REVIEW OF 7 COMMON MUSCULOSKELETAL DISORDERS: SYMPTOMS, CAUSES AND TREATMENT

According to the WHO^[1], musculoskeletal disorders are amongst the most prevalent diseases worldwide, affecting up to 1.71 billion people - roughly one fifth of the global population. They are the leading cause of disability on the planet, commanding the highest need for physical rehabilitation.

The following article reviews 7 of the most common diseases affecting the musculoskeletal system, delving into symptoms, potential causes, risk factors, and treatment options.

What Are Musculoskeletal Disorders (MSDs)?

Musculoskeletal disorders are defined as health conditions affecting the bones, joints, muscles and connective tissues, such as ligaments, tendons and cartilage. All tissues affected typically support the structure of the body as a whole, forming the joints and allowing for motion to occur. Musculoskeletal tissues are hence subject to the most mechanical wear and tear over time.

The most common symptoms pertain to pain and dysfunction of the musculoskeletal system, resulting in decreased dexterity and mobility. In severe cases, the quality of sleep may be affected and the person may be subject to permanent disability. Many people acquire these conditions as a result of their occupation.

Potential Cellular Causes

The main underlying cause for all MSDs would be chronic inflammation, which typically results in one of the following potential causes:

1. Cellular Senescence

When cells become damaged, they begin to change their structure and functionality, turning into aged or senescent cells. These cells are unable to divide and secrete inflammatory compounds on a continuous basis. The inflammations they produce are connected to the majority of MSDs.

In a normal healthy situation, these cells undergo apoptosis (programmed cell death) in order for the tissue to regenerate. In both aging and disease, apoptosis becomes faulty or impaired, resulting in a reduced clearance of these aged cells and an increase in bodily inflammation. As the musculoskeletal system is subject to physical injury and mechanical wear more than other tissues of the body, it is prone to collecting senescent cells.^[2]

Currently, novel therapies are under exploration that promote the clearance of senescent cells (senolytics) and that inhibit the inflammatory secretions these cells make (senomorphics or senostatics).

2. Protein Misfolding

Our cells produce hundreds to thousands of proteins all the time in order to function, as well as to divide and turnover. This is especially pertinent to muscle cells. The proteins our cells make tend to be complex, requiring a specific 3D orientation to fulfil their roles optimally. Ensuring proteins have the right shape and structure requires the process of protein folding, which typically occurs at specific organelles inside every cell.

Genetic analysis studies have revealed that those with musculoskeletal disorders typically have misfolded proteins, altering the ways in which muscles respond to contraction. These studies also highlight how protein folding traits can be passed down to offspring, increasing the risk of inheriting a similar disorder later on in life^[3]. Misfolded proteins are known to be involved in a number of relevant pathologies, including autoimmune diseases, metabolic disorders, neurological ailments, and chronic pain.

General MSD Risk Factors

Many events can precipitate into an MSD, which usually develops over the course of a lifetime. Some of these include the below risk factors:

• Injury. As may be expected, an injury typically promotes cellular damage and aging, with the end result being faulty cells. If the injury does not heal properly after the event, it can incite the onset of an MSD. Many with arthritis typically contracted the condition after recovering from a knee, hip or wrist injury. Herniated discs, sprains, strains or fractures are other examples of MSDs that occur as a result of an accident, however, these are typically transient. Repeated injuries in the same area are likely to result in chronic disease.
• Genetic Inheritance. As mentioned above, many MSDs convey a genetic component that can be passed down from parents to offspring. If someone in the family has an MSD, it substantially increases the risk of relatives acquiring one later on in life. Genes pertaining to muscle conformation, action and function are all involved, as are genes that regulate metabolism.
• Sympathetic Nervous System Dysfunction. Many MSDs are characterized by dysfunctions of the sympathetic nervous system. This branch of the nervous system performs numerous functions, one of which would be regulating muscle contraction. Muscle contraction requires sympathetic innervation. If one is overly stressed, the muscles of the body become tense and overly contracted. This eventually leads to pain, stiffness and pathological alterations in muscle development that promote the formation of MSDs.
• Physical Inactivity. Bones, muscles and the vascular system all require physical activity to balance cellular metabolism and turnover. Without proper renewal, a buildup of aged cells can result in increased pain, stiffness and weaker bones. Physical inactivity is a prime risk factor for developing insulin resistance, which is another contributing factor to many states of disease, including MSDs.
• Insulin Resistance. Insulin resistance is known to alter the metabolism of all cells, creating a buildup of glucagon. If not utilized properly, these stores can increase muscle stiffness and pain.
• Aging. The physiological changes that accompany the aging process increase the risk of acquiring an MSD substantially. These include an increase or decrease in fat mass, reduced muscle mass, and lower bone integrity; all of which are related to hormonal decline.
• Occupation. Those who have an occupation that demands physical labor, high risk or repetitive physical work, exposure to chemicals or who spend most of their time in front of a computer are at an increased risk of developing a musculoskeletal disorder. For those involved in this line of work, precautions are advisable (see tips below).^[4]
• Unhealthy Lifestyle. Leading an unhealthy lifestyle increases the risk of acquiring all forms of the disease. Smoking and obesity are two risk factors that increase the severity of symptoms experienced by those with an MSD.
• Gender. Females are at a slightly higher risk for acquiring an MSD than men; however, the risk is almost equal between men and women.

Review of 7 Musculoskeletal Disorders by Type

Forms of arthritis make up the majority of musculoskeletal disorders, with injuries, systemic autoimmune diseases, unspecified chronic widespread pain disorders and lower back and neck pain making up the rest. For all types of MSDs, one is typically referred to a rheumatologist for treatment.

Types of MSDs are classified according to the site of pain and dysfunction of the disorder^[5]. Most MSDs occur in the joints, bones, or muscles. Pain can be localized or systemic, as well as chronic or acute (episodic).

• Joints

In MSDs arising from the joints, swelling, pain, dull aches and stiffness of the joints are par for the course. Unlike other MSDs, the pain often recedes substantially with rest. Joint dislocation resulting from an injury is a common cause for this type of MSD.

1. Osteoarthritis

Osteoarthritis refers to arthritic degeneration of synovial joints, in which the cartilage of the joints wears down in response to aging, injury, stress and/or mechanical overload.

Synovial joints are the most common throughout the body. The cartilage in them is usually surrounded by synovial fluid^[6]. Inflammatory changes in osteoarthritis also affect the health of this fluid, eventually leading to friction and damage of the bones without any protective padding to cushion them. In late stages of the disease, the joint becomes completely demolished.

This form of arthritis is the most common in the elderly population, as well as the leading cause of disability in middle-aged individuals.

Symptoms

The main symptoms of osteoarthritis include joint pain and stiffness that intensifies with movement of the joint. Rest typically decreases pain, reducing the mechanical stress on the affected area. The most common joints to be affected include those of the knees, hips, lower spine, digits of the hands and feet, wrists and ankles.

Other symptoms include swelling of the joint, instability, joint misalignment and deformity. Symptoms get worse as the disease progresses.

Other Causes

Risk factors for osteoarthritis are the same as the general risk factors above, a number of which typically contribute towards a collective cause for disease onset.

Osteoarthritis may also present as secondary to another condition. These include joint abnormalities, chronic infection, Paget disease, diseases of the blood related to either iron (hemochromatosis) or copper (Wilson’s disease) metabolism and diseases of the connective tissues.^[7]

Treatment

Painkillers, careful exercise, and weight loss (if indicated) are the frontline therapies for those with osteoarthritis. A walking stick, crutches, splints or some other device to assist physical activity is also often of benefit to those with the condition. In some cases, antidepressants and nervous system depressants such as gabapentin are recommended. Platelet-rich plasma may yield beneficial results in early stage osteoarthritis.

For severe cases, total joint replacement surgery is indicated. Acupuncture is an alternative therapy for those unable to undergo surgery.

2. Rheumatoid arthritis

Rheumatoid arthritis is a disease very similar in presentation to osteoarthritis, wherein synovial joints degenerate over time. Unlike osteoarthritis, rheumatoid arthritis is an inflammatory condition caused by an autoimmune response.^[8]

Antibodies are often present that target citrullinated proteins. These are found in a variety of substances that form cartilage such as collagen and fibrinogen. When an antibody binds to one of these proteins, it triggers an immune response, serving to degrade the joint tissue.

As the disease progresses, extra blood vessels can develop in the synovial fluid, allowing for an increase in immune cell infiltration and a worsening of symptoms.

Symptoms

Symptoms of rheumatoid arthritis are similar to osteoarthritis, however, the joints affected typically differ.

In rheumatoid arthritis, the smaller joints of the hands and feet are affected first, with increases in the number of affected joints over time as the disease progresses throughout the body. Weight-bearing joints are often unaffected and pain is spread symmetrically across the body. Therefore instability and decreased mobility are often only present in late stages or severe presentations of rheumatoid arthritis.

Those with rheumatoid arthritis may have additional symptoms due to systemic inflammation and autoimmune responses. These can include gastrointestinal disturbances, skin conditions, depression, anemia and symptoms arising from other autoimmune pathologies. End stage arthritis may result in tissue damage to other systems of the body.

Other Causes

Injury is not a common risk factor for rheumatoid arthritis as seen in osteoarthritis. Autoimmune diseases, coronary heart disease, dental cavities, chronic infections, genetic predisposition, smoking and alterations in the gut microbiome are implicated in the development of this condition.^[9]

As with other autoimmune disorders, environmental triggers that result in increases in bodily inflammation can promote rheumatoid arthritis.

Elevations in growth factors are problematic for those with rheumatoid arthritis, lending to growth abnormalities frequently seen in the afflicted joints. These include excessive blood vessels, villous projections, and fibrous lesions.

Treatment

Treatment for rheumatoid arthritis mainly consists of antirheumatic drugs that help to lessen the inflammatory immune response. Classes of drugs used include:

• Interleukin-6 receptor blockers
• TNF inhibitors
• T-cell blockers
• Anti-antibody drugs
• Janus Kinase (JAK) inhibitors

Many prescription medications target several of the above inflammatory pathways for optimal results. If the patient is nonresponsive, surgery may be indicated.

The above medications should not be prescribed to patients with an active infection. Treatment can be resumed after the infection has subsided, which may require the use of an antimicrobial.

3. Carpal Tunnel Syndrome

Carpal tunnel syndrome refers to a specific entrapment neuropathy in which the median nerve is compressed in the wrist, just before entering the hand. The carpal tunnel is a structure that contains this nerve alongside all the muscle fibers leading to the hand. Another name for this condition is median nerve compression.^[10]

As the disease progresses, the nerve becomes more inflamed and eventually, lesions form in the myelin sheath and axon that innervates it.

Symptoms

Those with carpel tunnel syndrome have pain in their wrists, as well as numbness and episodic paralysis of the hand and wrist. The pain can radiate from the affected wrist into the hand and arm. Patients experience variability between which fingers they can use and where in their hands the pain is most persistent.

In the early stages, the symptoms are often only present at night time. During the progression of the disease, symptoms begin to manifest when using the hands for repetitive activities, such as writing, drawing or typing. Sensory nerve fibers are affected before motor fibers, which is why symptoms of pain present first, followed by symptoms affecting hand mobility at later stages.

In late stage carpal tunnel syndrome, symptoms can be constant and patients may have decreased fine motor coordination, weakness in the hands, clumsiness and muscle atrophy.

Other Causes

There is a high incidence of repetitive handwork in those with carpal tunnel syndrome, indicative of overuse of the hand muscles in disease onset. Construction workers, those that man heavy, vibrating machinery and those who work at the computer for long periods of time are at the highest risk.

On top of having a history of repetitive movements, autoimmune conditions, genetic inheritance, obesity and pregnancy are other factors that may serve to cause carpal tunnel syndrome in an individual.

Carpal tunnel syndrome may be secondary to the following conditions:

• Injury or wrist dislocation
• Muscle hypertrophy or hypertrophy of the median nerve
• Diabetes
• Thyroid imbalances
• Kidney failure
• Tumors in or near the afflicted area
• Chronic edema of the wrists
• Vascular diseases that restrict blood flow to the hand

Treatment

Treatment initially consists of patient education and a nighttime wrist splint, employed to restrict the movement of the wrist while performing daily activities. This helps to limit the progression of the disease.

Anti-inflammatories, such as steroid injections or NSAIDs, may be prescribed. Steroids are only advisable in specific cases of transient carpal tunnel syndrome, while NSAIDs do not offer optimal pain relief for the majority with the condition. Medications for neuropathic pain such as gabapentin and pregabalin may offer relief to a subset of patients.

In those who are suffering from severe axonal degeneration in the median nerve, for whom non-invasive therapeutics worked, surgery is indicated. The surgery is referred to as carpal tunnel release surgery, merely creating more space in the carpal tunnel which alleviates compression of the nerve. Success rates are as high as 90%, yet the results diminish after some time and the pain tends to return to patients.

4. Gout

Gout is another type of arthritis to affect the joints, precipitated by monosodium urate crystal deposition. Urate crystals in the joint perpetuate inflammation and swelling, promoting their destruction over time. Common sites for gout are the joints of the toes, feet, ankles and knees.^[11]

Symptoms

Unlike other MSDs of the joints, gout occurs in sudden episodes and is excruciatingly painful. The patient need not move the joint to experience the pain, and often the symptoms result in sleep disruption. The joints are often very swollen, warm, and red. Multiple joints may be affected at one time.

Fever, exhaustion, and other symptoms resembling an infection or sepsis are other common features of a gout flare-up.

Rare symptoms may include eyesight complications and tophi (urate deposits beneath the skin, resulting in lumps).

Other Causes

The only true cause of gout would be hyperuricemia. In this condition, the body produces an excess of uric acid or battles to excrete it. As a result, uric acid is dumped in affected joints in the form of urate crystals. Hyperuricemia may be caused by excessive protein intake, tissue breakdown, kidney damage or liver dysfunction.

Treatment

Analgesics are the first line of treatment for a gout flare-up. NSAIDs are known to work the best in the literature. For patients with renal insufficiency, corticosteroids are prescribed. After 7-10 days, gout flare-ups typically subside.

In between flares, treatment involves reducing systemic uric acid levels. Xanthine oxidase inhibitors (inhibits uric acid synthesis), uricosuric drugs (increases uric acid excretion) or interleukin-1 blockers (reduces inflammation) are the preferred medications of choice.

Physicians often limit purine-rich foods to patients with gout as well as other foods that may promote hyperuricemia. These include corn syrup, artificial sweeteners, excessive sugar intake, protein-heavy foods, and alcohol. Exercise and adequate hydration are important as well.

• Bones

MSDs of the bones are very common in response to injuries and developmental bone deformities. These typically result in pain emanating from the bones. Improper mineral utilization and deficiency, as well as physical inactivity and faulty insulin signaling often contribute to their development.

5. Osteoporosis

Osteoporosis refers to a condition in which a person loses optimal bone mineral density, leading to bone deterioration, decreased skeletal mass and an increased risk of fractures. In this condition, it becomes difficult to keep minerals within the bone matrix.^[12]

Symptoms

In the early stages, osteoporosis is often non-painful, yet pain may be experienced as the disease develops. Those with the condition are often frail, which tends to detract from the quality of life and may make it difficult to live alone. Frailty, pain and fractures may also result in disability in the later stages of the disease.

Other Causes

Age is the leading cause of osteoporosis. The combination of hormonal decline and decreased nutrient uptake seen in the aging process appears to be involved in the progression of this disease.

Secondary osteoporosis may occur as a result of other diseases; including anorexia, hyperthyroidism, chronic kidney disease, and Cushing syndrome.

Rapid hormonal decline, long-lasting amenorrhea, Vitamin D deficiency, malabsorption, and long-term immobilization can all contribute to the formation of osteoporosis. Steroid use, smoking, alcohol intake and being underweight are other risk factors for osteoporosis.

Treatment

For mild to moderate osteoporosis, lifestyle changes are the only prescribed mode of treatment. The patient is required to do regular weight-bearing exercises. Preferably these ought to enhance balance and coordination in order to prevent falls and potential fractures.

Smoking and drinking should be moderated and eventually stopped. Electrolytes and vitamin D status should be assessed. Supplementation is advisable for all with osteoporosis, however, if a deficiency is detected, the physician may prescribe a refeeding program for the patient to normalize levels. Adequate protein intake within the context of a nutritionally balanced diet is important for maintaining bone health.

Medications that stimulate bone anabolism (building) or that block resorption are often prescribed. Due to the hormonal nature of bone metabolism, men and women are prescribed different medications in order to enhance the effectiveness of the treatment. Women may be offered an estrogen receptor modulator or hormone replacement therapy in addition to these medications. Men are often placed on bisphosphonates, however, some experience discomfort a while after using them without any benefit.

6. Scoliosis

Scoliosis is an abnormal lateral curvature of the spine, characterized by rotation of the vertebrae to one side or the other. The majority of scoliosis develops during childhood without a known cause.^[13]

Symptoms

Scoliosis often does not present with any symptoms that would be of concern. Roughly a quarter of those with the condition can experience back pain. In some cases, scoliosis can promote deformities of the rib cage, which may promote irregular breast sizes in women. Those with scoliosis may be depressed as a result of living with a cosmetic deformity.

Most cases of scoliosis do not progress beyond adolescence. However, in rare instances, the spine can continue to become progressively more deformed. In these rare cases, the risk of back pain, nerve damage, breathing restriction, and heart failure increases every year.^[14]

Many types of scoliosis are the result of a neurological condition and therefore neurological symptoms may be present alongside scoliosis. These can include gait abnormalities, weakness, difficulties with balance, a lack of coordination, incontinence, or sensorineural symptoms.

Other Causes

Scoliosis may be present at birth, during development or as secondary to another condition. These include cerebral palsy, muscular dystrophy, chronic infections, connective tissue disorders, tumors, and neurofibromatosis. Injury or chronic pain can also result in scoliosis.

Scoliosis may also be inherited genetically from a parent with the condition.

Treatment

Treatment options vary depending on the cause of scoliosis and the severity. In patients with mild scoliosis, yearly checkups are all that is required to ensure that the curvature does not become worse. In most cases, the spine does not continue to curve with age, either remaining stagnant or stopping after physical maturity is reached.

For moderate scoliosis, a back brace may be prescribed by a physician. These do not improve posture or correct the problem, yet they may help to prevent scoliosis from worsening during development. Compliance and the age at which a brace is employed all impact the outcome of using one.

Surgery is indicated for severe scoliosis or for patients that are unable to maintain optimal balance as a result of the condition. The majority of surgical techniques make use of rods, hooks, screws and/or wires, which are implanted into the back of the patient in an attempt to correct the shape of the spine. In progressive cases, scoliosis gets increasingly difficult to treat as the patient ages.

• Muscles, Ligaments and Tendons

Muscles, tendons and ligaments may all become injured when overused. Strain, sprains, frequent cramps and spasms are all predisposing factors to MSDs that derive from these tissues. Pain experienced in these areas can seem similar to joint pain with the inclusion of muscle pain, burning and stiffness.

7. Chronic Lower Back Pain

Lower back pain is the most common pain disorder and symptom of pain amongst those with MSDs. It is estimated that as many as 80% of people will have experienced low back pain at some point in their lives.^[15]

Symptoms

Chronic lower back pain is characterized by lower back pain of an unknown cause that has persisted for longer than 3 months. This is the main symptom. Other types of low back pain are expressed as a symptom of illness.

Additional symptoms of low back pain may include emotional distress, mood swings, fatigue and muscle stiffness.

Other Causes

Nerve impingement is known to be involved in the development of the majority of low back pain cases.^[16] Other potential causes can include disc herniation, spinal stenosis (spinal compression)^[17], pregnancy, infection and other inflammatory MSDs. These causes are counted as differential diagnoses, where lower back pain becomes a symptom, rather than a standalone condition.

Tumors and Cauda Equina Syndrome are regarded as the worst possible causes of low back pain. The latter is a rare condition that can result in permanent incontinence and leg paralysis if not treated swiftly^[18]. Physicians are trained to check for red flags that indicate that the patient has these conditions when presented with low back pain as the main complaint.

Treatment Options

Treatment is usually limited to comfort control measures. These include proper back support at all times, over-the-counter painkillers, and back strengthening exercises when possible. If severe, prescription medications such as opioids, muscle relaxants, and gabapentin may be administered by a healthcare practitioner.

Within the first month, it may be worthwhile to consult with a chiropractor or physiotherapist, depending on the nature of the pain. However, chiropractors are not able to treat a slipped or herniated disc.

Surgery is indicated in severe cases of disc herniation, cauda equina syndrome and occasionally for tumors.

General MSD Treatment and Care

The following are often prescribed for those with MSDs:

Painkillers

For many types of MSDs, painkillers are only beneficial in the short term. Side effects pertaining to the chronic use of analgesics are not uncommon.

• NSAIDs are perhaps the most widely used of all over-the-counter painkillers. Long-term use is known to cause gastrointestinal upsets, as well as renal and cardiovascular problems. When applied topically to the affected area, some patients respond with skin rashes.
• Corticosteroids are usually prescribed to those with an autoimmune MSD who are experiencing pain as a result. These tend to interact negatively with other analgesics, suppress the immune system and can also interfere with hormonal stability. Steroids are contraindicated for the elderly and those with chronic infections.

Overuse of analgesics is not advised, especially in those who require surgery. Tolerance towards both the analgesic and anesthetic can be reduced in those who overuse painkillers, lowering their effectiveness and preventing future treatment for the condition.

Stem Cell Therapeutics

Stem cell therapies have been developed for use in surgically treating severe injuries^[19], thus aiding in the prevention of MSDs. They are currently being investigated for treating MSDs, with a particular interest in osteoarthritis and other similar forms of joint destruction.^[20] Stem cells are likely to lower the risk of prosthetic rejection in joint replacement surgery.

Experimental data support the use of stem cell technologies in treating osteoporosis^[21] and even in treating lower back pain pertaining to disc degeneration^[22].

Acupuncture

Acupuncture is a system of medical treatment that forms a branch of Traditional Chinese Medicine. It involves the use of pressure or needles that are applied to various points along the body. These points are believed to be intersecting points of ‘vital energy’; a principle that is key to the philosophy accompanying Chinese medicine. Acupuncture is generally very safe as a complementary treatment option; however, its efficacy is still being explored through testing.^[23]

With regard to MSDs, acupuncture has been shown to provide pain relief in some patients. For those with osteoarthritis who are unable to get joint replacement surgery, acupuncture has shown some promising results in several studies.^[24] Other data demonstrated that acupuncture is a viable alternative or complementary therapy in the treatment of lower back pain, with minimal side effects.^[25]

Experimental evidence suggests that those with rheumatoid arthritis^[26] and carpal tunnel syndrome^[27] may benefit from acupuncture. These studies are limited and further evidence is required for verifying the results.

Gentle Exercise

Both helpful for prevention and treatment of MSDs, exercise serves to strengthen all affected tissues. In the case of almost all MSDs, exercise proved to be of benefit. It promotes optimal cellular turnover, helping to get rid of aged and faulty cells which increase the risk of acquiring an MSD. Exercise in moderation is also consistently prescribed by physicians in the management of chronic pain disorders^[28].

Overuse of muscles and joints poses a major risk for these patients and thus exercise needs to be approached with caution. Yoga, tai chi, swimming, simple stretches and many other forms of gentle exercise appeared to be the most beneficial in combination with other treatment options. However, regularity appeared to convey the best results in the long run.

Ergonomics

Ergonomics refers to the study of workplace restraints on the health of the musculoskeletal system of employees, with the aim of reducing workplace burdens on their health. Ergonomically-designed equipment is made to lessen the destructive outcome of long-term repetitive work, improve posture, and reduce the impact of other occupational hazards in order to lower the risk of developing an MSD.

A part of ergonomics in the workplace is employee education. A great deal of risk can be cut down if the person practices maintaining a good posture and/or modifies their behavior in other ways that minimize the burden on the musculoskeletal system. Protective gear, correct body stance and taking frequent breaks from repetitive work all contribute towards protecting the employee in the long run.^[29]

The use of ergonomic office chairs and employee education promoted less pain among office workers in some studies. These outcomes were improved when combined with exercises that served to strengthen and loosen the neck.^[30]

Support Metabolism with Optimal Nutrition

For the health of the muscles, bones and joints, optimal nutrition is very important. The main dietary emphasis for those with MSDs and those at a high risk of developing them would be minerals, protein and fiber to support the gut microbiome. As is explained below, all of these classes of nutrients are connected naturally in the diet and are often consumed together for the best results.

Minerals are intimately involved with the movement of fluids in the body and in the metabolism of all our cells as a result. Electrolyte depletion promotes dehydration and is implicated in the development of most MSDs. Imbalances in these vital minerals detract from nervous system function, muscle contraction (or relaxation), bone mineralization and maintaining synovial fluid homeostasis in the joints. Of the electrolytes, calcium, magnesium and potassium are the most important for regulating these functions.

Other minerals aside from electrolytes are also critical for maintaining the health of the musculoskeletal system; the prime one being phosphorus. Bones and muscles require adequate amounts of phosphorus to renew them. Phosphorus is also the backbone of ATP (the energy molecule), being a prime substrate of metabolism.

Protein-rich foods are high in phosphorus and calcium, yet traditionally lacking in other electrolytes. Foods high in water soluble fibers contain the necessary electrolytes, as well as forming a prebiotic substrate that feeds microbes in the gut. These microbes are required for breaking down proteins, which are complex and often not completely digestible by human digestive enzymes. In this way, these two types of food are complementary and ought to be paired together in the context of a healthy diet plan.

Conclusion

Musculoskeletal disorders are the most prevalent diseases worldwide. The main causes of MSDs pertain to faulty cellular clearance and turnover, common to the aging process and those leading an unhealthy, sedentary lifestyle. Symptoms often predispose an individual towards chronic pain and eventual disability.

Medications are often employed to manage symptoms, while treatment and prevention both entail the use of regular exercise, employing ergonomic equipment while at work, leading a healthy lifestyle and consuming a diet high in nutrients that promote the health of the musculoskeletal system. In severe cases, surgery or complementary therapies such as acupuncture may be indicated. Future treatment aims at making use of stem cell technology to completely renew the musculoskeletal system, serving as a viable treatment option for those with MSDs.

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