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Rehab Science · Chapter 6

What Is an Injury?

An injury is an identifiable physical disruption of musculoskeletal tissue. Injuries and pain are related but separable: you can be injured with pain, injured without pain, or in pain without injury. Symptoms and function, not scan images, are the best gauge of progress.

CompleteSource: Rehab Science · Ch 6 · PDF pp. 106–114
You will learn to
  • ✓ Define injury and contrast it with pain
  • ✓ Explain the injury–pain paradox using imaging evidence
  • ✓ Describe why imaging reports can impede recovery
1.

What counts as an injury

📖 Rehab Science

An injury is a real, identifiable disruption of tissue—a torn ligament, strained muscle, ruptured tendon or broken bone. Knowing which tissue is involved, how it heals and what aggravates it lets you choose the right rehab plan. Injuries are temporary, and there is a lot you can do.

Source: Rehab Science · Ch 6 · PDF pp. 106, 107show sources ▾

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

2.

What an injury can teach you

📖 Rehab Science

Injuries often reveal something to change—too little conditioning, too much too soon, poor warm-ups or not enough recovery. Fixing those while you rehab makes you more resilient. Regular strength, mobility, flexibility and balance training lowers injury risk, although nothing prevents injury 100%.

Source: Rehab Science · Ch 6 · PDF pp. 108, 109· 3 original research citationsshow sources ▾
  1. [Ch 6·1] Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877. find original ↗
Also cited by the book on these pages:
  1. [Ch 6·4] Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy. 2015;31(6):1199-1204. find original ↗
  2. [Ch 6·9] Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021;372:n291. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

3.

Separating pain from injury

📖 Rehab Science

Roughly 40–50% of people with no symptoms have scan findings like labral or meniscus tears, disc herniations or arthritis. And 90–95% of low back pain has no identifiable specific cause. A clear scan does not mean your pain is fake; a scan finding does not prove it is the cause.

  • Injury + pain · injury without pain · pain without injury
Diagram · Pain and injury are related but separateOriginal illustration
Painwithout injurye.g. non-specific LBPInjurywithout paine.g. pain-free cuff tearbothinjury + pain
You can have an injury with pain, an injury without pain (40–50% of pain-free people show findings on MRI), or pain without an identifiable injury (90–95% of low back pain is non-specific). — Based on concepts in Rehab Science Ch 6 (PDF pp. 110–112).
Source: Rehab Science · Ch 6 · PDF pp. 109–112· 9 original research citationsshow sources ▾
  1. [Ch 6·2] Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. find original ↗
  2. [Ch 6·3] Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268-1278. find original ↗
  3. [Ch 6·4] Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy. 2015;31(6):1199-1204. find original ↗
  4. [Ch 6·5] Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. find original ↗
  5. [Ch 6·6] Wood KB, Garvey TA, Gundry C, Heithoff KB. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg Am. 1995;77(11):1631-1638. find original ↗
  6. [Ch 6·7] Jerosch J, Castro WH, Assheuer J. Age-related magnetic resonance imaging morphology of the menisci in asymptomatic individuals. Arch Orthop Trauma Surg. 1996;115(3-4):199-202. find original ↗
  7. [Ch 6·8] Schibany N, Zehetgruber H, Kainberger F, et al. Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study. Eur J Radiol. 2004;51(3):263-268. find original ↗
  8. [Ch 6·9] Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021;372:n291. find original ↗
Also cited by the book on these pages:
  1. [Ch 6·1] Lauersen JB, Bertelsen DM, Andersen LB. The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2014;48(11):871-877. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

4.

The trouble with imaging

📖 Rehab Science

Scan reports can cause anxiety that slows recovery. Worried people stop using the area, it weakens, and re-injury becomes more likely. Respect the injury, but track how you feel and what you can do—that is the real measure of progress.

Source: Rehab Science · Ch 6 · PDF pp. 112, 113, 114· 3 original research citationsshow sources ▾
  1. [Ch 6·10] Jacobs JC, Jarvik JG, Chou R, et al. Observational study of the downstream consequences of inappropriate MRI of the lumbar spine. J Gen Intern Med. 2020;35(12):3605-3612. find original ↗
  2. [Ch 6·11] Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine (Phila Pa 1976). 2013;38(22):1939-1946. find original ↗
Also cited by the book on these pages:
  1. [Ch 6·9] Hall AM, Aubrey-Bassler K, Thorne B, Maher CG. Do not routinely offer imaging for uncomplicated low back pain. BMJ. 2021;372:n291. find original ↗

Page numbers are those of the uploaded PDF edition. "Find original" opens a PubMed search for the cited study.

Check your understanding

1. Roughly what percentage of low back pain is classed as non-specific?
2. What is the best gauge of rehab progress according to the book?