Most of my clients present with muscular discomfort, typically low back pain or tension in the upper shoulder/back area. To those clients, it’s clear that they need a plan which addresses the soft tissues, generally a combination of massage, exercise for the chronically stretched muscles and stretching for the chronically contracted ones. It seems straightforward: pain in the muscles = address the muscles. However, when the pain is in their joints, many people apply the same logic (address the joint!) and overlook the importance of the soft tissue involvement. Often clients have seen a physician who has offered relief in one of two forms: symptom management through analgesics OR surgery to repair a structural imbalance believed to be causing the pain. In some cases, these remedies are necessary. In many other cases, however, the underlying problem is a soft tissue imbalance which can effectively be remedied through a similar protocol as above: massage, exercise and stretching.
An understanding of joint pain starts with an understanding of movement. We think of movement as the body moving through space, but the crux of all movement is occurring at the joint level, by way of muscles pulling on bones. Joints are the points of contact between bones, therefore it is the joint that allows those rigid structures to become a flexible system in motion. How the bones articulate at the joint structure is what determines how the movement will occur, but it is the muscle network attached to these bones that actually creates and controls the movement. The structural analysis of the pathology of a joint is not complete, then, without an accompanying functional analysis of what is happening at the musculoskeletal level.
I will explain using an example from my own health history. A few years ago I was suffering from debilitating pain in my right knee which made me unable to run. Unfortunately, I had not studied massage yet at that time, so I did not feel confident enough to research the condition on my own. I went to an orthopedist who determined that my knee cap was not tracking properly. It was gliding over the joint but slightly to the outside region of my knee, causing inflammation where it was rubbing against my thigh bone. I was told I needed a cortisone shot. I was feeling frustrated and defeated by my inability to run and I was desperate for a fix, so I just followed the doctor’s suggestion. I would not advise this as a first course of action to anyone else, although admittedly it did help. Normally steroid injections are not advisable for young healthy joints unless other options have been exhausted first, the most common being physical therapy. I knew I didn’t want another injection, in case the pain returned, which was a realistic fear. I was also curious as to why my knee cap suddenly started tracking off to the right, so I started doing my own research. When I started looking at diagrams of the knee and physical therapy exercises for the condition, it all began to make sense.
The root of my problem was muscular, and in order to truly heal my knee I needed to start looking at how the muscular systems involved in running might be problematically interrelating with one another. My quadriceps were more developed than my hamstrings, probably because for the two years leading up to my injury I had been training for long slow distance runs rather than doing sprints. The right one, in particular, was more developed than my left (I had been running with a slightly injured left Achilles tendon and had altered my gait to stay longer on my right leg in order to compensate – again, not advisable!). In addition, my IT band was taut due to muscular tightness in my hip and gluteal muscles, which was probably contributing to the misalignment of the knee cap. I developed a training and stretching protocol based on what I knew about those muscles, along with the physical therapy suggestions I found online. The knee pain never returned. The same principles can be applied to the shoulder and hip joints, which are also common areas of pain.
If you have joint pain, it is definitely worth getting a professional opinion. However, it is always important to advocate for yourself and do your own research. In many cases, there is a natural path to recovery that does not involve surgery or medication. It is important to explore physical therapy (and even diet) as a first step. There is an excellent article in this month’s issue of “What Doctors Don’t Tell You”, written by Dr. Mitchell Yass, a pain specialist who has been treating clients with knee pain for over twenty years. In it, he gives a very convincing evidence-based argument for looking at functional analyses of joint pathologies over solely structural ones, and he offers multiple exercises and stretches (with photos) to combat the three most common muscular causes of knee pain. It’s definitely worth a read.
“Ending Knee Pain Without Drugs or Surgery”, Dr. Mitchell Yass, What Doctor’s Don’t Tell You, May 2017