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Who is THE expert in treating clients with musculoskeletal issues?

Who is the expert?

We ask ourselves ‘Who is THE expert in treating clients with musculoskeletal issues?’ 

It’s an important question we need to ask, but before we answer that question let’s define what musculoskeletal issues actually are, their potential solutions, the current paradigm that every expert uses to treat, and who are ALL the professionals that take care of musculoskeletal clients. 

From here, together we can decide who is THE expert to treat clients suffering from musculoskeletal issues. If there is no THE expert for treating musculoskeletal issues, then the major question is what can we do to resolve this? 

The Science

What are Musculoskeletal issues?

Musculoskeletal Disorders or MSDs are injuries and disorders that affect the human body’s movement or musculoskeletal system such as:

Common musculoskeletal disorders include: 

More people suffer from the above than you may think these days, with pain and/or stiffness being one of the most common causes of discomfort in this day and age. Just because more people suffer from these symptoms, doesn’t mean that it should become the norm and we should just lay back and accept it. 

The Stats

You may not believe these stats but the Centers for Disease Control and Prevention reported this shocking figure…

‘Around 50 million American adults — 20.4 percent of the U.S. adult population are currently living their day to day life with chronic pain. That’s 1 of every 5 adults!’

The American Pain Foundation stated that…

“Most Americans (80%) will suffer from back pain at some point in their lives.”

The Good Body (Back Pain) did a study that showed that 

More than one in three adults say back pain impacts everyday activities, including their sleep.” and that “29% of Americans believe stress is the cause of their back pain”

Ultimately, the stats show that there is NO DOUBT that pain is a huge problem and has been for decades. There has now been a decline in the stats, just a steady increase falling in line with how busy and active our lives are becoming, with more and more of us having sedentary lifestyles with jobs that require us to sit for long durations of the day. This also means that when we do go out and play sports, do exercise or do anything heavy duty with our bodies – they are not used to it and this is when we often find injuries or underlying pain issues settling in. 

Possible Solutions

With all of these solutions, there must be a solution to resolve this pain. One of the solutions used widely nowadays for musculoskeletal issues is prescription medication drugs such as NSAIDs and Opioids. These types of medication cause more harm than they do good and often end up causing more problems and suffering later on down the line than the original problem they were intended to treat.  

When you look at the statistics, they are devastating and tragic, to say the least. According to the National Institute of Drug Abuse, a study they ran in 2017 showed that more than 47,000 Americans died as a result of opioid abuse, and a staggering 1.7 million people in the United States are estimated to be suffering from substance use disorders related to prescription opioid pain relievers. 

Not only do patients run the risk of addiction and abuse, but these over the counter NSAID’s also have tremendous life-affecting side effects. Back in 2005, the FDA initially warned about nonsteroidal anti-inflammatory drugs (NSAIDs) and that it could increase the risk of having a heart attack or stroke. In July 2015, on the advice of experts, the FDA took the unusual step of further strengthening the warning and risks of taking NSAID’s. This is a clear warning sign showing that the use of these substances are less than ideal. 

But what if there was an alternative treatment?

Alternative Treatment Plans

Other alternatives and solutions for musculoskeletal issues are conservative care from licensed professionals such as physical therapy, chiropractic, athletic training, and massage therapy. These are great alternatives that are less invasive in the sense of taking medication, and these alternatives aren’t as likely to leave long-lasting negative side effects. 

On the other side, in the past 15 years, there has been a massive increase in alternative healing unlicensed professionals such as personal trainers, strength coaches, yoga therapy, and pilates. Overall we have hundreds of thousands of licensed and unlicensed professionals all working to be THE expert in treating musculoskeletal issues. 

What I find interesting is that if the licensed professionals are truly THE go-to experts, then how come we have had over the last 15 years a proliferation of non-licensed professionals treating musculoskeletal issues effectively? It goes to question, that if the alternative treatments are solving the musculoskeletal issues for clients then is there a need for ‘THE Experts’ with their medicational solutions. I truly believe every healer (licensed or not) wants to use their knowledge in their perspective field to help people suffering from musculoskeletal issues, but ultimately, it’s about finding the best route of treatment that is best suited for the client in pain. 

Deep Dive

The current paradigm for all professionals treating musculoskeletal issues is that ALL of them follow the same philosophy. This philosophy is what is referred to as the musculoskeletal model, and the insistence that every profession must first figure out the “WHY” of what is the cause of the musculoskeletal issue that is “causing” the pain. I put “WHY” and “causing” in quotes because these are all assumptions. Since pain is a sensation, not a musculoskeletal structure like a muscle, tendon, ligament, or nerve it is IMPOSSIBLE to really know the “WHY”. All these professionals continue to work very hard with all good intentions to help people suffering from pain, however, the evidence is clear that it is not working. 

We can all agree:

The current “WHY” musculoskeletal philosophy is taught in every medical school or secondary educational training for treating musculoskeletal. So every physical therapist, chiropractor, athletic trainer, massage therapist, as well as every personal trainer, strength coach, yoga therapist, pilates trainer, and stretching trainer has been taught they need to figure out the ‘WHY”. The potential “WHY’s” are muscles, ligament, tendon, nerve, knots, and/or fascia. Meaning that every professional will come up with which of those “WHY”s” is wrong and then spend days, weeks, months, and even years to fix those “WHY’s”.

There could be an argument to be made that non-licensed professionals are replacing licensed professionals in the treatment of musculoskeletal issues. While this might be true or not every practitioner should be alarmed by what is occurring from Digital therapeutics a startup Kaia Health which raised $8M in funding led by Optum Ventures to support the accelerated execution of clinical trials required to demonstrate efficacy to the FDA.  

This is the objective of Kaia health is to use Artificial Intelligence (AI):

The scary idea perpetrated by powerful insurance companies is to show that AI is better at solving back pain than any physical medicine practitioner. While most practitioners will probably argue they can not be replaced I believe the focus must be on developing a new paradigm.

This might be controversial, however, my intention is not to offend any professional but to demonstrate we need a new paradigm to treat musculoskeletal issues. If we can’t recognize there is a problem then obviously we don’t need a new solution. Unfortunately, without a new solution, people continue to suffer from pain at alarming rates as more and more practitioners are taught a musculoskeletal “WHY” model that is not effective.

As we already stated pain is a sensation, so what is the reason for this sensation? While most practitioners have determined that pain is due to a structural issue, unfortunately, that leaves out any non-structural potential contribution to pain. It has been a long-standing principle in the mental health field that pain (depression, anxiety, worry) has an effect on the body. Peter Levine has developed Somatic Therapy a profound and effective way to integrate the body or soma to help heal pain (depression, anxiety, worry). We as physical medicine (structural / body) practitioners are missing is that to treat pain we must include the structural as well as a non-structural approach. Some of our leaders in the field of physical medicine such as David Butler and Lorimer Moseley explain pain according to a Biopsychosocial model whose underlying principle is to understand that pain is not just structural and how you communicate with your client is vitally important. Statements like your spine looks bad, broken, aged beyond your years, etc… cause a sufferer of musculoskeletal issues i.e. pain to worsen or not get better. I’m a huge advocate of communication according to Butler and Moseley as well as therapies like Cognitive Behavior Therapy, Somatic Therapy, AEDP. Butler attempts to combine the structural and non-structural, however, this still falls under the flawed musculoskeletal “WHY” model. 

In the new paradigm, there is a transformational shift from the musculoskeletal “WHY” model to what is termed the embryological model. The unique difference is that in the new paradigm – embryological model the “WHY’s” are not needed to be known or thought to be known. Meaning you can start to treat without knowing if the pain is due to a tendon, ligament, muscle, nerve, and/or fascia. For the new paradigm, there needs to be a new definition of pain. Pain is the body’s way of expressing protection. Just like crying is the body’s way of expressing sadness. Hopefully, this will help to cement the idea that we need a new paradigm. If a practitioner was to treat sadness we would not just treat the eyeballs and the eyeballs are not the only area that is sadly, even though that area is the only area exhibiting sadness (pain). Pretty obvious, however, if someone has neck pain or low back pain that is exactly what the current paradigm will do is treat the “eyeballs” local area that exhibits pain. In addition then tell a person that is suffering that their back pain is due to fill in the “WHY” blank (tightness, weakness, age, weight, some type of “itis”, fascial restrictions, or worse the pain is in your head). While Butler and Moseley attempt to deliver a better message, which I applaud, the issue is that the flawed musculoskeletal local treatment model will continue. The embryological model can best be described by an example of first the current musculoskeletal model and then the embryological model. 

If a person walked into a room and a light bulb was not on or not working and you wanted the light bulb to work would you work on the light bulb or first try the light switch? To ask us a question is ridiculous since the answer is so obvious. In the current musculoskeletal “WHY” model if a person has a musculoskeletal issue to their back “bulb” every practitioner will first tell them what is wrong with their back ‘bulb” according to their specialty. The MD’s “WHY” for the back “bulb” is an “itis” – tendonitis, bursitis, or arthritis. The physical therapist, ATC, personal trainer, strength coach “WHY” for the back “bulb” is tightness or weakness. The chiropractor’s “WHY” for the back “bulb” is subluxation or postural boney alignment issues. The massage / myofascial therapist “WHY” for the back “bulb” is knots or myofascial restrictions. Then once the practitioner figures out or thinks they have figured out the light bulb “WHY” they will start to treat the local area. If a practitioner wants to improve their skill set in their profession they just learn the other practitioner’s ‘WHY” bulb. So a physical therapist that has a “WHY” as a weakness or tightness will learn about postural alignment like a chiropractor and learn about myofascial restrictions like a massage therapist. Overall the practitioner becomes more knowledgeable and entrenched in the current structural musculoskeletal “WHY” model. After the back “bulb” “WHY” is decided then the practitioner will treat the local musculoskeletal structural area.

In the new embryological model, if a person has a musculoskeletal issue to their back you would NOT explain any ‘WHY’s” since they are not needed and just ask where is the pain located, the local light bulb area i.e. back ‘bulb. Now once the back “bulb” area is decided then the practitioner will treat non-local, unseen (non-structural) embryological switches. The embryological switches as is the embryological model are based on embryology and the unseen anatomical connections. The embryological model is part of a system called Color Mapping which was developed by Andrew Bloch which is his own interpretation of the Balance System created by Dr. Richard Tan. To understand the unseen anatomical connections is to just observe the obvious. Embryology starts with an egg and a sperm connecting to form one cell. Then that one original cell begins a process of cell division where the one cell divides to become 2 identical cells, then divides to form 4 identical cells, then divides to form 8 identical cells, then divides to form 16 identical cells, and so on until there is a microscopic group of identical cells. At some point, this process finishes and begins the process of cell differentiation which is when the identical cells start to separate but they are no longer identical. The embryo develops into a fetus to eventually develop into a baby. As the embryo grows it separates to create unseen anatomical connections. The hands eventually separate from the feet which both look very similar, five fingers – five toes. The wrist separates from the ankle, elbow from the knee, and the shoulder from the hip. They all look very similar. Obviously, this is not a very detailed study of embryology. These unseen anatomical connections can be used easily to make transformational differences when treating musculoskeletal issues i.e. pain.

Some of the biggest advantages of using this new paradigm Embryological Model are:

Explaining the WHY

If a person came into your office and was red-faced, sweating, had a dry tongue and they told you they had been working out in the sun all day, and that they want help as they were suffering. You would spend the next 15-20 minutes telling them “WHY” they are dehydrated, the science behind H2O, and how drinking eight glasses of water is needed so their body will be properly hydrated or would you give them a glass of water. Thus the real question is when a person comes in with pain are you going to tell them all the musculoskeletal issues causing their pain or are you going to give them a glass of water i.e. immediate pain relief. 

Who is THE expert in treating musculoskeletal issues?

Overall, there is no expert in musculoskeletal pain as it’s all of us. It is any of the above practitioners that use the new embryological model since the embryological model is what actually treats pain not what is thought to be the cause of musculoskeletal issues. The main point is to find the reason WHY and from there you will be able to see the Unseen. There is an opportunity for ALL practitioners to use the new paradigm (Color Mapping), Embryological non-local unseen anatomical connection to switch the pain off immediately, and ultimately build a better way of working and a more solid foundation for treating pain effectively.

Andrew Bloch, PT, Dipl.Ac, L.Ac