My guiding principle: Pain is intelligent and intentional – Part 3.
How you think about pain will determine how you treat it. Embody this principle and it will improve your efficiency and your treatment outcomes. Part 3 discusses some of the physiology…
Questioning conventional assumptions.
The idea that a huge percentage of chronic pain is not caused by the immediate structures (such as inflammation, nerve compression or mechanical impingement) but is secondary, mediated through the fascia and skeletal muscle … somehow. In other words the body intelligently ‘refers’ pain to the site of mechanical dysfunction or potential injury. So the pain is just the messenger. A very intelligent and intentional messenger.
I have come to this conviction simply because every week in a clinical setting I am resolving chronic pain that has a clear mechanical or physiological explanation. For example the DOA in the knee joint is obvious even to the uneducated observer. The enlarged femoral and tibial plateaus make the joint look, not swollen, but ‘bigger boned’ than the healthy knee. It has been like that for years now. Yet manipulation to muscles and tendons that act on that joint resolve the pain. Pain that we all assumed was inflammatory or mechanical just wasn’t.
Strength, range of movement and proprioception . . .
To continue with the fascinating observations, when the muscles and tendons are skilfully, even briefly, manipulated not only is pain resolved but strength improves – markedly. Range of movement improves – dramatically. And proprioception improves considerably. (Improvement in proprioception is most obvious in the scenario of the peroneal myofascial complex and ankle stability).
What we are observing is clearly the resolution of a deliberate inbuilt mechanism of the body that refers pain, restricts movement, ‘dumbs down’ proprioception and reduces strength. All of these symptoms are traditionally treated separately and with other methods.
- For the pain – anti-inflammatories, pain killers, steroidal injections and so on.
- For the proprioception and strength – strength and coordination exercises to ‘build up’ the weak muscles.
- For the range of movement – stretching and massage.
Deliberate shutdown . . .
Yet all of these aspects find lasting improvement in the space of a few minutes with the right manipulation.
Are we then dealing with smaller, weaker muscles that require strengthening or are we dealing with muscles that have been ‘deliberately temporarily shut down’ by 30 per cent through a built-in physiological mechanism?
Are we dealing with a loss of proprioception due to simply to underuse or are we dealing with joint and muscle mechanics that have been ‘deliberately temporarily decreased’ through a built-in physiological mechanism?
Are we dealing with restricted movement that has simply occurred due to underuse or are we dealing with a ‘deliberate temporary restriction to ROM’ through a built-in physiological mechanism?
In most cases of chronic pain there is mechanical fault, injury or structural degeneration present however to immediately ascribe the pain, weakness and restriction directly to that visible structural dysfunction is a mistake. The body is simply smarter than that.
Wishing you the best of success.
Timothy J. King
