An Integrated Whole Person Approach to Musculoskeletal Conditions

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An Integrated Whole Person Approach to Musculoskeletal Conditions

Musculoskeletal conditions are a broad term for problems that affect your muscles, bones, joints, tendons, ligaments, and nerves. This can include everyday aches and pains, but also serious conditions that can limit your mobility. Some common examples include back pain, neck pain, arthritis, and repetitive strain injuries. These conditions can arise from injuries, overuse, age-related wear and tear, or even underlying diseases. They can cause pain, stiffness, weakness, and make it difficult to perform everyday activities. The good news is that there are often ways to manage these conditions, including exercise, manual therapy, medication, and lifestyle habits.

Conceptualizing musculoskeletal conditions as a complex network of symptoms and treatments as a way to change these symptom networks offers a valuable perspective on managing these complex conditions within a whole person approach. Various pharmacological and non-pharmacological treatments can be used in combination to help manage musculoskeletal conditions, all working to support healthy aging of the whole person.

Symptoms as interconnected nodes:

  • Imagine each symptom of a musculoskeletal condition (pain, stiffness, swelling, poor sleep, decrease in physical activity, etc.) as a node in a network.

  • These nodes are not isolated but interconnected, meaning changes in one can impact others.

  • For example, pain might lead to muscle weakness, which then contributes to decreased range of motion, further worsening pain.

The available evidence suggests that the effects of an intervention cannot be explained by a single mechanism. Instead, it acts through a complex interplay of interconnected responses. This aligns with the concept of a "whole-person approach," which emphasizes the interconnectedness of biological, psychological, and social factors that contribute to our overall health and well-being.

Treatments as network modifiers:

  • Treatments then become tools to modify disrupt the cycle of interconnected symptoms.

  • This approach goes beyond simply addressing individual symptoms, the aim is to recognizing how biological, psychological, and social factors are interconnected.

  • Different treatments like physical therapy, medication, massage therapy, or acupuncture can target different nodes and connections within the network.

Example: Osteoarthritis can cause pain, stiffness, and decreased joint mobility. Medication might improve sleep (one node) and manage pain (another node). Massage therapy might improve mobility (one node) and reduce pain (another node). physical activity and exercise (another treatment) then helps strengthen the muscles (another node), further reducing pain and stiffness, creating a positive feedback loop. Once symptoms stabilize people may feel comfortable managing symptoms with various self-management strategies. All three treatments together contribute to an overall improvement in the symptom network.

Benefits of this approach:

  • Whole Person Approach: This shift in perspective from isolated symptoms to recognizing how biological, psychological, and social factors are interconnected offers a foundation for developing and implementing a whole person approach to musculoskeletal conditions.

  • Individualized care: This allows for tailoring treatment plans to address the specific network of symptoms impacting each individual.

  • Improved outcomes: By considering the broader picture, this approach can lead to more effective and sustainable improvements in function and well-being.

References and Sources

Bialosky, J. E., Beneciuk, J. M., Bishop, M. D., Coronado, R. A., Penza, C. W., Simon, C. B., & George, S. Z. (2018). Unraveling the Mechanisms of Manual Therapy: Modeling an Approach. The Journal of orthopaedic and sports physical therapy, 48(1), 8–18. https://doi.org/10.2519/jospt.2018.7476

Bialosky, J. E., Cleland, J. A., Mintken, P., Beneciuk, J. M., & Bishop, M. D. (2022). The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain. The Journal of manual & manipulative therapy, 30(2), 68–77. https://doi.org/10.1080/10669817.2021.1989754

Cormack, B., Stilwell, P., Coninx, S., & Gibson, J. (2023). The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization. Physiotherapy theory and practice, 39(11), 2273–2288. https://doi.org/10.1080/09593985.2022.2080130

Dunn, M., Rushton, A. B., Mistry, J., Soundy, A., & Heneghan, N. R. (2024). The biopsychosocial factors associated with development of chronic musculoskeletal pain. An umbrella review and meta-analysis of observational systematic reviews. PloS one, 19(4), e0294830. https://doi.org/10.1371/journal.pone.0294830

Graham, K. D., Foley, H., Adams, J., & Steel, A. (2023). Complex systems, complex practice, complex outcomes: a call for the development of complexity-informed implementation models (CIIM) for traditional, complementary, and integrative medicine. European journal of integrative medicine, 64, 102314. https://doi.org/10.1016/j.eujim.2023.102314

Grenier, J. P., & Rothmund, M. (2024). A critical review of the role of manual therapy in the treatment of individuals with low back pain. The Journal of manual & manipulative therapy, 1–14. Advance online publication. https://doi.org/10.1080/10669817.2024.2316393

Hardcastle, V. G. (2024). Entangled brains and the experience of pains. Frontiers in psychology, 15, 1359687. https://doi.org/10.3389/fpsyg.2024.1359687

Iovoli, F., Hall, M., Nenadic, I., Straube, B., Alexander, N., Jamalabadi, H., Jansen, A., Stein, F., Brosch, K., Thomas-Odenthal, F., Usemann, P., Teutenberg, L., Wroblewski, A., Pfarr, J., Thiel, K., Flinkenflügel, K., Meinert, S., Grotegerd, D., Hahn, T., Goltermann, J., … Rubel, J. A. (2024). Exploring the complex interrelation between depressive symptoms, risk, and protective factors: A comprehensive network approach. Journal of affective disorders, 355, 12–21. https://doi.org/10.1016/j.jad.2024.03.119

Klyne, D. M., Barbe, M. F., James, G., & Hodges, P. W. (2021). Does the Interaction between Local and Systemic Inflammation Provide a Link from Psychology and Lifestyle to Tissue Health in Musculoskeletal Conditions?. International journal of molecular sciences, 22(14), 7299. https://doi.org/10.3390/ijms22147299

Langevin, H. M., Weber, W., & Chen, W. (2024). Integrated multicomponent interventions to support healthy aging of the whole person. Aging cell, 23(1), e14001. https://doi.org/10.1111/acel.14001

Lutke Schipholt, I. J., Coppieters, M. W., Diepens, M., Hoekstra, T., Ostelo, R. W. J. G., Barbe, M. F., Meijer, O. G., Bontkes, H. J., & Scholten-Peeters, G. G. M. (2024). Systemic Inflammation, Sleep, and Psychological Factors Determine Recovery Trajectories for People With Neck Pain: An Exploratory Study. The journal of pain, S1526-5900(24)00377-8. Advance online publication. https://doi.org/10.1016/j.jpain.2024.02.010

McParlin, Z., Cerritelli, F., Rossettini, G., Friston, K. J., & Esteves, J. E. (2022). Therapeutic Alliance as Active Inference: The Role of Therapeutic Touch and Biobehavioural Synchrony in Musculoskeletal Care. Frontiers in behavioral neuroscience, 16, 897247. https://doi.org/10.3389/fnbeh.2022.897247

Montano, M., Oursler, K. K., & Marconi, V. C. (2024). Healthy aging: Linking causal mechanisms with holistic outcomes. Aging cell, 23(1), e14065. https://doi.org/10.1111/acel.14065

Coninx, S., & Stilwell, P. (2023). Chronic Pain, Enactivism, & the Challenges of Integration. In Situated Cognition Research: Methodological Foundations (pp. 241-276). Springer International Publishing.

Nijs, J., Malfliet, A., Roose, E., Lahousse, A., Van Bogaert, W., Johansson, E., Runge, N., Goossens, Z., Labie, C., Bilterys, T., Van Campenhout, J., Polli, A., Wyns, A., Hendrix, J., Xiong, H. Y., Ahmed, I., De Baets, L., & Huysmans, E. (2024). Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. Journal of clinical medicine, 13(3), 644. https://doi.org/10.3390/jcm13030644

Párraga, J. P., & Castellanos, A. (2023). A Manifesto in Defense of Pain Complexity: A Critical Review of Essential Insights in Pain Neuroscience. Journal of clinical medicine, 12(22), 7080. https://doi.org/10.3390/jcm12227080

Scheffer, M., Bockting, C. L., Borsboom, D., Cools, R., Delecroix, C., Hartmann, J. A., Kendler, K. S., van de Leemput, I., van der Maas, H. L. J., van Nes, E., Mattson, M., McGorry, P. D., & Nelson, B. (2024). A Dynamical Systems View of Psychiatric Disorders-Theory: A Review. JAMA psychiatry, 10.1001/jamapsychiatry.2024.0215. Advance online publication. https://doi.org/10.1001/jamapsychiatry.2024.0215

Scheffer, M., Bockting, C. L., Borsboom, D., Cools, R., Delecroix, C., Hartmann, J. A., Kendler, K. S., van de Leemput, I., van der Maas, H. L. J., van Nes, E., Mattson, M., McGorry, P. D., & Nelson, B. (2024). A Dynamical Systems View of Psychiatric Disorders-Practical Implications: A Review. JAMA psychiatry, 10.1001/jamapsychiatry.2024.0228. Advance online publication. https://doi.org/10.1001/jamapsychiatry.2024.0228

Sturmberg, J. P., & Martin, C. M. (2024). From theory to practice: The pragmatic value of applying systems thinking and complexity sciences in healthcare. Journal of evaluation in clinical practice, 30(2), 149–152. https://doi.org/10.1111/jep.13979

Tabor, A., & Constant, A. (2023). Lifeworlds in pain: a principled method for investigation and intervention. Neuroscience of consciousness, 2023(2), niad021. https://doi.org/10.1093/nc/niad021

Vaz, D. V., Stilwell, P., Coninx, S., Low, M., & Liebenson, C. (2023). Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management. Brazilian journal of physical therapy, 27(5), 100554. https://doi.org/10.1016/j.bjpt.2023.100554