Chronicity may be defined as a problem (loss of function, pain, etc.) that has continued much longer than the tissue damage from the injury has. In medical circles the problem or pain is typically lasting longer than 6 months.
Ligmanents, Tendons, and Intervertebral Discs are poorly vascularized and may take a substantial time to heal (in the order of 8-12 weeks). Muscles and skin heal quickly because they have good blood supply. The normal inflammatory process will generally resolve in 3-5 days followed by fibrosis occurring in 17-21 days. Most tissues are “healed in this time frame”, but normalizing the tissues strength and function continues during the maturation phase of healing of the tissues over the next 3-6 months. If pain and dysfunction continue much longer than these time constraints one could say their problem is chronic, ie lasting longer than the healing of the tissues.
When a problem exists longer than these time frames then it is helpful to see a medical doctor who can either evaluate the problem clinically for potential pathology, or order imaging studies to see if the tissues are anatomically abnormal. If there is no identified pathology then the problem would be considered dysfunctional. Physical therapists treat dysfunction, and the sequela of pathology, not the pathology.
Most problems that are chronic have an increased reaction to an injury that stimulates systems that facilitate the pain pattern, either the Sympathetic (fight or flight) nervous system, the Immune system (stimulates cytokines- pro inflammatory), the Endocrine system (stimulates cortisol through the adrenal cortex), Peripheral Nervous Sstem (sensitized and responds to internal environmental stress to insert receptors that can maintain the pain sensitization)
These problems are more in the continuum of fibromyalgia and central sensitization, etc. in the patient’s subconscious, a normal stimulus may be identified as potentially injurous, which may stimulate a system (see above) which can sensitize the nervous system and augment and maintain their pain. Patients with frequent pain will think that movement will cause more pain so they simply shut down. They need to consider that “hurt does not necessarily mean harm”
Most patients that do not have marked pathology just need a thorough examination, because oftentimes something has been overlooked, or not considered important.
What I find is that many patients have not had a full biomechanical examination, which means that they require an exam that includes screening tests (selective functional movement assessment), gait assessment, mobility assessments, strength assessments, and the frequently overlooked neurodynamic assessment. Often at the end of the evaluation in our clinic the patient will say “nobody has examined me like you have”
If the problem continues, over time, the patient will begin to compensate by moving in a manner that may diminish pain, but perpetuates muscle imbalances or motion restrictions. This is why it is generally accepted that “pain often occurs in the tissues that are compensating rather than those that are in dysfunction”. It is the physical therapists responsibility to identify the primary dysfunction and other dysfunctions which are required to be treated, so the patient can eventually move pain free and friction free. Let Sports And Orthopaedic Therapy Services help you find your way back to normal function and diminished pain.
A FREQUENTLY OVERLOOKED PORTION OF OUR EXAMINATION OF THOSE WITH CHRONIC CONDITIONS IS NEURAL TENSION EXAMINATION- UPPER AND LOWER EXTREMITY EXAMINATIONS.
ULNT2A- NON REACTIVE TENSION, REACTIVE RESPONSE MOBILIZE WITHOUT TENSION.