So now that we have a better idea of how fascial distortions can cause pain in the same area, I’d like to explore an example of how they can lead to pain elsewhere in the body. The patient I am about to describe is actually quite common, though I often see patients like him after unsuccessful visits to multiple practitioners. Why? Because the underlying cause of his pain was not in the area he was experiencing symptoms.
One year prior to meeting ‘Mr Smith,’ an avid runner, he had strained his right lower back lifting a heavy box. The discomfort from that injury faded over the next couple months, and since the symptoms were getting progressively better he decided he would not get checked out by a healthcare practitioner.
Once his pain was gone, he resumed his daily run and progressed back to five miles per day. Within 2-3 months, he began to notice a mild pain in his right knee after his morning jogs. It wasn’t long before this pain was present during his runs as well, and within a few weeks he could no longer run. His Orthopedic specialist referred him to Physical Therapy with a diagnosis of Patellar Tendonitis. After a few treatments, Mr. Smith’s symptoms began to improve, and he started some light jogging. Two months, many Physical Therapy treatments, and a cortisone injection later, Mr. Smith was still not able to progress beyond a two-mile jog without pain. The ultrasound, leg/hip stretching and strengthening, and massage of the painful area had all helped but had not solved the problem.
When I saw Mr. Smith the first time, and watched the way he stood, walked, and ran, I noticed a very slight lean/shift of his trunk to the right. This prompted me to ask about his back, and any injuries/pain he may have had in the past. By the end of the evaluation, and after ruling out a few other factors such as leg-length differences, it was clear that his tendon irritation was due to repeatedly overloading his right leg. This overload was due to the fact that the injured myofascia in the low back had remained tight even though the pain faded over time, and it caused him to shift his weight slightly to the right. The overuse manifested as an irritation of the patellar tendon, though it actually could have come up as pain in a variety of other areas. The Orthopedist was correct. Mr. Smith did have inflammation and irritation of his patellar tendon. Treatment of this area was effective to a point, but was not addressing the underlying cause of the overuse. A few Manual Physical Therapy treatments to release the myofascia in his right lower back, and Mr. Smith was back to running 5 miles pain-free.
The moral of the story is that even if an injury ‘fades’ quickly, it does not mean that it didn’t leave behind a problem. Though the true source of musculoskeletal pain may often be in the same place symptoms are experienced, it is also quite common for it to exist in a different part of the body.