Treatments differ slightly depending on the location of the injury and which specific tissue type suffers the greatest impact. In general, for acute musculoskeletal traumatic injury (excluding broken bones) we try to make the injury "NICER"—that is, we use NSAIDs, Ice, Compression, Elevation, and Rest, all of which are designed to reduce the early phase of inflammation present in acute traumatic injuries. While making an injury "NICER" may or may not speed healing (see below), it almost certainly will improve pain.

In chronic overuse injuries, however, inflammation may not actually play a significant role, which may explain why NSAIDs in that setting, while often useful for reducing pain, are often unhelpful in actually healing the injury itself. When tendons injured chronically from overuse, for example, are viewed under the microscope we see very little inflammation. As a result, the term "tendinopathy" is now preferred over "tendonitis" to suggest the pain may be coming from microtears or some other mechanism besides inflammation.

The main therapeutic treatment I apply to most musculoskeletal injuries, whether acute or chronic, is the simplest: rest. Whenever you develop force across an injured tissue, you're almost certainly retarding its healing. Some musculoskeletal injuries can take literally years to heal completely (I once injured my shoulder bench pressing and had to wait three years before I could bench press again without pain). Sometimes rest can only be enforced by applying a splint (such as to the wrist in order to prevent force being delivered across the elbow during wrist extension in tennis elbow). Patients—especially active, athletic ones—typically hate hearing they need to stop using the injured tissue even for a little while. But it's far better to stop using it—even for months, if need be—than suffer an injury that takes years to heal. How do you know you're adequately resting an injury? It's easy. Don't do anything that causes it to hurt...

...with one possible exception. Studies of patients with Achilles' tendinopathy have shown improved healing from eccentric exercise. Eccentric exercise involves lengthening a muscle against resistance (in other words, a controlled lowering of a weight) compared to shortening a muscle against resistance (as when you curl a dumbbell with your bicep to your chin, for example). Some degree of discomfort during the eccentric training of these patients' Achilles' tendons was actually associated with faster recovery times. Studies showing the benefit of eccentric exercise for other types of tendinopathies are beginning to appear as well, suggesting its prudent use for other tendon injuries seems reasonable. Be careful to reserve this modality for chronic overuse injuries, however, in which acute inflammation is less likely to be playing a role as the cause of pain and under the supervision of your doctor and/or physical therapist.

Physical therapy, by the way, consisting of stretching and strengthening exercises is usually quite helpful at improving pain and joint range of motion if appropriately timed and done on a regular basis. Though modalities such as ultrasound and iontophoresis have been shown to improve swelling and inflammation at a microscopic level, little if any evidence exists that they actually speed healing.

NSAIDs

NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin) have played a role in treating musculoskeletal injuries for decades, but data proving their effectiveness in speeding healing (compared to providing pain relief) is surprisingly scant. In fact, even though some studies suggest their use results in a speedier return to normal strength in the short term, their use may actually retard healing in the long term.

NSAIDs provide two independent effects: pain relief and reduction in inflammation. However, these two benefits occur at different dosages. For example, ibuprofen can provide pain relief at just 400 mg/day but only at 1800 mg/day does it provide an anti-inflammatory effect. Pain from a musculoskeletal injury may or may not be caused by inflammation (see above), but NSAIDs can provide pain relief from injury without reducing inflammation, or in the absence of inflammation, via reduction of prostaglandin production in the central and peripheral nervous systems. However, such mechanisms almost certainly don't speed healing.

Many people don't know that NSAIDs come in different classes. NSAIDs from one class may be of tremendous benefit in controlling your pain but not help someone else at all and vice versa. In general, if one NSAID isn't working to reduce your pain, switching to another one from another class might help. Check with your doctor to identify which NSAIDs come from classes other than the one you're currently taking.

In general, after an acute musculoskeletal injury, I will recommend NSAIDs at anti-inflammatory level doses for brief periods on a scheduled basis (1-2 weeks at most) and then on an as-needed basis for pain control thereafter.SPECIFIC

COMMON INJURIES

What follows is intended as a broad discussion of the most common types of musculoskeletal injuries. You should take care not to conclude that any pain you may be experiencing could only be coming from the diagnoses discussed below, nor should you use this discussion as confirmation of a diagnosis you may be considering yourself without consulting your own doctor. Having said that, once a clear diagnosis is made, you may find the principles below helpful: