Bruce Konings

Musculoskeletal Injury and Pain

Research and statistics

  • Between 25% and 45% of our (western) population is presently experiencing significant musculoskeletal pain.
  • 80% of people suffer at least one significant episode of Lower Back Pain at some time in their lives.
  • More than 10% of our population experiences debilitating Lower Back Pain every day.

The good news is that the vast majority of these painful problems are not permanent, and can be much improved in less than a week with great physiotherapy.

There are two main causes of musculoskeletal pain :

  1. Accumulative strain and;
  2. Trauma and disease.

Accumulative strain

Accumulative strain or Cumulative Trauma¹ is the process of minor forces repetitively acting on ligaments, joints, muscles or nerves due to a lack of good control (poor position) of the body parts involved. A simple analogy can be if you imagine a door with its hinges positioned incorrectly and the corner rubbing against the frame every time it moves – eventually the structure of the edge of the door breaks down. Our bones are like the frame and door and the hinges are like our muscles controlling the door.

Some tissues suffer accumulative strain through sustained tension over time. Another simple analogy is if you imagine a rubber band that has been held in a stretched position for a long time; its structure is weakened and requires very little force to snap the band. A similar process occurs to tissues in the body such as the ligament tissues; for example the annulus fibres that make up ‘discs’ between our spinal vertebrae.  These ligaments are quite elastic, like a rubber band, and if your muscles don’t hold a good position of the vertebral bones (i.e. poor posture) then sustained or repetitive tension is applied to the ligament fibres and this can weaken the structure.  It doesn’t take much force (slouching, or sitting up too straight, is enough), or time (just twenty minutes or more each time repeated frequently over months or years) for the fibres to ‘strain’ to the point that negative signals are sent to the brain warning of the damage becoming dangerous. Protective mechanisms and pain are the result.

Trauma and disease

Trauma and disease or non-accumulative strain is commonly caused by:

  • A one-off incident with high force causes the injury and pain. For example; a motor vehicle accident, slipping and falling or being tackled or hit etc.
  • More rarely, diseases cause musculoskeletal pain, for example different types of arthritis, infection, and genetic diseases.

It is not commonly known that great physiotherapy can relieve the strain to the vast majority of musculoskeletal conditions in both the categories above very quickly. You don’t have to wait for healing to occur to be able to be pain free.

The causes of pain and injury:

You might be surprised to learn that Accumulative Strain is the major underlying cause of most injuries and pain.

Often when the pain onset seems to occur suddenly it is actually the movement which was the ‘straw that broke the camel’s back’. Another way to analyse if the cause of a problem is accumulative is to look at whether the same, or similar, activity when the pain occurred had been performed previously. If so, then it is unlikely that the activity itself was the cause, but more likely the many times it had been performed in the past without adequate muscle control.

The graph below summarises:

  • ‘Optimal’ with the blue line showing minimal strain with well balanced ‘hinges’ (muscles and joints) during daily life.
  • ‘Subclinical’ strain that builds up over time, the maroon area, and not enough to require conscious warning with the brain creating pain.
  • ‘Clinical’ is shown by the yellow area, where the brain’s guarding protection and warning signal creating pain turns into a vicious cycle that does not quickly settle by itself.  The point where the Strain Line hits the Pain Threshold is the point where the ‘straw breaks the camel’s back’.

Model of Musculoskeletal Health


Table from – Ridgway Method.

Common activities that produce the kind of accumulative strain shown may simply involve:

  • Pushing beyond normal ranges, and-or prolonged fatiguing positions
  • Turning your head to reverse the car
  • Bending over to put on shoes
  • Bending over to pick up a heavy object such as a pot plant
  • Using the same actions for many hours each day – Sitting or driving
  • Repetitive tasks without many breaks and variation – Painting, cleaning or manual work
  • Repetitive actions in sport

Any repetitive action performed for long periods or over a period of months or years may result in an accumulative strain musculoskeletal injury.

Activity and performance

It’s not the activity that leads to accumulative strain; it’s the way the activity is performed with your muscle control. Sometimes the body part in which the brain creates pain is the area that has suffered the injury.

Most likely the area you experience your pain is different to the body part that suffered the accumulative strain.  This is called ‘referred pain’.  You might imagine it can be tricky to solve the cause of a condition if the pain is in a different area. Our practitioners have a unique system that allows us to potentially solve the cause of the pain very efficiently.

The graph below describes the typical results achieved.

Each improvement made with this approach to treatment is represented by a downward slope of the graph.  In this example below, the treatments achieve a pain-free state in 120-minutes (four sessions).  The norm is for this method to achieve pain-free, full range in 60-240 minutes of assessment and treatment (2-8 visits) within 2 weeks.  If the results are not coming this quickly we may not be the right practitioners for the job.  In these cases we will help you find the right practitioner.

Accumulative strain can happen in almost any part of your body and encompass all kinds of conditions from spinal disc strain, sciatica, neck-headaches, tennis elbow, shoulder impingement, carpal tunnel, muscle tears and many more.

For optimal results prevention of recurrence is the key. For this reason it is important to note that increasingly less frequent sessions are needed after achieving the pain-free stage (X, Y and Z above) – We recommend a series of tune ups.

The very positive side-effect of this kind of treatment is that performance enhancement also occurs, as optimal muscle control to prevent recurrence is the same muscle control required for best performance.

Common question

Why can’t I just change and hold a good posture (such as sitting up straight) to prevent pain and further injury?

There are two answers to this question:

Most commonly when we ‘sit up straight’ our automatic action doesn’t position the spine into its ideal curves. While a ‘straight’ spine looks good, it can still place excessive strain on the tissues between the vertebrae.  It’s the way the sitting-up is done that matters.

Once we have developed a habit of less-than-ideal posture, the gradual stiffening of the joints actually makes it harder to get into the ideal positions when we try. Correcting this common problem most rapidly requires a good problem solving system as each individual is different

Our hands-on approach based around a results-based recovery process for relieving strain for Traumatic and Accumulative injury, strives for a long term solution for each individual. This problem solving process for pain requires a lot of technical skill, a lot of individual personal attention including advanced problem solving and advanced testing methods. Our team undertake advanced training and advanced assessment skills to assist in the technical problem solving process.


We understand the importance of everyone working together to achieving your goals. This is why we work hard at helping the people that support you – instructors, coaches, personal trainers, parents of younger clients, group leaders, therapists, GPs etc.

Please consider sending the link to this page to someone you think would be interested to learn this forward-thinking information. If you have questions please contact us and ask.

Please note – Your situation may vary from the explanation above.  If you are not sure, please ask your physiotherapist to confirm your individual condition.

We offer our unique injury prevention services in one-on-one, hands-on consultations ready for your booking for today, or you can express you interest in our group workshops.

Please feel free to ask questions about this material – Call (08) 8555 596.

** The term musculoskeletal refers to muscles, joints, bones and nerves.
¹Published journal article: Marras W M S: The case for cumulative trauma in low back disorders. The Spine Journal 3 (2003) 177.