Musculoskeletal Longevity for Lifelong Strength and Mobility

Evidence informed practise is an approach to patient care that takes three different perspectives into consideration. The scientific research on a topic, a practitioner’s experience and a patient’s perspective are all an equal part of this model.

I’ve now been in practise for over twenty years in Burlington, seeing many patients each day with different musculoskeletal injuries.  Perhaps different from other healthcare providers, the visits are long enough and frequent enough for patients to share their stories and insights into their condition.  I get to hear their perspective on what they believe caused their pain, what helped with their recovery and, in general, what they’ve learned about their musculoskeletal health over their years of being active.  Fortunately, I also get to brainstorm and share patient cases with my wife on a regular basis, who also has over twenty years of experience as a chiropractor.  Along with these experiences, I do my best to keep up to date with current research in musculoskeletal healthcare.

Every month, we post a blog on our website on various concepts related to musculoskeletal health.  For the coming year, I’m going to focus on topics and areas that seem important to musculoskeletal longevity. I don’t profess to be the absolute authority on all of these topics, but I would be comfortable saying that the information presented is a nice blend of evidence informed practise; my knowledge from trying to keep up with the latest research in the field, the feedback and stories I’ve heard from my patients in Burlington, as well as my own personal take on what I’ve seen work and not work in clinical practise.

Before delving into specific areas of the body, I thought a general framework for many injuries might be helpful.  Many of my patients will be familiar with this explanation as I use it in the clinic quite often.  I believe that it provides a helpful visual, conceptual model that patients can keep in mind as they encounter various aches and pains in their lives.

Activity Pattern

The above graph is an example of a person’s activity pattern. It will be different for everyone, so keep in mind that this is an example of a general concept.  In this person’s case, they are doing activities that might challenge their system but not cause any discomfort.  A round of golf (a), raking leaves (b) and tying shoes(c) are examples of more difficult activities for this person when specifically focusing on their lower back health. This framework can be applied to different areas of the body and different injuries that might occur.

Capacity or Tolerance  (blue)

In the graph above, we see a horizontal line that represents the person’s ability or tolerance.  This can also be considered their “capacity” or threshold for discomfort.  In this example, with the capacity line in its horizontal place, and the person’s activity pattern layered on the graph, we can see that this person is easily capable of those strenuous activities (golf, raking and tying shoes) with no threat of injury.  The red line (activities) does not cross the person’s capacity (blue line).

Threshold of a Sedentary Person

The graph above is an example of a person who has perhaps neglected their lower back health and is very sedentary.  For lack of a better word, their lower back wouldn’t be considered athletic.  They don’t move very well, and they’ve never strengthened the muscles around their lower back.  As you can see, they might be at risk for pain unless they do something about their horizontal line!

Activity Level of an Active Person

In this example above, the person has a very good capacity for activity, but they’re still doing a little more than what they are generally capable of.  For example, they can tolerate one round of golf, but for this person, golfing every day of the week is just too much at their current level of health and the accumulation of stressors has resulted in discomfort.

We should always try to push the horizontal line (capacity) higher so that we are more capable of the activities we want to do.  Strengthening and mobility exercises are perhaps the most common ways to improve our capacity.  Keep in mind, this concept is not always black and white and doesn’t necessarily apply to every situation. There are also other variables that interplay with both lines on the graph, such as sleep, diet, attitude, beliefs and mental health, to name a few.

Based on the most current research, my clinical experience and feedback from patients over the years, our next blog will outline the most common injuries and helpful prevention strategies for lower limb injuries.  In simple terms, what are some things I can do to prevent lower limb injuries and keep my foot and ankle health optimized for as long as I can?