“It Hurts When I Do This…”
Shutterstock credited to "Lopolo".
by Eric Winder, D.C.
It’s a sad joke. “Doc, it hurts when I do this,” a patient says. The doctor replies, “Well, don’t do that!” This is such a missed opportunity.
In an ideal situation, the patient’s doctor would analyze this painful movement, looking for problems such as glitches in the motion, abnormal muscular balance and tissue restrictions. The underlying issues could then receive appropriate treatment, and the patient could respond, “Doc, this movement doesn’t hurt anymore!”
Unfortunately, many don’t ever find relief from this type of movement-induced pain. They stop activities that were once enjoyable or important because they haven’t found a way to perform them without discomfort. With the right approach, however, these painful motions can often reveal the underlying source of their aggravation.
At our office, we carefully examine faulty movement patterns to look for their root causes, and most often, we find them in the form of restrictions in the connective tissue called fascia. Fascia is a fibrous connective tissue formed in layers that covers other tissues, including the muscles and joints. Nerve endings in this fabric-like network are stimulated by stretch and pressure, constantly telling the nervous system how body parts are positioned and where those body parts are located.
In other words, fascia gives our brains the internal picture, or sense, that we need for coordinated motion and upright posture. Position sense helps maintain alignment and stability, both at rest and in motion. We need this for protection against injury.
Sometimes areas of fascia become tight and restricted because of a past injury or other causes. This confuses the body’s vital position sense, which can cause misalignment, instability and pain. Fortunately, such problems tend to leave clues about the source of confusion. Here are some examples from real patients at our clinic (names changed for privacy):
George dealt with sharp pain in his right thumb and hand whenever he tried to hold anything with a tight grip. However, he couldn’t recall an injury that might have caused this pain. When I asked him to squeeze a therapy ball and maintain the pressure, George felt intense pain, and I was able to see the cause — unstable (too much) motion in several knuckle joints, as well as spasms in the muscles of his forearm. I traced these problems back to restrictions in the fascia of his forearm muscles, palm and the right side of his neck. After releasing those restrictions, his joints restabilized, and the muscle spasms disappeared. More importantly, he could squeeze the ball firmly without pain.
In Laura’s case, she beat me to the problem by asking, “What if you examined me while I was in a handstand?” This made sense — as an active patient, no other motion gave her shoulder pain, only the handstands in her yoga practice. She hadn’t shown any obvious problems during the earlier examination, but when she performed a handstand, there was obvious weakness in her shoulder blade muscles and restriction of motion in her acromioclavicular (AC) joint. Now that I knew how the dysfunction was presenting, I could trace the problem to nearby fascia restrictions. Releasing these with gentle manual therapy restored joint motion and muscular balance, while relieving the pain. Handstands became a favorite part of her workout routine once again.
Sarah’s lower back only hurt while driving her car. Sitting in a chair or even riding as a passenger were not painful to her at all. Moreover, an examination showed no pain anywhere in her spine, even with motion. When I asked her to sit while extending her right foot forward to push on a foam wedge (used to mimic a gas pedal), even this position showed no change in her spinal joints or muscles. Finally, I instructed Sarah to hold a clipboard up in front of her with both hands as if using a steering wheel. This shift in her posture activated that familiar tension and tenderness on the left side of her low back. From there, I was able to locate the real problem — an unstable hip joint on her right side. Knowing where the problem was made it possible to find the fascia restrictions at the root of her difficult pain. After a few treatments to release those restrictions, Sarah was able to drive long distances, entirely pain-free.
Whether it’s a painful motion from a golf swing, an achy elbow at the computer, or a knee that hurts when climbing out of the car, sometimes the solution can be found with skilled detective work. If someone says, “It hurts whenever I do this,” the best answer could be to seek treatment with a healthcare professional who knows how to evaluate the problematic movement. A provider who understands human biomechanics, muscle anatomy and joint function, combined with fascia therapy, might just have you responding, “It feels great when I do this.”
Eric Winder, D.C., uses gentle manual therapy and rehab techniques to help patients with a wide range of pain and injury problems. Dr. Winder has offices in Sarasota and Osprey. For more information, call 941-957-8390 or visit Gentlebay.com.