If the diagnosis is a structural problem, then the location of pain is almost always where the structural lesion is. Structural lesions with bones, muscles, tendons, ligaments, discs, cartilage, and menisci create local symptoms. The main exception is when structural lesions occur with nerves, in which case symptoms can travel along the nerve. So if what you suppose is a problem in a structure changes location, it’s more likely that instead of there being a problem with the structure, there’s a problem with how things are functioning - which is the majority of problems. With functional problems (that is, something is not working well instead of a structure actually being broken), it's common for pain to change location. Muscle strain, tear, pull pain doesn't move. It's where the strain, tear, pull is. -- Laura
I consistently hear my patients - and people in general - tell me about their muscle problems. "My upper trap is tight." "My quad is weak." "My piriformis is killing me." "I pulled my calf muscle." "My infraspinatus is in spasm." "My hip doesn't rotate because my muscles are tight." Have you stopped to consider how a muscle would get into such trouble?
While muscle pathology coming from the muscle exists, it is indeed rare. Symptomatic muscle tears and strains are not common. (Often, muscle tears are simply incidental findings on MRI - meaning that while the tear is there, it is not the source of the patient's problem, and may have been there for years.) Muscle tightness and weakness are more common than tears, but are not usually the fault of the muscle itself. Even though we tend to adopt certain unilateral movement patterns (as a result of being right-handed, for example), this should not cause discernible differences in muscles on one side of the body versus the other. And muscles usually don't just spontaneously become painful, tight, or weak all by themselves.
So, if we can't blame muscles, what can we blame? Joints!
Joints commonly move out of their proper position. Haven't you sat on a bent knee and then had to shake it out once you stood up to get it back in place to walk? Or rested on your neck in an awkward position and then had to wait a few seconds for it to straighten out? McKenzie-trained therapists would say the joint has deranged, or, rather, that there is a joint derangement. In these two examples, the derangement is normal and very quickly resolves on its own. However, joints are often deranged more seriously. And when they are, they can refer sensations via nerves of tightness, pain, and weakness away from the joint ... appearing in the muscles.
In extremity joints, the pain is typically referred locally along the nerves. For example, if the shoulder joint is deranged, pain often appears in the lateral upper arm. With an ankle derangement, pain can refer to the bottom of the heel. Joint derangements also frequently create nearby muscle weakness since nerves provide both sensation and electricity to the muscles. Derangements in the joints of the spine behave somewhat differently since these joints can influence the major nerves to the extremities. A joint derangement in the spine can, like extremity joints, refer symptoms locally; a derangement in the low back can create symptoms in the quadratus lumborum or psoas nearby, for instance. But if a major nerve exiting from the spine is impinged, local and/or distant pain/tightness/numbness/tingling/weakness can result. For example, I commonly see tightness in the hand, cramping in the calf, weakness in the hip flexors, tingling in the foot, or pain in the shoulder blade or buttocks as a result of a derangement in the joints of the spine.
The good news is that joint derangements are usually rapidly fixable! McKenzie-trained therapists like myself are trained to differentiate between true muscle pathology and joint derangements creating symptoms that can mimic muscle problems. Over 70% of orthopedic problems are joint derangements. So let's start blaming joints - not muscles! And let's also start fixing them quickly through specific movements. -- Laura
A muscle strain (aka a pulled muscle) is a minor tearing of muscle fibers. It can also occur in the tendon portion of the muscle. A more significant tearing is simply referred to a muscle tear or a torn muscle. A strain is usually caused by a quick or unexpected motion, and often the patient can recall the moment of injury. Local pain and inflammation occur and the muscle may feel weak. The area may also appear bruised. A strain is treated for a few days with RICE as needed [rest (eg reduced weightbearing), ice, compression, and elevation]. Over this time, it should gradually get better. (If it is not getting better, it's likely that the diagnosis is not a muscle strain!!) Next, full muscle strength as well as motion in the nearby joints needs to be restored so that the muscle is able to handle all that is thrown at it - that's where I come in. -- Laura
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