Joint Pain Is A Complex, Worsening Problem
The illusion of muscle and joint pain is that it is coming from one source.
Even the words we use to describe our pain reinforce this misunderstanding, e.g., “I have a back problem.” Rather than being caused by a single factor, research shows muscle and joint pain arises from a complex combination of biomechanical, structural, inflammation, and nervous system problems.
In our experience working with thousands of people with chronic muscle and joint pain from all over the world, we have found that on average there are between 15-30 contributing problems feeding into one's experience of pain.
Think of it like this: you are in a pool sitting below a large waterfall. The water is pounding down on you. All you can experience is the one waterfall, and it’s crushing pressure on you. Unbeknownst to you, there are 15 streams of water all merging directly above you to create this tremendous force you are experiencing. Chronic muscle and joint pain is exactly like this. You are experiencing terrible, life-draining pain, but behind that pain are 15-30 individual “streams” of problems.
Your pain signals aren’t a precise, detailed map telling you where to find the root causes of your problems. Your pain signals merely exist to alert you there is a problem which needs to be addressed. They do very little to clarify what the root cause of your pain is.
The root causes of chronic muscle and joint pain can be organized into four categories:
Biomechanical problems
Structural problems
Inflammatory problems
Nervous system problems
Let’s briefly explore each of these.
Biomechanical problems
Biomechanical problems are when your joints aren’t working properly. Biomechanical problems fall into three types:
Mobility or range of motion problems
Stability or muscle atrophy problems
Strength or load-bearing capacity insufficiencies
Whenever a joint isn’t mobile, stable, or strong enough, it creates highly focused areas of stress, strain, and impingement. Over time, these highly stressed areas cause pain, break down, develop arthritis, or require joint replacements. If small problems of this type aren’t dealt with, they multiply themselves into groups of 5, 10, or 15 different issues.
Structural problems
Structural problems are what you find on an X-ray or MRI. Structural problems found on imaging are often misleading because, after a long season of chronic joint pain, it’s easy to think you have finally found “the problem”. The research shows most people have structural/degenerative problems and have no pain at all. For example, 88% of people at age 60 with no pain have disc degeneration. 69% of people at age 60 with no pain have bulging discs. 50% of people at age 60 with no pain have arthritis/degenerative patterns in the facet joints of their spine. Please don’t misunderstand, I am not saying surgeries are never necessary or structural issues cannot be a cause of pain. The research indicates different structural conditions have higher or lower correlations to pain. You must use caution when reviewing your MRI report, understanding many of the findings may have little or no correlation to pain.
Inflammatory problems
Chronic Inflammatory problems can come from many sources. Common sources of inflammation include excessive refined sugar, ultra-processed foods, excess caffeine, excess salt, and dairy and gluten for some. Other causes of chronic inflammation include gut microbiome imbalances, autoimmune disorders, and lymphatic problems.
Nervous system problems
You want a healthy, regulated pain signaling system which alerts you, via pain, to potential threats. Sometimes, your pain signaling systems can get dysregulated and send you pain signals even when there is no threat present.
One of the leading causes of this type of dysregulation is the pain itself. After three months in pain, your brain, spinal cord, and nerves begin to “memorize” the pain pattern through structural and functional changes. After years in pain, pain adaptations can become deeply entrenched.
Other causes of nervous system dysregulation include insufficient sleep, micronutrient imbalances, gut problems, opiate usage, stress, anxiety, depression, fear, loneliness, and PTSD. Additionally, neuropathic disorders such as post-herpetic neuralgia, multiple sclerosis, neuropathy, and post-surgical pain can also cause dysregulation of the pain signaling systems.
The chronic pain spiral
If someone has 15 different problems, those problems don’t live isolated from each other. Joint dysfunctions cause stress and strain on the joints above and below, causing degenerative conditions. Those joint issues make movement painful, so you move less. This leads to insufficient lymphatic movement and increased joint inflammation. The pain and inflammation creates sleep disturbances. This all causes more stress, anxiety, and isolation. This leads to more sugar, salt, processed foods, and alcohol. This creates gut issues, making your pain worse. This makes you move less. This worsens your mobility and strength issues, which starts the spiral all over again.
In summary
Chronic pain is a multifaceted problem which worsens over time. Your original 3-5 problems multiply into a complex web of 15-30 joint, inflammation, and nervous system problems. The longer chronic pain problems are allowed to exist, the worse they get and the more they multiply.
The best way to fix these problems is a whole-person approach to finding and eliminating the root causes. Haphazardly chosen, single-problem treatments will not fix your complex pain problem for good. What’s needed to fix your pain problem for good is a thorough process of identifying and eliminating all of the possible pain generators.
References
Reliability of MRIs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728666
Usefulness of MRIs: https://caringmedical.com/prolotherapy-news/getting-accurate-mri
Acute vs Chronic Inflammation: https://www.health.harvard.edu/staying-healthy/understanding-inflammation
Your Pain System Has Been Hijacked: The Neurobiology of Chronic Pain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725747
Pain & Depression: A Neurobiological Perspective of Their Relationship: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310906
The Neurobiology of Central Sensitization: https://onlinelibrary.wiley.com/doi/full/10.1111/jabr.12137
Author Matthew Lister
CEO & Founder of Align
