendonitis) of the rotator cuff.

Staying on the theme of weight, it stands to reason that if excess fat is predominantly situated in one area of the body, this area will naturally have to withstand far greater stress and strain than it’s supposed to. The clearest example of this is how a larger or protruding belly can be a fundamental cause of a person’s lower back pain.

The gut itself acts like a sieve for the rest of the body. Its main purpose is to allow healthy nutrients from the food we eat to pass through to other areas. While preventing too much of the lesser desired things, such as nasty bacteria, from travelling to the same places. If the gut fails to do its sieve-like job properly, it may lead to muscular or joint pain.

Furthermore, a poor diet or inactive lifestyle can lead to an individual putting on weight around their abdomen. Their lower back then has to support a tremendous amount of added weight, and the stress from this can soon result in musculoskeletal pain in this area.

An additional factor we must consider is how detrimental bad posture can be to our lower back. From office workers sitting at a desk to pregnant women and taxi drivers, there are a number of reasons why some of us are more susceptible to posture problems than others. Nonetheless, it is very important to remember to sit up straight whenever we do find ourselves slouching a little too regularly over the keyboard.

As it may have hopefully become a little clearer already, my fellow musculoskeletal specialists and I take a far more holistic approach when meeting patients experiencing these injuries for the first time.

From shoulder and back pain, to heel injuries or indeed any musculoskeletal disorders of unknown cause, our role first and foremost is to find the most accurate diagnosis for each patient. In this sense, compared with a normal GP appointment, we encourage patients visiting us at Chiswick to talk more openly about their overall health and lifestyle habits.

These discussions, and the relevant tests we carry out, help to inform both the short and long-term treatment plans we tailor to each patient.

The immediate treatment prescribed for musculoskeletal pain is done so to provide pain-relief. Dependent on your condition and its severity, treatment options we offer at Chiswick include:

• steroid injections which serve as anti-inflammatory medicine in the area where the musculoskeletal pain is occurring
• platelet-rich plasma (PRP) injections is the process by which we use an individual patient’s own healing system to improve musculoskeletal problems. A centrifuge is used to harvest platelets from a patient’s own blood, before then injecting them back into the musculoskeletal pain area in order to accelerate the healing of injured tendons, ligaments, muscles and joints
• shockwave therapy to irritate the tissue in the pain area, allowing it to self-heal of its own accord. This can be particularly helpful for treating heel pain and plantar fasciitis.

Alongside more common pain-relief medication, the above are only some examples of the advanced treatment options we offer – all of which are carried out with the help of ultrasound guidance.

We pride ourselves on supporting initial treatments with longer-term care plans for every patient we see with these types of musculoskeletal injuries.

This is enacted by discussing each case as a multidisciplinary team that includes leading specialists and sub-specialists such as physiotherapists, dietitians, podiatrists and orthopaedic surgeons. The shared expertise of each specialist helps us to create a clear treatment plan with a particular emphasis on diet, exercise and rehabilitative care. This is designed to alleviate primary factors such as stress and weight problems which likely contributed to the original musculoskeletal pain.

Above all else, at Chiswick Medical Centre we understand the importance of providing the local community with exceptional care when you need it the most.

Our centre combines the specialist knowledge of leading consultants with the very latest medical technology, and so if you or any one of your family members has a musculoskeletal injury or any health concerns as a whole, please do get in touch as we are perfectly placed to ensure you receive the highest standards of care.