Heads, Shoulders, Knees and Toes
According to the World Health Organisation, low back pain is one of the most commonly reported symptoms in primary care, costing the economy millions in sickness and time off work. In an ageing society, arthritis is also on the rise, meaning more of us will suffer at some stage with muscular skeletal symptoms. This comes at a time when the Government have just released plans to clamp down on the points needed to apply for disability allowance.
It felt like the right time for me to put on my medical thinking cap, to come up with information, advice and tips on how to combat muscular skeletal pain, whether from age, injury, surgery or illness. A lot of the knowledge I bring to you is directly taken from experience, and recent evidence based guidance and some of the other more natural remedies have taken a bit longer to bring together, as I scatter my “info-net” a little further beyond my usual medical journals and online medical forums.
As always, I have a professional responsibility to patient safety, so anything that I write about is guidance only, and not designed as a replacement for an actual clinical assessment. If you are concerned about an injury, or any muscular skeletal symptoms, please either ring your NHS GP or NHS111.
Most of the experience I had with acute joint and limb presentations was during my time as a nurse practitioner in urgent care centres, where I assessed and treated a range of injuries, from sprains, strains, fractures, tears, dislocations, infections. I learned some really useful information which I passed onto patients, about the management of most injuries, with the exception of the more complex, which tended to be referred on to an orthopaedic specialist.
Let’s assume for argument (and safety) sake, you have toppled over and twisted your ankle. You are in pain, the ankle has swollen, and there is some bruising. You manage to hobble to the nearest seat, or, as is often the case, you are on a football pitch, and you carry on playing (adrenalin is a natural pain killer!). Either way, you have been able to weight bear, but you are using some choice words to express the pain.
You are one of many of the patients who attended my place of work, back in 2017, where I would get you seated, and perform what, in the minor injuries world we called: “look, feel move”. Obviously this would come after the introductions were made! Essentially the “look” part of the examination started right when we watched you walk from the waiting area. You may have limped down to the room, or happily pranced, it really depended on the injury. This part of the examination was possibly the most crucial part. Patients often didn’t realise we were watching from a far. Some would only start limping once they came into view.
Once up close and personal the assessment of the affected limb or joint was further inspected for redness, skin changes, pallor, bruising, abrasions, and swelling, fluid, temperature changes. The latter was assessed in the second stage “feel”. In this part of the examination we anticipated some “owes” and “yikes” here and there, especially if the patient had a fracture. A response where we had to scrape the patient off the top floor ceiling, was what we medically termed “bone pain”. In these scenarios we might suspect a fracture, so would be very careful with the “move” part of the examination.
This three step examination applied to all joints, knees, elbows, wrists, shoulders. For lower limbs there are the Ottawa Rules for X ray. These are evidence based questions, and they allow us to score the likelihood that a patient has a fracture, thus saving the ones who are not at risk, from the unnecessary exposure to radiation. However, in my experience of working in minor injuries, every second patient and his/her /their dog, wants an x ray. They all think they have fractured something.
I would stress that often strains and sprains are more painful than fractures, there is a lot of nerve supply in the ligaments, which have the added burden of poor blood supply, meaning increased pain on healing, but slower to recover.
If we applied the Ottawa rules and deemed them at risk of fracture off they would go, for x ray, and then onto the fracture clinic, as needed. For all other injuries, we assessed, diagnosed and provided recovery advice. This was always the part where patients felt short changed. They had experienced what, to them, was a really painful and disabling injury, and quite understandably were limping in pain and my parting advice, was that it would likely take six weeks to heal, with elevation, ice, anti-inflammatory medication and good old fashioned rest.
A lot of these patients returned, days or weeks later, complaining of the pain, and lack of recovery. From my experience, expectations are everything! I would always give the bad news, that it takes six, even eight weeks to recover, and my patients would tend to accept this. Where this was made less clear, patients would obviously feel frustrated when, only a week later, they were still in pain.
I don’t work in minor injuries anymore but I am never short of muscular skeletal complaints in both in private and NHS health, where I now signpost all acute injuries on to my previous colleagues over in the urgent care centres. I manage patients who have more chronic pain who may not recall an injury or trauma. These can feel more challenging, because sometimes there is no obvious reason for a swollen or painful joint, especially if the patient is young, with much less risk of generative conditions like arthritis. I am often wracking my brain for a diagnosis. This is compounded by remote working, when I cannot even adopt the “look, feel, move”, only managing the first one, often with a grainy video.
What I have learned as part of writing this article, is that there are so many ways to manage muscular skeletal complaints, so as long as I can effectively rule out any worrying cause for my patient’s symptoms, I have a wider understanding of treatments designed to reduce joint pain, inflammation and swelling. The guidance for managing joint pain, with the exception of back pain, is conservative treatment; rest, stretches, exercises, anti-inflammatory medication, and /or paracetamol. This treatment is evidence based, and applies to all joints where a trained clinician has ensured that there is no underlying pathology which would require onward referral. The course of this treatment is perhaps, harder to swallow for patients than the pain relief. It is expected that it can take ten weeks for recovery for joint aches and pains.
You might imagine how it feels for patients, when I explain that unless they have carried out the rest, stretches, exercises, rest, appropriate pain relief and ice for ten weeks I cannot refer them for a scan. It’s worse when the patient is paying for private health. But there is a common misconception, that private health follows different pathways because it is funded by the patient. This is not the case. We still use exactly the same evidence based guidance. I knew I had to up my game for these patients, to bring more to them than a ten-week stretch, literally and figuratively speaking!
So with a bit of my own research I have come up with some additional and more natural options for treating muscular skeletal pain, in particular, joint pain. Some of it is still very new, there are still studies being conducted, and certain treatments are still not widely available, but it is all food for thought.
I read an article on Linkedin, about peptides and there were some promising ideas about peptides and their role in joint healing. Below are some additional therapies, including emerging information about peptides in healing, to provide an alternative for managing joint and limb pain and disability.
Peptides are short chains of amino acids that function as signalling molecules within the body. They play a vital role in biological processes such as cell growth, repair and inflammation control. Peptides show promise in reducing discomfort, improving mobility and promoting tissue repair.
BPC-157 known for its regenerative properties BCP-157 accelerates the healing of tendons, ligaments and joints by enhancing blood flow and reducing inflammation. TB-500 (Thymosin Beta-4) know for improving cell migration, helping tissues recover faster and reducing inflammation in injured joints.
Collagen-boosting peptides – encourage collagen production which is crucial for maintaining cartilage strength and joint flexibility. Clinical studies suggest that peptides like BCP-157 and TB-500 accelerate tissue repair, reduce inflammation and improve overall joint function.
Traditional treatments – NSAIDS and corticosteroids offer effective pain relief short term but don’t target the underlying cause of the pain. Additionally, prolonged use can have increased further damage.
SAFETY – peptides are naturally found in the body; they are generally well tolerated when used correctly. Proper administration under clinical supervision minimizes risk of adverse effects.
NSAIDS carry risks such as GI disturbances, cardiovascular concerns, and kidney damage with long term use. Corticosteroids can provide short term relief but long term can lead to tissue degradation.
Peptides lead to longer lasting improvements.
The use of peptides requires some further studies to ensure safety of use and cost and accessibility may be a limitation and are not widely available yet.
Common homeopathic remedies
Arnica Montana – best for muscle pain, bruises and injuries. Reduces swelling and promotes faster healing.
Bryonia Alba- effective for joint pain that worsens with movement.
Hypericum perforatum – ideal for nerve pain, especially after injuries or surgeries.
Rhus Toxicodendron- helps with arthritis stiffness and back pain that improves with movement.
Magnesia Phosphorica – a great remedy for muscle and menstrual cramps.
Belladonna- useful for acute inflammation with throbbing pain and redness.
Osteopathy is a holistic approach to health, focusing on the body’s structure and function. It emphasizes the interrelationship between the body’s muscles, bones and joints, aiming to promote overall wellness and alleviate pain.
Osteopaths use hands on techniques to stimulate the body’s natural healing mechanisms. They address issues like back pain, neck pain, joint pain and headaches through gentle manipulations and stretches, enhancing blood flow and mobility.
