As I understand it, the most common cause for both acute and overuse musculoskeletal injury, from training, is poor load management. And a way in which strength training reduces the risk of such injury, is the strengthening of tissue.
Now, of course acute/overuse musculoskeletal injury doesn’t necessarily mean tissue damage.
So, I’m wondering;
whether poor load management CAN cause tissue damage, given that it’s not the case that musculoskeletal injury, by definition, must imply tissue damage. From my understanding, it CAN, based on strength training reducing injury risk via the strengthening of tissue (this seems to imply that weaker tissue can get damaged by poor load management); and because Charles Dickson’s article states that “…the experience of pain with a sudden, acute injury tends to correlate more strongly with tissue damage”; and because of a series of other statements I’ve observed in your articles.
(if poor load management can cause tissue damage), what kind of tissue damage can poor load management cause? I’ve missed this in my reading. Muscle tears? Herniated discs? Ligament and tendon stuff?
I also get that tissue damage implies a tissue’s deviation from the norm, which is a problematic concept from the start because of millions of asymptomatics walking around with e.g. herniated discs, putting the idea of normativity in question. So I guess my question in the strictest sense is What can happen in/with the tissues, or what kinds of “movements” can occur in the tissues, due to poor load management?
I fully buy that psychological and social factors influence pain perception. I mean, it seems trivially obvious, even – a given stimulus doesn’t hurt/affect everyone equally… but it still feels like if I pull 500 and I don’t just feel pain, but also something “moving” in my back, that something happened with some tissue. And yeah, that’s an acute injury and thus “tends to correlate more strongly with tissue damage (than overuse injuries)”. So IF it’s tissue damage, what kind of tissue damage COULD it be?
We would not make the claim that a given injury can be isolated to a singular “cause” – all injury is complex and multifactorial. However, we argue that managing loading is among the best ways we have to mitigate injury risk.
I’m having a hard time understanding this question, but I think it’s fairly obvious that excessive/inappropriate loading can cause tissue damage, as seen in muscle tears, tendon/ligament ruptures, fractures, etc.
As above.
I’m similarly having a tough time understanding that specific questions that follow. We know that a number of tissue “abnormalities” can be involved in a pain experience. We also know that a number of tissue “abnormalities” can occur in the absence of any symptoms including pain. Unfortunately (and I think this is the heart of your question), the specific differences that explain who develops symptoms and who doesn’t from these abnormalities are not well understood.
I too am unsure what you’re asking but here are some examples that come to mind on poor load management being associated with tissue/structural damage/alterations:
Acute ACL or achilles tendon ruptures: loads exceed capacity of ligament or tendon.
Acute Bone fracture: loads exceeds capacity of bone, or loads were applied in a direction the bone is unable to accommodate (ski boot fractures)
Femoral Neck Stress Fractures. Likely the loads exceed the adaptability of the individual: see case below
Sorry for the confusion and thank you for the reply.
To clarify: I began with the premise that “injury” doesn’t necessarily mean that tissue damage is present – believing that one is injured alone, means that one is injured, due to decreased performance resulting from that belief. So Question 1 was “CAN excessive loading cause (or be a factor in causing) tissue damage (not “injury”, but tissue damage)?”, to which you replied that it can. My guess as to the correct answer previous to your response was that it can, because “strengthening of tissue => reduction in injury risk” seems to imply this.
Question 2 was “IF the answer to Q1 is Yes, THEN what are some examples of tissue damage that poor load management can cause?”, which you also answered.
The question(s) after that: “tissue damage” is hard to define, because it implies abnormality, and abnormality is hard to define because there are individuals with supposed abnormalities that have no symptoms, as you said, and therefore it seems weird to uncompromisingly put them and their tissues in the “abnormal” category… so, I replaced the questions “can poor load management cause tissue damage?” and “if so, what kind of tissue damage?” with“what can happen/what alterations can occur, in the tissues, due to excessive loading?” – I basically just got rid of the “damage” part.
That’s what I was looking for – some examples of tissue damage resulting from excessive loading. As I explained to Austin, I second-guessed using the “damage” part of “tissue damage”, because “damage” implies deviation from how tissues are “supposed to be”, and how they are “supposed to be” seems hard to assert, because of e.g. people with herniated discs showing no symptoms, and being able to live “normally” i.e., the way that people with non herniated discs live. You said “tissue alteration”, which I’m totally using from now on.
Out of curiosity, do you believe that the surgery described in the link you provided was necessary/appropriate/optimal?
Truth be told, I’ve not looked much into the evidence for surgical management of femoral neck stress fractures. I’m not a surgeon and its not a common presentation in the settings I’ve worked. In ten years I’ve not seen a case in the clinic.
My understanding, which is admittedly limited, is that management is based on fracture type (tension vs compression) and whether the fracture is displaced or non-displaced. These fractures carry a fairly high morbidity level (non-union, avascular necrosis). One outcome stat that got my attention is some case reports show these fractures result in a 40% medical discharge from military.
I’m trying to piece together enough information to feel safe out there, so to speak, in novel situations. BBM’s taught me a lot. And as great as that is, it comes with the cost of the skepticism-induced stress that surgeons’ enthusiasm precipitates. Bees Knees, for instance, got me thinking that maybe I shouldn’t be regretful of not jumping under a knife in my early teens. So I’m trying to build a comprehension base strong enough to know where to start looking for options and expert opinions if any pain and/or tissue alterations were to occur in my life… in case you’re wondering what I’m trying to find out. Some surgeries seem to be a waste of time, money, and an unnecessary death risk.
the first question I ask and first treatment option I offer in the clinical setting:
Do nothing. Some call it benign neglect, watchful waiting, regression to the mean, etc. Many in healthcare can’t fathom the idea of doing nothing. They take the stance of “don’t just stand there do something.” In many cases the saying should be “don’t just do something, stand there.”