Improving Musculoskeletal Health Through a Whole-Person Approach

March 14, 2022

Article was written by WholeHealth Living

We tend to think of our aging muscles and creaky bones like an old car – the shocks squeak, the bearings growl, and the brakes are worn out. This mechanic’s picture of our body overlooks how the musculoskeletal system is an essential component of human health.  In addition to providing structure and movement, the musculoskeletal system supports our endocrine system.  Our endocrine system is stimulated by exercise and communicates via biochemicals to signal other organs to maintain optimal health.

Could the multiple roles played by muscles and bones explain why exercise can alleviate musculoskeletal pain?

The Complexity of Musculoskeletal Pain

Not so long ago, most doctors and therapists advised people with musculoskeletal pain to rest and avoid activity. Today, that advice has been overturned completely. Of all the remedies and treatments that promise to ease pain, exercise is considered among the most effective – but unlike the squeaky shocks in an old car, musculoskeletal health is derived from many contributing factors. What’s more, each case of chronic pain varies from the next.

According to a study published in Musculoskeletal Science and Practice, “With chronic low back pain, it’s not simply biological aspects of tissue damage, but there are psychosocial elements at play, as well things like a person’s mood or confidence in their own abilities to do something,” the study’s lead author, Dr. Matt Jones said.1

This new, more encompassing picture is driving a move toward a more comprehensive, whole-person approach to musculoskeletal health. The goal is to empower patients to improve their health and pain-related behaviors by engaging the mind-body therapies.

A Multidisciplinary Approach to Musculoskeletal Health

Tivity Health® is bringing this new approach to health plans through its two health enhancement programs:

  • SilverSneakers®, the nation’s leading fitness program designed specifically for seniors, and
  • WholeHealth Living®, Tivity Health’s national network of physical medicine and integrative health practitioners.

WholeHealth Living gives health plan members access to chiropractors, acupuncturists, massage therapists, naturopathic physicians, and other modalities. The goal is to help resolve the musculoskeletal barriers to movement and empower health plan members to live the life they love.

How Skeletal Muscle Functions as an Endocrine Organ

It’s hard to talk about “my aching back” or musculoskeletal issues without picturing that old, broken-down car. But the musculoskeletal system is far more complex.

As the largest tissue in the body, measuring 40% of body mass in lean individuals, the skeletal muscle plays a lead role in energy metabolism and insulin sensitivity. Insulin is a pancreatic endocrine hormone. The excess glucose from the food we eat is absorbed up by skeletal muscle and stored as glycogen in response to insulin signals. If necessary, these glycogen stores can be broken down again to glucose for energy. Plus, they also provide structural support in various tissues in your body.

The musculoskeletal system works with other hormones, for example, when the uterine muscle contracts during delivery, when the pituitary gland releases the human growth hormone (HGH) after exercise to burn fat and build muscle, or even when endocrine signals shivering movements when our body is cold.

The endocrine connection suggests why muscle and bone interactions play an essential role in maintaining health. Lack of exercise leads to obesity and increased complications such as diabetes and metabolic disease.

Musculoskeletal Disorders – The Leading Cause of Disability

As we age, it’s harder to maintain musculoskeletal health. Increasing cases of sarcopenia, osteoporosis, arthritis, and hip and knee replacements serve as evidence.

Musculoskeletal conditions are the leading contributor to disability worldwide, with low back pain being the single leading cause of disability in 160 countries. An aging population, plus lifestyle factors are to blame.2

Typical musculoskeletal conditions include:

  • Osteoporosis – Bones progressively weaken from bone tissue not being adequately replaced.
  • Osteoarthritis – The cartilage that coats and cushions bones and allows joints to operate smoothly deteriorates and results in pain, swelling, and movement problems.
  • Rheumatoid arthritis – Inflammation of the joints and other tissues often stem from autoimmune disorders where the immune system attacks the body.
  • Bone and joint problems – Bone and joint problems can result from obesity, lack of muscle tone, sports injuries, or diseases like diabetes.
  • Cancer – Musculoskeletal cancers can develop on bones, muscles, tendons, and ligaments.

Musculoskeletal Conditions Require a Whole-Person Approach

With musculoskeletal pain, we instinctively treat the source of the pain. But pain is also a multi-dimensional expression of the whole person. Diet, lifestyle, and a person’s mental or emotional state can influence our pain threshold and how we experience pain. For example, individuals can respond to aches and pains differently based on their mental outlook or typical lifestyle.

Pain is signaled through the nervous system, often over-activated by depression, anxiety, and stress. In addition, excess weight can overburden the joints, while too much dietary sugar can increase inflammation and musculoskeletal pain. Musculoskeletal conditions develop from lifestyle factors, mental-emotional states, and a range of comorbidities.

With so many factors driving musculoskeletal conditions, an integrated approach is required. A care plan might include some combination of acupuncture, chiropractic care, physical therapy, massage, nutritional support, and exercise.

Studies Show How a Whole-Body Approach Improves Musculoskeletal Outcomes

The Agency for Health Research and Quality recently reviewed 202 non-drug clinical trials and found that mind-body therapies were more effective than body-focused treatments on their own. Interventions in the study that improved function and pain for at least one month included:3

  • Chronic low back pain: Exercise, psychological therapies (primarily cognitive behavioral therapy), spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation
  • Chronic neck pain: Exercise, low-level laser therapy, Alexander Technique, acupuncture
  • Knee osteoarthritis: Exercise, ultrasound
  • Hip osteoarthritis: Exercise, manual therapies
  • Fibromyalgia: Exercise, cognitive behavioral therapy, myofascial release massage, tai chi, qigong, acupuncture, multidisciplinary rehabilitation
  • Chronic tension headache: Spinal manipulation

Another study found that patients had less pain, fewer physical limitations, and improved mental health when they received mind-body therapies with their usual medical care compared to patients who did not receive them.

  • “Among adults with chronic low back pain, treatment with mindfulness-based stress reduction or cognitive behavioral therapy, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks.”4

According to a study published in BMC Musculoskeletal Disorders, behavior changes like quitting smoking, weight loss, and better diet can improve bone health, reduce chronic musculoskeletal pain, and reduce the risk from other chronic diseases.

  • “Addressing lifestyle behavior change in patients/clients with chronic pain, e.g., back pain, as a first-line intervention might not only constitute a novel approach but also reduce the socioeconomic burden related to chronic pain as well as non-communicable diseases.”5

A Whole-Person Approach toward Musculoskeletal Health

Tivity Health’s whole-person approach to musculoskeletal health incorporates holistic treatments and nonpharmacologic options as its first line of care.

“We have found that musculoskeletal conditions require a whole-person, comprehensive approach for long-term impact,” said Maria Granzotti, Chief Medical Officer of WholeHealth Living of Tivity Health. “Our synergistic model uses WholeHealth Living’s physical medicine and integrative therapies to relieve pain and support lifestyle changes. When combined with SilverSneakers, we offer a cost-effective approach to improving musculoskeletal conditions.”

Through the partnership of SilverSneakers and WholeHealth Living, Tivity Health offers an integrated approach for health plans that empower members to restore musculoskeletal health and enhance well-being.

To learn more about WholeHealth Living’s whole-person approach to improving health outcomes while reducing costs, please visit www.wholehealthliving.com.

[1] https://www.newswise.com/articles/exercise-for-low-back-pain-beneficial-but-no-one-agrees-on-why

[2] https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions#:~:text=Musculoskeletal%20conditions%20are%20the%20leading,of%20disability%20in%20160%20countries.&text=Because%20of%20population%20increases%20and,musculoskeletal%20conditions%20is%20rapidly%20increasing.

[3] https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/nonpharma-chronic-pain-cer-209.pdf

[4] https://pubmed.ncbi.nlm.nih.gov/27002445/

[5] https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-015-0545-y