Where the pain is might not be where the problem is

Where the pain is might not be where the problem is

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We had a patient in the clinic this week who came in with a complaint of lower back pain. After a thorough assessment and treatment with our osteopath Katie, the patient commented that ‘you didn’t treat my lower back at all’ to which Katie responded: ‘that’s because it’s where the pain is, it isn’t where the problem is’.

This concept seems to be a huge revelation to patients, but it’s an important one to understand if you suffer with chronic pain.

To give a couple of common examples, ‘sciatica’ is a condition where pain and other symptoms are often felt in the legs but the ’cause’ of true sciatica is rooted in the discs and nerves in the lower part of the spine. If you try to treat sciatic pain in the legs by directly working on the legs it won’t work. To make matters even more complicated, there is almost always a combination of ‘underlying’ reasons why someone gets discal problems in the first place (in the case of sciatica it’s usually around the area that doctors call LS4/5 S1) and those problems are NOT just related to the back. For some people that point in the back is a ‘place of least resistance’ where a host of underlying biomechanical issues are culminating. Like the point in a dam where a flood breaks through. So problems can arise in the feet, manifest in the lower spine, and cause symptoms in the legs. (Yes, really).

There’s also the phenomena of ‘referred pain’ whereby you might feel pain or other symptoms like numbness or pins and needles in one part of your body due to a problem somewhere else. A common example is neck and shoulder aches and inflammation that cause numbness or tingling down the outside of the arm and into the fingers. You feel the symptoms in your hand but a good therapist will work on the appropriate points in your shoulder where the problem is originating.

It’s sometimes easier to think of it in terms of analogies. Like…

Water flowing down a mountain doesn’t flow in a straight line. It follows the path of least resistance which depends on the contours of the land and the hard or softness of the material (soil = soft, rock = hard). In the same way stresses and strains experienced in one part of your body (or mind) sometimes flow through the path of least resistance and you can get symptoms where you least expect them.

When you have a rubbish day at work and your boss chews your head off you can’t take it out on them in case you lose your job so you go home and shout at your family (or kick your dog). In the same way you might experience ’emotional stress’ as physical symptoms like back pain.

When the axle is out by a few millimetres on your car it can set your wheel balance out so badly you feel like you’re driving around in a fairground ride. In the same way you can experience major symptoms in your body (the car) if your ‘axle’ (your ankle, hip, or other major joints) are ‘out’ even a little. Trying to treat the symptoms directly is like giving the passengers a big cushion to sit on rather than fixing the tracking.

When there’s a puddle of water on your floor you can ‘treat’ it by mopping it up or putting a bucket under it. In this analogy let’s say the puddle is ‘back pain’ and the mop is a pain-killer; the bucket is a back support vest.  So, unless you identify whether the puddle (or the back pain) is caused by a leak in your roof, a leak in your plumbing, rising damp or your dog knocking over its water bowl (in retaliation at your kicking it instead of your boss, perhaps?) you can’t permanently ‘treat’ a puddle by mopping it up. In the same way, you can’t successfully treat chronic back pain with a painkiller or a support vest.

So…if you have chronic pain, particularly if it has a big musculoskeletal component, don’t be surprised if your clinician focuses their treatment away from the place you’re experiencing pain or other symptoms. In fact, if they do focus exclusively on where the symptoms are, they’re probably missing the bigger picture and it might be time to get a second opinion.



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