What do they have in common?
Aside from being painful and in completely different and seemingly unrelated parts of the body…
From a mechanical standpoint, there is a long chain that would connect them all!
Of course they’re all connected in some way, but if you move your foot it's not like it's going make your shoulder move or make your neck wobble. Our nerves, lymph, arteries and veins however are an intertwined system and all of these make the entire body a much more tightly knitted unit.
As more research gets published, we are noticing more and more, that recurrent gradual onset of pain, that is not caused by trauma (i.e. you didn't fall and land on your elbow as a cause of pain) is more a sign of tissue "sensitivity" than it is actual tissue 'damage'.
How do we know this?
Time and time again (and as it's been portrayed in the research), patients complaining of foot pain that mimics plantarfasciitis, elbow pain that mimics tennis elbow and patients that have headaches, undergo MRI studies… which come back with findings that display no tissue damage that might correlate to the patients pain.
When we see this in the clinic, our patients say one of three (or all) things:
That's so frustrating and what a waste of time and money that was
So, does that mean that the pain is in my head? (i.e. feeling that their experience has been invalidated)
What does this mean? If there's nothing on MRI, then why do I have pain?
The MRI isn't lying, and neither are you.
Getting scans are great to rule in/out pathology and they help us grade the severity of pathology allowing us to know what to do in the case there is serious pathology. So they're good to have. But when they come back completely clear of pathology and this pain is bad enough that it wakes you up at night, or it's so sharp that you can't walk on it, or your head is pounding to the point you can't concentrate… something has got to explain this.
Let's draw attention to the nervous system.
The Biomechanics of Running Podcast
Jess Larder is one of the fittest Physios you will ever meet and on this talk Jess uses her first hand experience to dive into the common issues involved with running. Jess talks about the biomechanics, common issues runners experience, and the other non biomechanical factors that influence runners. If you’re a runner or participate in running sports then you will love this chat.
Our nervous system detects sensation from our tissues and from the outside world, synthesises it in the brain, decides what to do about it in the brain, and then sends signals to the muscles ordering action associated with what decisions were made (simples right!?!)
When someone has pain, it's because your brain is synthesising certain sensation and interpreting it as threatening and that threat is perceived as pain.
The trick with our nervous system though…
It's sensitivity is impacted by stressors that are physical, chemical and psychological… yes, doing 1000 squats the day before will add to some sensitivity for the next little while, but so will stress, emotional awareness and management, foods that are irritants, a poor work/home environment!
Essentially, anything that is not in line with promoting health will detract from it and add to increasing sensitivity (huge generalisation but for simplicity let's go with it).
If you've collated a cocktail of stressors, it can sensitise your nervous system and start to amplify nerve signals that already exist and because of this amplification, the brain synthesises it as unusual and therefore threatening leading to the perception of pain… only in this circumstance, there's actually no tissue damage - in fact, your function is no different to yesterday and the day before.
This is why we hear…
"I think my elbow is sore from using my mouse too much"
And this same person, hates their job, is stressed at home, eats way too much chocolate (amidst their healthy diet) and has fluctuating exercise habits (sorry if you feel attacked - we hear it all the time).
Is it really the elbow, the foot or the headache?
Or is it sensitivity coming from all your stressors?
Now one thing for sure, pain doesn't accidentally choose the elbow, foot or head! There are probably some mechanical implications that are leading to an overload in the regions as well. So often though, we restore the function in the area, and pain persists… health is holistic and you need to start looking at stressors.
The take home message here is…
Pain is a symptom and a sign of more things happening under the surface.
Being healthy is removing stressors and adding things that are good for you
See a psych or a dietitian, they'll probably help you with contributors to your persistent pain
Pain in the absence of injury, we need to look at you health holistically and Physio/Chiro is likely to be ONE (albeit important) component