The ghost in the machine – Is musculoskeletal medicine lacking soul?

Publication date: Available online 28 February 2018
Source:Journal of Bodywork and Movement Therapies
Author(s): Matt Wallden, Paul Chek
In recent times there have been, concurrently, increasing volumes of research questioning whether biomechanics have any relevance at all to musculoskeletal medicine; and a blossoming field of Pain Science identifying that perception of, and context for, pain is often more important than the tissues generating the pain in the first instance. From the academic world to social media, much excitement has been generated in supporting this new direction. However, most of the great work arising from the Pain Science arena is focused on pain itself and on the patients' conscious beliefs around their pain. A redirection of focus toward function beyond the pain, and awareness of how unconscious behavioral programming accounts for the majority of lifestyle habits and perceptions, may facilitate more effective outcomes. Other unconscious processes which are known to contribute to persistent pain, yet are still largely unacknowledged in musculoskeletal practice, are those involved in central sensitivity. A plethora of systemic and visceral conditions are known to contribute to central sensitivity yet are barely considered in typical clinical screening or management. The more that is understood about the complexity of these and other interacting factors in pain, the more the inadequacies of our prevailing research and clinical methodologies are exposed. The question posed is, are unconscious processes the next key field of exploration and "harvest" in musculoskeletal medicine and, if so, how can we most effectively address them?



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