Cumulative injury disorder can be defined as a group of injuries to muscles, tendons, fascia, nerves, blood vessels and bones. The cumulative injury cycle involves a lovely and vicious little circle consisting of weak/tight musculature/tissues, friction/pressure/tension, decreased circulation and nutrient delivery and adhesion/fibrosis. This is the cycle that is responsible for many cases of chronic pain that people have.
There are generally three types of injuries that can lead to this frustrating cumulative injury cycle. Acute injury, which we mentioned earlier, is the type of injury that most people know of. What many do not realize, however, is that an acute injury (i.e. muscle tear) can lead to the cumulative injury cycle if not treated correctly.
A very common yet not often talked about type if injury is repetitive motion injury. This results from many common tasks and postural patterns that people undertake daily. To get a better sense of this injury type, we will look at what is known as the law of repetitive motion. This can be defined by the formula I=NF/AR. I= tissue insult; N=number of repetitions; F=force or tension of each repetition in relation to one's max strength; A=amplitude of each rep; R= rest time between reps. Bad posture that is held for a long duration of time has a force that is high, an amplitude close to zero and pretty much no rest time. This yields a high insult to your tissues. What this means is that even though you may not be “exerting yourself” as you sit at your wonderful computer all day or lounge on the couch eating potato chips and watching Wheel of Fortune, certain tissues are undergoing a heck of a lot of stress to maintain the posture that you are, although in fact should not be, supporting yourself with. Typing on a keyboard for a long period of time is a good example of a repetitive motion with constant stress that can cause problems with the hands and forearms, all the way up into the shoulders if the table and chair height are not right. Factory workers and mail office workers are two good examples that have repetitive motions that can be damaging if not combated with proper movement and exercise.
Another nice little tidbit is the fact that someone who is weak or possesses a low level of max strength, has to use more energy and reserves to perform even the most mundane, itty bitty little tasks (like, say picking up a pen that was dropped while sitting at a desk) and will have a much easier time injuring themselves, regardless of the type of injury. What that means is that you should quit doing your hundred rep toning sets with your 2 pound dumbbells that your unqualified celeb trainer has you doing on the latest exercise video from Target, and get into the weight room and pick and squat some heavy freaking objects up. A good strength exercise will have good force (at least it should but probably won't if all you do is tracy anderson workouts :), a decent number of reps, a good amplitude and good relaxation time between sets/reps. This yields a nice equation and will help balance out the “bad” stress from the postural patterns of the day and will provide the body with a “good” stress to make those tissues stronger and healthier.
A constant pressure or tension injury decreases circulation and compromises cell recovery, resulting in poor repair, changed function, pain and inflammation. A poor static posture will usually be the culprit here.
Whichever way you look at it, these situations will cause muscles to be weak and tight/taut. This can cause internal forces on the tissues to rise, creating friction, pressure or tension. What this all means is that injury and inflammation can result even if there is no external force occurring. In other words, you don't have to get laid out by Darrrren Sharper while rushing for the end zone in a football game to have an “injury.” Internal forces within your own body are probably causing some damage to your tissues right now as you read this awesome article.
Soooo, once you have weak tissues and negative tissue stress, you then get decreased circulation. This means less blood flow, which means less nutrient and oxygen delivery.
This decreased circulation then leads to the development of adhesions. Adhesions can develop between fibers of a single muscle, between fibers of adjacent muscles, between a muscle and a nerve or between any of these structures and tendons, ligaments and vessels. The longer these adhesions are left alone, the worse they get and the more issues they can potentially cause. Restricted oxygen makes pain receptors more sensitive, adhesions disrupt proper biomechanical movement with your body (which can lead to more problems) and a whole vicious cycle begins. If the tension or forces mentioned above are strong enough, a tear or crush can occur and severely disrupt the tissues. This can occur from internal or external forces.
Whether the cycle begins with an acute tear or long term poor posture/repetitive motions, it will continue until something is done about it. With an acute injury, your body will generally try to heal things with the inflammation cycle. You have a window of opportunity here to stop the chronic cycle before it begins by breaking up scar tissue (your body's repair puddy) and realigning the muscle fibers with proper rehab and movement training. If this opportunity is missed, the cycle will begin and you'll have more work to do down the road. With long term poor posture or repetitive motion related issues (which can also result from an acute issue), the tissues can enter into this cycle that involves chronic inflammation, decreased circulation, multiple adhesions and fibrous tissue and weak, stiff musculature.
The bottom line here is that you can cause much damage to your body by doing “nothing.” I have had more than a fair share of people ask me “Isn't lifting all that weight like bad for your back and stuff?!”; (to which I respond with a 45lb plate to their head ;jk although sometimes I would like to:) to which I respond well with bad form, it most certainly could be but with proper form, it is about one thousand million times less likely to cause any harm than you sitting on your couch with bad posture is. Sitting for long durations of time, doing nothing but repetitive motions every day, doing nothing but repetitive motions for exercise (excess running, ellipticals, biking, seated machine exercises,cough cough cough) and of course doing high rep power snatches after doing heavy triples in the squat and a balls out 100 yard sprint (big cough) are all much more damaging to your body than lifting 2-3 times your bodyweight with proper form for a few sets ever will be. (Ok the last example has nothing to do with this article but just had to throw it in :)
So what all of this means is that there is a good chance that the pain in your forearm, elbow, knee, low back, wrist, hand, neck, shoulder or whatever pain it is that you have is not, in fact, from old age, arthritis, an old injury, “a bad back,” high school football, training arms 5 days a week at the gym, wait that one probably is really causing some pain sorry, or any of these common excuses and reasons that people often like to use. There is a good chance that you have some nice little adhesions (knots would be the more conventional term) that are restricting tissue motion and oxygen delivery, and are causing pain either at the adhesion site or far away from the adhesion site (trigger point referrals). Taut muscles can pull on their bony attachments causing pain, internal tissue forces can cause pain from lack of oxygen, trigger points (tiny tensed up piece of a muscle fiber) can refer pain all over the place via neural pathways, imbalances can cause overload on certain tissues either with poor movement or poor static posture, nerves can be entrapped by adhesions that don't allow them to slide around muscles how they are supposed to and the list goes on. People are usually doing something they don't realize that is causing issues and they can also usually do something they don't realize to get rid of issues. Sooooooooooo what the heck should we do Nick?!!
Well, these adhesions that have developed either recently or over time as part of the chronic CID cycle can be broken up with the proper hands on treatment. There are many ways of doing this. The most important things are finding the location of entrapments and restrictions and finding out how and why they are there by analyzing movement, joint motion and daily activities. Whatever tool is determined most appropriate for releasing these adhesions (I am a big fan of Active Release Techniques as they have developed hundreds of specific protocols to treat many of the most common CID issues that people will have), the adhesions need to be broken up so that proper blood flow can start again and oxygen and nutrients can be delivered to the starved tissue. Once tissues can move freely and are nourished properly again, the muscle fibers need to be realigned and reatrained neurologically to fire correctly. This is where properly designed exercise programming and movement training come into play. One word of caution: Often times, there will be trigger points or adhesions in certain muscles in order to compensate for something going on somewhere else. Releasing them can make problems worse. If you take care of the root problem, these trigger points will often release themselves. For example, someone might have bad trigger points or adhesions in their quadratus lumborum (spinal stabilizing muscle that attaches at the top of the pelvis, 12th rib and lumbar spine) because it is overworked due to a lack of help from its synergizing muscle(s), such as the glute medius. Well, if you keep releasing QL and don't strengthen the glute med, the problem will keep coming back. This is why proper assessment and understanding of the whole picture with each individual is so important so that you can ensure that the correct areas are released. Opposing and synergizing muscles need to be balanced out appropriately, caught up tissue needs to be released and proper alignment and movement needs to be trained (both full body and relative joint motion). Doing any without the others will usually lead to less than optimal results.
So, here a few things that you can do to help yourself out if any of what you just read rings a bell for you.
- Get a good assessment from a qualified professional
- Once you learn what is causing your problems, be conscious of your posture and movement throughout the day. If you sit a lot, make it a point to get up every 20 minutes to walk around and stimulate your hip extensors. If you stand a lot, sit down once in awhile. When you are sitting, make sure you have decent posture with a neutral back position and hips underneath you.
- Learn how to move correctly. Learn how to squat, hip hinge, rotate, walk (no, you might not walk right), balance out each side of your body, and make sure you are using the right muscles at the right time. Get your hips, thoracic spine and ankles all moving well. This is where getting some coaching from a qualified strength coach or therapist goes a long way. Even the best still get coached. Drop the ego and get some help if you ever want to get better.
- Get proper treatment from a qualified soft tissue therapist who knows their way around the body and can treat you properly (hopefully the person or company of the person who assesses you and teaches you the other things talked about). Once treated, invest in some self massage tools. A la crosse ball, foam roller and body back buddy or theracane are all must haves in my opinion. Once you learn where you need to focus your massage tools on, these are all great tools to help you get the job done yourself.
- Get strong. Get some coaching and venture into the world of lifting heavy. If you are weak, you will get hurt easily. If you are strong, you will not. Its that simple. Whether you are trying to get rid of pain or just get a wickedly developed, rockin body, you need to get strong.
- Learn how to breathe properly. This could probably go at number one. If you are not breathing properly with good diaphragm function, you will not have good oxygen flow and your posture and alignment will not be optimal. You will also be sympathetic dominant with your nervous system (your body thinks you are constantly being chased by a lion) and pain and stress will result. Breathing sets the tone for everything else. More on this soon.
- Get a good assessment, treatment and coaching from a qualified professional. I'll say this one again if I have to. If you want to get anywhere, you need to learn exactly what you have going on, which is almost impossible to do all alone. You then need to have a properly designed program with rationale behind everything in it. As I've said many times before, random workouts produce random results.