Muscle Or Joint Pain? Which One Is It?
I typically hear this same question weekly, if not daily, “Is my pain coming from the muscle or joint?” I usually answer, “Probably a little of both.” This always seems to put a perplexing look on most patients’ faces. The bones and the muscles depend on each other to function properly and an injury to one, more than likely causes pain and dysfunction to the other.
Musculoskeletal System
The musculoskeletal system is composed of your bones, joints, muscles, ligaments and tendons. Each of which has its own specific function but together create stability and function. The ligaments attach the bones together to form joints while the muscles attach to the bones by tendons to make an anchor for locomotion. A “joint complex” consists of the union of two or more bones and all the surrounding muscles, ligaments and tendons. For the most part, injuries I see here involve the entire joint complex, which consists of treating the joint dysfunction or pain and at the same time addressing muscular sprain/spasm as well.
Joint Sprains
Joint sprains are injuries that occur when a joint is suddenly moved or forced beyond its normal range of motion and the ligaments are severely stretched or torn. Ligaments connect adjacent bones together to give support and stability to joints. Sprains cause the injured joint to become weak and unstable. A common injury for athletes is the ankle sprain. This is caused when the ankle “rolls” outwardly, forcing the joint beyond its normal range of motion. How badly the ligaments are damaged defines the degree of injury.
A first-degree sprain is a minor stretch of the ligament while the integrity of the joint remains intact. Usual symptoms include mild pain, swelling and immobility of the joint. In the case of a second degree sprain, the ligament is stretched more severely causing a degree of micro-tearing of the ligaments. This will result in increased pain, swelling, moderate immobility, moderate instability of the joint and bleeding of the tissues causing ecchymosis (bruising) of the skin at the site of injury. Third degree sprains occur when the ligaments are more torn to the point of rupture. Symptoms are severe pain, swelling and joint instability. Ruptures or complete ligament tears occur when the fibers of the supporting ligaments become torn and are no longer intact.
Muscular Sprains
Muscular sprain/strains or “pulls” as patients call them are injuries to the muscles and tendons from over-stretching or exerting some part of the muscle beyond its normal length. Muscles are attached to bones by tendons and the tendons are what allow the muscle to contract. When there is an injury to the muscle it can become stretched or torn and muscular strains are graded according to their severity. First degree sprains are a mild injury to the muscle causing mild tissue tearing and pain. The result is pain, mild swelling, muscular spasm, but with full range of motion. Second-degree muscle strains involve moderately torn muscle or tendon tissues.
Along with above symptoms of the first degree sprain, additionally there will be a loss of muscular strength, limited range of motion and bleeding of the muscle fibers that will result in an ecchymosis at the site of injury. Third degree strains are a complete rupture of the muscle or tendon from the bone. In this case, there will be a complete loss of muscle function. Initially with injury there will be severe pain with limited or no movement.
Injury Cases
In the majority of injury cases, whether it is an ongoing condition or an acute injury, there is usually a muscular and a joint component. Granted, I am not saying that there are not true joint injuries (a ligament tear of the ACL of the knee) or muscular injury (a strain of back muscle), because initially this is true. However, with either a joint or a muscle injury, both can lead to adverse effects on the other. The bones of the skeleton are the frame and provide attachment points for muscles which cause motion at/around the joints. This synergy enables the muscles to create movement. The big question when evaluating injury is to determine which the primary cause of pain is and then deal with any other additional issues as well.
When the normal joint mechanics become altered, as with the joint and muscle injuries above, the function of all the components of the joint complex are altered as well. Musculoskeletal injuries, whether it begins with a joint sprain or begins a muscle strain, will lead to detrimental effects in the other parts of the joint complex. It is also important to note that even though the pain from a muscle or joint injury has “gone away”; it does not mean that normal function has been restored. Many times we suffer the effects of injuries many weeks, months or years after the initial event. Another important component of the injury process that most people miss is the rehabilitation phase. For all significant injuries it is necessary to re-strengthen the injured area to prevent the injury from reoccurring.
Treatment Protocols
For all acute injuries, I recommend to act immediately and aggressively. Treating
the injury immediately can greatly reduce the recovery time. It is best to always remember this acronym: P.R.I.C.E.S.; PROTECTION, REST, ICE, COMPRESSION, ELEVATION & SUPPORT. Immediately ice the injured area to reduce swelling and any bleeding. Use a compressive bandage to wrap the area thus reducing more swelling, giving the area support and protecting it from re-injury. Rest the area and avoid activity that will put stress on the injury site. Then elevate the area, above the level of the heart, to assist in the reduction of inflammation. Another question that is frequently asked is about the use of ice or heat. For all acute injuries use ice for the first 48-72 hours. For muscular injuries I recommend implementing heat after about 72 hours. For joint injuries, continue to use ice until the swelling resolves (like in the case of ankle sprains). And lastly, if a mild injury does not improve within a few days, worsens or the injury appears severe enough to seek care, don’t hesitate to get treatment.
Dr. Jim Hendricks is a doctor of chiropractic at Freeport Integrated Health Center in Freeport and has been in practice for 15 years. His undergraduate education is in Sports Biology and he is Certified Strength and Conditioning Specialist. His main focus of care is musculoskeletal injuries and pain with a special interest in sports injuries. For more information go to: www.freeporthealth.com.
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