The biomechanical basis for early care programmes

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Abstract
Musculoskeletal injuries in the workplace are at epidemic proportions. The total cost in terms of disability, suffering and economic loss is enormous. The soft tissues are frequently involved in these injuries. Soft tissues respond to the mechanical forces on them. Without the stimulus from mechanical forces, there are biological changes in the tissues and poorer organization of newly synthesized collagen. The consequence is a softening and loss of mechanical strength. Joint fibrosis and contracture also occur. In contrast, exercise results in increased collage fibril size and increased strength. Treatment of soft tissue injuries remains a balance between the immobilization required for primary healing of the tissues and the motion- and stress-dependent homeostatic response. These concepts are important in the early care of all soft tissues. The concepts can also be used to study treatments frequently used in the most common occupational injury-low back pain. Some studies have shown bedrest to be effective in the short term. However, the evidence is not strong that this is the treatment of choice if patients do not respond quickly. The back school appears to be very effective. It is probably effective because the patient becomes more self-confident, receives important information, and is encouraged to get moving and return to work. Thus the vicious circle of dependency is obviated. Traction or bedrest with traction are also popular treatments. There is little evidence of their efficacy although traction and exercise appears to be a beneficial combination. Mobilization and manipulation have some capacity to hasten the resolution of symptoms in some patients, but the long-term prognosis is unchanged. Corsets and braces are not justified in most cases of acute low back pain. The emphasis must be on returning the patient to function as soon as possible. It was Aristotle who observed that ‘movement is life’.

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