What is the difficulty in resolving your particular muscluloskeletal issues? Part 2
You may want to review Part 1 for all the rules and framework.
Other than that, here we go!
Location: Elbow
Description: the elbow joint and the tissue on either side into your forearm and up into your low biceps
General Risk of Score: 1 — Very low
Strain Score: 4 — Long
Duration Score: 5 — Very High
Reinjury Score: 5 — Very High
Ouchy Score: 3 — Moderate
Overview: 15 — A little bit spicy
Notes: Elbows are the first entrant on the tricky list as they are joints that have the potential to take a tremendous about of strain in activities and life. It is incredibly common to have persistent and nagging pain at the elbow joint (golfer and tennis elbow) and these things can persist for a long time. The good news is that the effort put into the elbow isn’t too taxing to put in the work. The ranges of motion are generally small, the loads generally light and you can start to see improvement rather quickly — even if the long term solution takes quite some time.
Location: Wrists
Description: the joint, not your hand, not your forearm but the space where all the movement goes down
General Risk of Score: 2 — Low
Strain Score: 1 — Very Low
Duration Score: 4 — Long
Reinjury Score: 5 — Very High
Ouchy Score: 3 — Moderate
Overview: 15 — A little bit spicy
Notes: Wrists also take a ton of abuse but mostly by way of small repetitive stress movements. Typing, phones, all our modern activities tend to get very troublesome outcomes for the wrists. And once you are in that zone, it can be very difficult to get out. Carpal Tunnel is one of the most common household names for “syndromes” that we all understand at face value. It is also a very common surgery and the space is sticky and takes a long time to resolve. It won’t be a high exertion process, but it takes ages and can get a little prickly.
Location: Knees
Description: your knee joint and the tissue immediately above and below it on the front and back
General Risk of Score: 4 — High
Strain Score: 4 — High
Duration Score: 3 — Moderate
Reinjury Score: 3 — Moderate
Ouchy Score: 3 — Moderate
Overview: 17 — Fairly Ouchy
Notes: The first of the 4 horsemen of human pain. Almost everyone has had knee pain at some point, even if just one time after a basketball game. The knee is the largest and most consistent transistor of force in the body and at the intersection of the huge amounts of athletic output from the hips down through our feet for locomotion. It is attached to the quad and hamstring and calf. Big, powerful muscles. This means that it’s gonna suck to fix your knees. Pushing burn through those big muscles groups is not fun. The good news is, for most “moderately sore knees” they respond relatively quickly. So if you don’t yet have known tissue damage, the above is actually an asset in resolution. Once you have tissue damage, the process slows down quite a bit — and you still have the exertion to get through as you proceed from damage to baseline and into athleticism.
Location: Achilles Tendon
Description: not your foot, not your calf, but the specific intersection where most people feel pain on or just above their heel. The 5 or so inches between the base of your heel and the lowest part of your calf
General Risk of Score: 3 — Medium
Strain Score: 2 — Low
Duration Score: 5 — Very Long
Reinjury Score: 5 — Very High
Ouchy Score: 3 — Moderate
Overview: 17 — Fairly Ouchy
Notes: a little less common, but incredibly pernicious once you get fired up here. Part of the reason is the same as the knee — the Achilles is a huge band of connective tissue that is integral in all athletic outcomes. Once it degrades, that implies it has undergone a LOT of stress in that process. Also, because it is connective tissue, it is going to have less blood flow and less progress in adaptation. Relieving stress in the Achilles is not incredibly painful, but very long in duration, tediou in its inputs and susceptible to reinjury.
Location: Low back
Description: you know what I mean
General Risk of Score: 4 — High
Strain Score: 4 — High
Duration Score: 4 — Long
Reinjury Score: 4 — High
Ouchy Score: 3 — Moderate
Overview: 19 — Fairly Ouchy
Notes: The second of the 4 horseman of the pain apocalypse. If you haven’t had low back pain, you are lucky. Just like knees, this gets almost everyone at some point. Low backs are interesting because, very similar to necks, they manifest very often as symptoms and are rarely the cause. Correlated with low back pain is almost always tight hip flexors, weak abs, weak and tight hamstrings as well as the actual musculature of the low back being weak itself. Because it is the lynch pin between our upper movements and lower, it is also always in the crosshairs for stress. Almost everything we do will intersect with lower back — even lying down! As such, it takes a tremendous amount of effort to rectify low back issues. The good news is, there are many ways to address it and each will produce incremental outcomes. Whereas fingers will tend to get damage right at the joint due to repetitive stress or acute injury and attention to your shoulders will have little impact on your fingers (obviously), addressing the hamstrings, hip flexors, even the shoulders upstream will ALL have an impact on low back outcomes.
Location: Abs
Description: All things above the waistline up to the rib cage
General Risk of Score: 2 — Low
Strain Score: 5 — Very High
Duration Score: 5 Very High
Reinjury Score: 2 — Low
Ouchy Score: 5 Very High
Overview: 19 — Farily Ouchy
Notes: People rarely have problems with their abs. They rarely hurt. It is their inactivity that is problematic. Because they are directly attached to fixed bony structures (rib cage and pelvis) there isn’t much to “hurt” due to ab dysfunction as compared to knees and shoulders. The outcome will almost always be elsewhere — such as the low back pain or shoulder pain due to lack of stabilization. The challenge is that abs are incredibly arduous to work. They will sap your energy unlike anything else. And it is very difficult for most people to properly engage and utilize their abs to prevent all of the things mentioned here. If I could wave a magic wand and increase your ab strength 110% of their baseline needs, you would find a huge host of things resolve as a consequence.
Location: Hamstrings
Description: everything from the back of your knee up to the base of your butt
General Risk of Score: 4 — High
Strain Score: 5 — Very High
Duration Score: 4 — Long
Reinjury Score: 5 — Very High
Ouchy Score: 5 — Very High
Overview: 23 — This is probably going to suck
Notes: The 3rd horseman of the pain apocalypse. Everyone has weak hamstrings. Let me repeat that — even if you THINK you have good hamstrings, you don’t. They are incredibly easy to miss in training. They are very difficult to activate correctly even when you do target them. They are critically tied to athletic outcomes. They support low back health. Hamstrings and abs suffer in all the same ways including their intensity with proper training. If I could add hamstrings to that magic incantation from above, you would have amazing outcomes with just these two muscle groups improved.
Location: Hips
Description: Includes a lot, but the system is inextricably tied together. Hip flexor, glutes, top of hamstrings, sides of hips, top of quads
General Risk of Score: 3 — High
Strain Score: 5 — Very High
Duration Score: 5 — Long
Reinjury Score: 5 — Very High
Ouchy Score: 5 — Very High
Overview: 23 — This is probably going to suck
Notes: Most people don’t feel the outcomes of bad hip function until they are either put into specific mobility demands or the wear and tear requires a hip replacement. Most people with bad hips almost always have back pain. The lack of hip movement transists upstairs at a very consistent rate. Working on hips is intricate and painful to address. The rotation of the legs and abduction (i.e. spreading your legs apart) will pull on the groin which is incredibly sensitive in most. Because they are attached to basically every single large muscle in the body, they can also endure a tremendous amount of stress which is necessary to create adaptation. The saving grace is that gravity is on your side. Nearly every stretch for the hips relies on letting gravity do some work, which is a huge advantage to your progress.
Location: Shoulders
Description: Includes a lot, but the system is inextricably tied together. Rotators, delts, top of tricep, lats get included here, high traps can get included here. Anything that is involved in General Risk of Score: 4 — High
Strain Score: 5 — Very High
Duration Score: 5 — Long
Reinjury Score: 5 — Very High
Ouchy Score: 5 — Very High
Overview: 24 — This is probably going to suck
Notes: Hips and shoulders are basically fraternal twins. They are ball and socket joints. They perform all of the same movements. As such, they are basically the same in resolution with one small exception — the shoulders are small and don’t get an edge from gravity. The shoulder moves in the largest range of motion of any joint along with poor inherent stability. Shoulders are capable of producing quite a bit of force, but also susceptible to extreme injury with fairly minor inputs (i.e. tearing a rotator cuff playing basketball). The combination of demands, function and sensitivity make it without a doubt the most difficult joint to resolve that will take the most time, require a ton of stress and also patience to adapt smaller muscle groups. But here is the rub on shoulders — many people simply choose to live with the pain. When your feet hurt, you can’t walk. When your neck hurts, it is so cerebral it can ruin your day. When your back hurts…everything hurts. When your shoulder hurts, you can ignore it — especially if it is on your non-dominant side. As such, people just live with nagging shoulder pain for perhaps their whole lives. When we finally get in there to work on something, it is a mess and everything is a problem. The shoulder is the sleeper candidate for the MOST DIFFICULT joint to resolve for that reason.
Hope that helps you frame your journey! In EVERY case, my estimation is that resolving your joint pain is worth it. It takes a good bit of time, yes. BUT, having an absence of pain is a relief most people write off. We get used to pain and become numb to how it impacts our mood, sleep, quality of life and overall ability to have a great day.
Get out there and make some progress on your joint pain!
