Relapse after treatment, why?
As pointed out in another article, relapse after musculoskeletal medical treatment is uncommon. Suppose it does occur regularly, what could be the reason and how can this be prevented?
I think it's important to pay attention to this. Besides the fact that with this knowledge it is possible to help some people to get rid of the complaints permanently, factors that cause relapse are also factors that can lead to the first complaints and can maintain them, such as with chronic complaints.
A- Physical constitution
Some people are extra vulnerable to the recurrence of disorders, resulting in a relapse of symptoms.
- People with strong left-right differences (leg length difference of more than 2 cm, scoliosis) can lose balance more quickly with less stress, as can people with a strongly bent posture (kyphosis).
- People with physical limitations (for example as a result of wear and tear, cerebral infarction, fixed vertebrae, artificial joints) will adapt in one way or another in order to function as well as possible. This can be at the expense of the regions that are deployed extra, with possible overload and setbacks as a result.
- There are also people with hereditary or congenital hypermobility, which can be at the expense of stability.
Depending on the underlying cause, treatment options are available, such as: heel elevation and exercise therapy in various forms.
B- Behaviour
Perhaps this is the most common reason for relapse: maintaining the behavior that caused the complaints (and abnormalities).
- Attitude: in my opinion an underestimated factor in the development and maintenance of complaints
- Too little exercise: the physical condition is not strong enough for daily strain.
- Too much movement/overload: there is too little opportunity for recovery, damage builds up.
- One-sidedness of movement: actually falls under a form of overload, but then one-sidedly focused, such as with assembly line work or asymmetrical sports that are practiced intensively (golf, tennis, board rowing, hockey).– Use of painkillers so that there is no physical warning of an imminent calamity.
Changing behavior takes attention, time and practice. It starts with awareness of what is going on. It is then possible to estimate per person what is needed to adjust the behavior. This is almost always accompanied by exercises for a longer period of time.
C- Accident
If there is a significant impact on the musculoskeletal system, due to a fall, a (traffic) accident or otherwise, a permanent disruption can occur. Dysregulation in the sense of damage to structures (e.g. periosteum, muscles, ligaments), disruption of the mutual relationships in joints resulting in, for example, orthomanual problems, coordination problems or adaptive reactions of the body such as building up protective muscle tension.
If these disturbances are not recognized, there is certainly a risk of repeated treatments. There is a chance of improvement upon recognition, for example if sufficient time is taken for wound healing, with forms of exercise therapy or otherwise.
D- Requirements of the environment
Examples include office furniture, overtime, physically demanding work (construction, vibrating machines, ship welders). These are factors that can lead to a form of overload and can therefore lead to 'missteps' more quickly. When using certain medications (particularly those that dampen the nervous system such as sleeping pills, antidepressants, antipsychotics), a degree of passivity can arise, resulting in a loss of accuracy and fine coordination, also with the risk of 'missteps'.
It is not always possible to do something about this. Depending on the situation, this could include high-low desks, taking frequent and long breaks, and reconsidering medication. And last but not least: dare to say 'no'.
E- We don’t know
Unfortunately, it also happens that no reason for relapse is found. In order to minimize that chance, it therefore makes sense to go through the above factors each time to see if there is room for change. Otherwise, re-treatment with musculoskeletal medicine is an option, especially if previous treatments were successful.