Treatment Mismatch - Addressing the Evolving Nature of Musculoskeletal Disorders

In the 21st century, healthcare professionals are witnessing a growing trend of musculoskeletal disorders (MSDs) that no longer respond effectively to traditional treatment methods. This phenomenon, which I term "treatment mismatch," arises from the rapid and profound changes in our environment and lifestyle. Understanding this concept is crucial for developing more effective therapeutic strategies that address the modern aetiology of these disorders.

The Evolutionary Mismatch

To comprehend the treatment mismatch, we must first explore the concept of evolutionary mismatch. For 99% of our evolutionary history, humans lived as hunter-gatherers in small, nomadic groups. This lifestyle, deeply intertwined with nature, shaped our physiology and behaviour. Our bodies evolved to respond to acute, short-term stressors with the fight-or-flight response, a mechanism designed to handle immediate physical threats.

However, the last 10,000 years have seen a dramatic shift. We transitioned from a nomadic lifestyle to agrarian societies, then to industrialised cities, and now to an information age characterised by rapid technological advancement. These changes have occurred so quickly that our physiological adaptations have not had time to keep pace. As a result, our stress response, once advantageous for survival, has become maladaptive in the face of chronic, psychosocial stressors such as work overload, social pressures, and the constant connectivity of modern life.

The Rise of Psychosocial Stressors

In today's world, many MSDs are not caused by physical trauma but by psychosocial stress. Chronic stress, job insecurity, fear of change, and even frustrations like an internet outage trigger the same physical stress response our ancestors used to deal with immediate threats. This includes neurohormonal changes that tense muscles, alter vascularisation, and redistribute nutrients—all of which are inappropriate for addressing the subtler, chronic challenges of the modern environment.

Traditional Treatments and Their Limitations

Traditional treatment methods for MSDs, developed in the 19th and 20th centuries, were primarily designed to address biomechanical issues resulting from physical trauma. These methods include manual therapies, physical exercises, and ergonomic adjustments that focus on correcting mechanical dysfunctions and alleviating pain through physical means.

While these treatments can be effective for conditions with a clear biomechanical origin, they often fall short in addressing MSDs driven by chronic stress and psychosocial factors. This is the crux of the treatment mismatch: therapies that worked well for the health problems of the past are less effective for the stress-related disorders prevalent today.

Addressing the Treatment Mismatch

To bridge this gap, manual therapists and healthcare professionals must adopt a more integral approach that integrates the understanding of psychosocial stressors and their impact on physical health. Here are several strategies to consider:

1. Integral Assessment: Evaluate patients not only for biomechanical issues but also for psychosocial stressors. Understanding the broader context of a patient's life can provide insights into the underlying causes of their MSDs.
2. Stress Management Techniques: Incorporate autonomic nervous system balancing methods, like The Reaset Approach, into treatment plans. Techniques that modulate the stress response and reduce its impact on the musculoskeletal system should be applied first, before treating overcompensations and the biomechanical dysfunction(s) themselves.
3. Patient Education: Educate patients about the role of stress in their condition and teach them self-management strategies. Empowering patients with knowledge and tools to manage stress can enhance the effectiveness of their treatment.
4. Adaptive Therapeutic Practices: Stay informed about the latest research and developments in the field of psychosocial health. Incorporate evidence-based practices that address the evolving nature of MSDs into your therapeutic repertoire.

Conclusion

The concept of treatment mismatch highlights the need for a paradigm shift in how we approach musculoskeletal disorders. By recognising the role of psychosocial stressors and adopting holistic, interdisciplinary strategies, we can develop more effective treatments that are attuned to the realities of modern life. Addressing this mismatch is essential for improving patient outcomes and promoting long-term health and wellbeing in the 21st century.

References:

• European Agency for Safety and Health at Work (2021). Musculoskeletal disorders: association with psychosocial risk factors at work - Literature review. Publications Office of the European Union. https://osha.europa.eu/sites/default/files/2021-11/MSDs_association_pshychosocial_risks_factors_at_work_report.pdf
• Manus M. B. (2018). Evolutionary mismatch. Evolution, medicine, and public health, 2018(1), 190–191. https://doi.org/10.1093/emph/eoy023
• Sapolsky, R. M. (2004). Why Zebras Don't Get Ulcers. Stress Response and Modern Stressors. Holt Paperbacks.
• Meyers, T. (2024). The Rise in Stress-related Physical and Mental Health Problems in the 21st Century: A conflict between biology and culture? https://www.dhirubhai.net/pulse/rise-stress-related-physical-mental-health-problems-21st-tom-meyers-7oxie/?

By understanding and addressing the treatment mismatch, we can better serve our patients and adapt to the changing landscape of musculoskeletal health.

Additional reading

• Sunstr?m, L. (2015). Success is Hard: 7 Evolutionary Mismatches You Must Overcome. https://startgainingmomentum.com/7-evolutionary-mismatches-you-must-overcome
• Giphart, R. and van Vugt, M. (2018). Mismatch: How Our Stone Age Brain Deceives Us Every Day (And What We Can Do About It).

FYI: This article represents the ideas researched by Tom Meyers and created with the assistance of ChatGPT, ensuring a blend of expert insights and advanced AI support.