The Rubber Band in the Back of the Drawer

"I don't understand.  I've been doing the same thing for years and I've never had a problem before.  Why do I have pain now all of a sudden?"  I hear some variation of this statement all the time in my clinic.  It's a fair question, and one that has a relatively straight forward answer. 

You know those rubber bands that you come across that haven't seen the light of day for way too long?  If you ever need to use one of them, you know how ineffective they are.  You go to stretch them over whatever it is you need bound together, and they either snap or just stay expanded, rendered completely useless.  Now, think of the soft tissues in you body;  ligaments, tendons, muscles, nerves, and fascia.  Just like rubber bands, these parts of your anatomy require regular movement so that they stay strong and flexible.  As we get older, unfortunately these soft tissues begin to lose some of their elasticity, making them prone to injury.  This damage can be as slight as some mild inflammation, or as significant as a complete rupture. 

Our bodies are amazingly complex machines.  However, things can be simplified from a musculoskeletal standpoint when you consider that our movement is essentially driven by a series of pulleys and levers.  Muscles and tendons pull (never push) our bony skeleton (supported by a vast network of ligaments) which responds with physiological movement (e.g., raising your arm over your head).  In order for this series of pulleys and levers to work most efficiently, two main components are required:  strength and range of motion. 

Now, why am I choosing to write about rubber bands and pulleys?  It's because I don't want any of you to experience to kinds of aches and pains that commonly arise when we treat our bodies like the neglected rubber band.  As I mentioned earlier, so many of my patients are incredulous that seemingly benign activities such as painting a wall, playing recreational tennis, or simply sitting can lead to pain.  I especially find this disconnect in people who are in their thirties.  This is the most common decade for the types of overuse injuries usually associated with tendon damage.  People in their 30's are generally still active to some degree or another.  The problem is, they go about their weekend activities thinking they're still sporting a 22 year-old body.  An old friend asks you to play a few sets of tennis?  Sure, you think, I'm going to go out and crush him/her just like a did last time we played together.  Only that was 15 years ago.  A lot has gone on in that 15 years, and you may not be as Nadal-fit as your mind tells you.

Even more vexing than the weekend warrior injury is pain associated with prolonged sitting.  It's one thing to sustain a shoulder injury while gunning down you opponent at the plate on a Sunday afternoon.  It's another thing entirely to understand that just sitting can cause pain.  Simply put, we are not designed to sit all day.  We are especially not designed to sit all day with a computer screen and keyboard in front of us.  But this is exactly what so many of your jobs require of you.  Have you ever experienced that ache between your shoulder blades, right at the base of your neck?  You know, the one that comes on by mid-afternoon after you've been staring at your spreadsheets and documents all day, stressed by your deadlines?  Or how about that dull ache in the small of your lower back after a long car drive?  You are not imagining your pain, and there's a very simply explanation for it.  Chances are, you're not sitting bolt upright, feet squarely supported on the floor, forearms supported by an ergonomically correct office chair, shoulders back in a military pose.  That's not the real world.  The more likely scenario has you slumped down with your lower back unsupported, your head jutting out to read your screen, shoulders rounded forward.  Sound familiar?  If so, you may ask yourself, "So what?  I've been sitting like this for 15 years and I've never had a problem before."  Well, that's exactly the point.  I'm sure that your once proud rubber band thought (if it was able), "I've bound mail all over the continental U.S., including all those holiday catalogs, and I've never broken before!"  But that was before it found it's way into the back of the drawer, much the way our bodies found their way into the inevitable grip of an office chair.  If you don't use it, you'll lose it.  In the situation I described, the structures in the back are likely being over-stretched and simultaneously weakened, while the structures in the front are being adaptively shortened and weakened.  This doesn't happen over night, but is rather a cumulative process.  And then, one day, the pain kicks in.

Wow, this all sounds kind of depressing!  You hit your thirties and you just start unravelling?  No hope but to start popping pain management meds (which the pharmaceutical companies would no doubt love)?  NOT AT ALL!  I believe there is a simple solution to these physical ailments which doesn't require a lot of time, money or energy.  The aim is to try to recapture the symmetry that your 18 year old body possessed, and the measures don't necessarily require expensive gym equipment and strenuous exercise.  The pain for which people seek treatment can usually be addressed in the short term, but that is only half the battle.  If the underlying cause is not also take care of, then you will likely end up with the same overuse injury down the road.

I hate hearing people, especially relatively young folks, say, "I guess I'll just have to live with this pain." Do not resign yourself to such thinking.  I believe there is a solution to everything, and in the case of overuse injuries due to poor posture and tissue condition, the fix may be a lot easier than you imagine.  So many people believe that they just don't have time to help themselves, because life is pulling at them from multiple angles.  But if you are willing to invest just a little in your health, you won't find yourself snapping like that old rubber band in the back of the drawer.

P.S.  I purposely avoided mentioning specific interventions because I didn't want to generalize.  However, if anything is aching, or if you know someone dealing with pain, please feel free to reach out.  I'd be more than happy to offer some advice.