Structure vs. Functional Injury/Pain: Definitions & Treatments

Structural injuries are when your knee hurts because something is wrong with your knee.

Functional injuries are when your knee hurts because something is wrong with your feet or hips. 

That’s as simple as I can put it, but we’ll go into more detail later.

Structural vs. functional is a topic we talk about daily in our clinic.

There is a huge difference between structural issues like a herniated disc, torn labrum, or torn ligament, and functional issues like pain, loss of mobility, and overall function loss.

Not all structural issues cause functional changes. Likewise, not all functional problems are because of structural matters. 

Why is this distinction so important? Because this determines where you need to go to have your injury diagnosed and treated.

Up to 55% of sports injuries are skeletal muscle injuries. Yet, there is some confusion about basic terminology when discussing muscle injuries.

What are the types of muscle injuries? Types of muscle injuries include:

  1. Overextension-related
  2. Neuromuscular disorders
  3. Partial tears
  4. Total or subtotal tears/tendinous avulsions
  5. Contusions

The severity of muscle strains can also be broken down into 3 grades:

  • Grade 1 refers to mild damage to less than 5% of muscle fibers.
  • Grade 2 describes more extensive damage that takes months to recover.
  • Grade 3 is a complete tear of the muscle or tendon, which could require surgery.

Differences Between Structural vs. Functional Injury

In our clinic, we’re always discussing the difference between structure vs. function.

Determining whether pain and other symptoms are due to structure or function tells you what kind of care you should seek.

Structural Muscle Injury

Structural muscle injury is when you injure a muscle and that muscle hurts.

For instance, you strain your back muscle groups, then you experience back pain.

According to the Munich consensus statement, a structural muscle injury is any muscle injury with MRI evidence of muscle tear. (MRI stands for magnetic resonance imaging.)

A structural abnormality that causes a functional limitation necessitates a structural fix. A sports medicine-trained orthopedic surgeon is the best choice in this situation. They address the underlying structural cause that prevents the athlete from returning to a fully functioning lifestyle.

Does a muscle strain hurt all the time? A mild strain may feel slightly stiff, but flexible enough to use. Severe muscle strain results in near-constant pain and limited movement.

How do you know if your muscle is pulled or just sore? Pain from a pulled muscle is immediate. Pain from muscle soreness usually takes hours or a couple of days to set in.

Functional Muscle Disorder

Functional muscle disorder is when you have to look at the function of the whole body to find the root cause of pain or function loss.

A more functional approach is necessary when the structure isn’t causing the problem. 

Looking at the whole body as one machine is essential to the functional approach.

For instance, is knee pain always a knee problem? What we may find is if the foot isn’t doing what it should do or the hip isn’t moving properly, so the knee will take on additional stress. Too much stress over time will lead to pain from overuse.

Regardless of how much we work on the focal point of pain (the knee), the problem will persist. However, addressing the hip or foot’s function will restore the primary function to the knee.

According to the Munich consensus statement, a functional muscle disorder is a muscle disorder without MRI evidence of muscular tear. I interpret this to mean the underlying cause of pain or dysfunction is found elsewhere from the focal point of the pain.

Examples of Structural Injuries

Simply put, structural damage is defined when the site of injury is also where musculoskeletal pain originates. Below are some examples of structural injuries:

  • Muscle strain injuries
  • Connective tissue tear
  • Disc degeneration
  • Hip adductors injuries
  • Hamstring injuries
  • Musculotendinous junction injury

There are 2 types of exercise-induced muscle damage:

  1. Delayed onset muscle soreness
  2. Muscle fatigue-induced soreness

Examples of Functional Problems

Functional problems describe when the injured area causes pain or other symptoms in another part of the body besides the injured area. 

Examples of functional problems include:

  • Pain
  • Decreased range of motion
  • Loss of mobility
  • Muscle weakness
  • Lower back pain due to leg dysfunction
  • Headaches due to spinal misalignment
  • Swelling
  • Edema
  • Fibromyalgia
  • Myofascial pain syndrome
  • Quadriceps activation in knee pain

Expected Recovery Time

At Action Spine & Sports Medicine, we are committed to getting athletes and other sports injury sufferers back into the real world as quickly and as safely as possible. We ensure your expected recovery time is as short as can still be effective and healthy.

Athletes may return to normal physical activity when they are pain-free, have a complete range of motion, and can use their full muscle strength. Before any of these apply, an athlete risks reinjury.

With a minor (Grade 1) muscle injury, it could take 2-3 weeks to fully recover.

It may take 2-3 months for your muscle tissues to fully recover from a more extensive muscle injury (Grade 2). The most severe cases (Grade 3) may require surgery and 3-6 months of expected recovery time.

Some advocate for aggressive treatment for professional athletes. For example, NFL players with hamstring muscle tears may be given a cortisone injection and not miss a single game.

For most patients, physical therapy, chiropractic care, and pharmacological treatment are enough to ensure a safe and speedy recovery. 

For severe cases such as large intramuscular hematoma, though, surgery may be necessary. Example: If you sprain your knee, an arthroscopy may be recommended.

The Role of Chiropractic Care

Chiropractic care has an important role in recovering from functional limitations. Not only do chiropractors manipulate your lumbar and/or upper cervical spine, but they can also mobilize fascia/muscle tissues and soft tissues.

A sports chiropractor is able to improve communication between muscle fibers and your nervous system. He ensures that any structural injury has not affected your all-important spinal alignment.

Research shows that chiropractic care helps prevent/treat lower limb muscle strain, back pain, neck pain, and tennis elbow. And that’s not to mention the personal success stories we see every day. (Click here to read testimonials from real patients.)

Dr. Ben Cowin is a world-renowned orthopedic specialist and sports chiropractor. He is dedicated to getting athletes back on the field quickly and safely.

Click here to set up your appointment with Action Spine & Sports Chiropractic today!

How to Treat Functional Limitations

Treating functional limitations starts with diagnosing the root cause.

How do you check for muscle damage? A doctor will check for muscle damage using diagnostic tools, such as physical examination, history of past injuries, x-rays, MRI (magnetic resonance imaging), and ultrasonography.

Rest is becoming less and less popular for sports injuries. However, it is advised during the first 3-7 days, allowing scar tissue to gain strength. 

Afterward, mobilization is recommended so the muscle doesn’t atrophy, and recovery time isn’t slowed down. Regular movement in the form of light cardio and targeted stretching is necessary to keep blood flow strong and speed the healing process.

In general, you should not ice an injury beyond 24 hours from when the injury took place.

Some functional problems may benefit from gentle stretching and trigger point therapy.

Chiropractic care is essential to ensuring you don’t suffer from functional limitations, such as spinal misalignment adversely affecting your nervous system.

Healthcare professionals may recommend over-the-counter or prescription medications, such as pain relievers (acetaminophen) or NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen). These are helpful in the short-term to manage pain but do little in the long-term to restore muscle function.

At Action Spine & Sports Medicine, we utilize evidence-based treatment plans to get you back in the real world as quickly and safely as possible. Dr. Cowin fully endorses chiropractic care for sports injury rehabilitation.

Call us at (720) 541-7098, or set up your appointment online. We can’t wait to see you at Action Spine & Sports Medicine, here in the heart of Denver, CO.

Sources

  1. Mueller-Wohlfahrt, H. W., Haensel, L., Mithoefer, K., Ekstrand, J., English, B., McNally, S., … & Blottner, D. (2013). Terminology and classification of muscle injuries in sport: the Munich consensus statement. British journal of sports medicine, 47(6), 342-350. Full text: https://bjsm.bmj.com/content/47/6/342
  2. Salehi, A., Hashemi, N., Imanieh, M. H., & Saber, M. (2015). Chiropractic: is it efficient in treatment of diseases? Review of systematic reviews. International journal of community based nursing and midwifery, 3(4), 244. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591574/
  3. Akseki, D., Pinar, H., Bozkurt, M., Yaldiz, K., & Arag, S. (1999). The distal fascicle of the anterior inferior tibiofibular ligament as a cause of anterolateral ankle impingement: results of arthroscopic resection. Acta orthopaedica Scandinavica, 70(5), 478-482. Full text: https://www.tandfonline.com/doi/pdf/10.3109/17453679909000984
  4. Steffen, K., Myklebust, G., Andersen, T. E., Holme, I., & Bahr, R. (2008). Self-reported injury history and lower limb function as risk factors for injuries in female youth soccer. Am j sports med, 36(4), 700-708. Abstract: https://journals.sagepub.com/doi/full/10.1177/0363546507311598
  5. Guermazi, A., Roemer, F. W., Robinson, P., Tol, J. L., Regatte, R. R., & Crema, M. D. (2017). Imaging of muscle injuries in sports medicine: sports imaging series. Radiology, 282(3), 646-663. Full text: https://pubs.rsna.org/doi/full/10.1148/radiol.2017160267
  6. Gregory, N. S., & Sluka, K. A. (2014). Anatomical and physiological factors contributing to chronic muscle pain. In Behavioral Neurobiology of Chronic Pain (pp. 327-348). Springer, Berlin, Heidelberg. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4294469/
  7. Baoge, L., Van Den Steen, E. L. K. E., Rimbaut, S., Philips, N., Witvrouw, E., Almqvist, K. F., … & Vanden Bossche, L. C. (2012). Treatment of skeletal muscle injury: a review. ISRN orthopedics, 2012. Full text: https://www.hindawi.com/journals/isrn/2012/689012/

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