A muscle therapist's greatest challenge is to find the source of what is causing their client's pain. This is usually the reason why people come to see us so it is important for us to get our client's out of pain fast. Getting someone out of pain is one thing, finding the cause of why they are in pain in the first place and where it is coming from is where it gets really interesting.
It would be safe to assume that if the client points to an area of tenderness the logical thing to do would be to treat that point. Although there is good reason to firstly assess and treat the location of pain, perception of pain and the location of dysfunction are at times two entirely separate concepts and often the client's perception of pain is well away from the source of dysfunction or injury.
As a muscle therapist we need to consider that part of the problem and therefore solution may lie in a location opposing the site of pain or an area that works in tandem with the perception of the pain site. Poor posture, old injuries or accidents, compensatory changes, joint degeneration, lifestyle habits and many more factors need to be taken into account.
Getting to the root cause of a problem involves assessment and a thorough case history. Without all of this information we are just guessing in the dark.
When your therapist assesses you they are looking for restrictions and dysfunctions in movement and posture. Once identified it becomes obvious where tension is being accumulated in the body. Often the area you are feeling pain is the hardest working area. It is basically being overused. If we can take pressure off this area and improve the biomechanics to balance out the muscles and fascia then less stress will be placed on individual structures, the load can be spread more evening through the body, reducing and illiminating the painful area.
It certainly can get tricky when there is more than one action that perpetuates pain in an individual. Essentially there is no "one size fits all" type scenario as everyone is built on different foundations, in which most of us have fallen once or twice. Our body's have adjusted accordingly to keep our eyes in line with the horizon. A therapist's desire and commitment for improvements in their client's is what makes all the difference in treatment outcomes.
Here are some examples we have found to help people when we’ve looked "beyond" the location of pain:
In cases where a client complains of sciatic type pain, treating the quads can be pivotal in releasing hamstrings, especially where the pain accentuates in "kicking" types of action.
When a client has neck pain on rotation, working through the upper thoracic in through the shoulder blade can make all the difference in pain free movement.
Lower back pain can be significantly reduced by working though the front of the upper thigh and the from the anterior superior iliac spine and inferiorly.
There are many biomechanical issues (too many to list here) that can cause pain in an area away from the site of dysfunction. Some of these include - over pronation of the foot can cause pain in the knee or hip/lower back; hunched shoulders can cause pain in your shoulder and neck.
Myofascial tracks through the body - the body is held together with a web of soft tissues, namely muscles and fascia. These connect together in intricate patterns. A restriction or dysfunction in one area of the body can be pulling on another area of the body causing pain. An example is the connective tissue in the foot (plantar fascia) can tighten up from poor footwear and can then lead to tightness in the Hamstrings which may become susceptible to injuries and tears. Treating the foot can release the tightness in the hamstrings.
Myofascial Trigger points are examples of where you may feel pain in one area that can be originating in a different location. Here are 2 commonly overlooked examples:
When Sciatica isn't Sciatica- a lot of clients present in clinic with pain radiating down the outside of the leg and into the outside of the foot.They often self diagnose as sciatica which can have the same referral pattern depending on where in the spine it may be coming from. By pressing into the Gluteus Minimus area of the buttock (the upper outside part of the buttock) a trigger point referral pattern can be felt radiating down the outside of the leg. By releasing this trigger point the referral down the leg is fixed. And it was never sciatica. A likely cause can be a tear in the Gluteus Minimus Muscle.
Headaches- a common trigger point in the side/front of the neck in the Sternocleidomastoid muscle can refer pain into the temples and side of the head. Does this headache feel familiar? By releasing the SCM the headaches miraculously disappear.
If your therapist is looking "beyond the location of pain” then they may be able to find where your pain is really coming from and fix that chronic problem. Therefore he or she may just be worth hanging on to!