What makes you hurt________? (Fill In The Blank)
Pain is often a confusing and frustrating phenomenon. More often than not, the area that feels painful is not the cause or source of the problem. In fact, the painful site could be a compensation for a problem that lies somewhere else in a neighboring or distal anatomical area.
Alleviating a painful point may relieve the symptoms temporarily, but not the cause. Consequently, the problem will recur.
It is quick and easy to go right to the area where “it hurts”, but it is more effective to identify when or what makes an area hurt, as this often identifies the underlying source and area to focus treatment.
In school (Medical, Chiropractic, Naturopathic, Acupuncture and Massage), we are taught about muscles, tendons, ligaments and nerves as being the main sources of musculoskeletal pain, with a cursory overview of fascia.
Current research has identified fascia as a sensory organ surrounding literally all the tissues in the body, including muscles, tendons, ligaments and organs. Deep fascia serves as a communicating system via proprioceptors and mechanoreceptors.
Every time the fascia is mechanically affected by pressure, muscle contraction or stretching, the status of the muscle tone, length and movement is transmitted to the nervous system via spindle cells (sensory receptors).
It is essential that spindle cells are able to stretch and shorten during a muscle contraction, in order to provide feedback to the nervous system.
For this to occur, the fascia must be free to glide. If not, spindle cell function will be inhibited.
The “key” to musculoskeletal pain may lie in identifying fascial adhesions affecting fascial glide and concomitant spindle function.
A biomechanical model of the fascial system was developed by the Italian researcher Stecco, who identified Myofascial Units (MFU) and segments that control specific joint movements, i.e. the segments of the spine and the upper and lower extremities.
Each MFU is responsible for controlling a specific movement as well as moving a joint in a particular direction. There are 3 planes of motion that joints move:
- Sagittal (e.g. flexion and extension)
- Frontal (e.g. abduction and adduction)
- Transverse (e.g. rotation)
Within each of the MFUs are centers of coordination (CCs) located over muscle bellies, which are the active component of the MFU. Many CCs are acupuncture points located in the fascia.
Myofascial tension and forces converge at the CCs. In healthy tissue, the fascia is free to slide over the underlying muscle fibers and over muscle bellies (where a majority of the spindle cells are located).
As mentioned previously, when adhesions form in the fascia as a result of some sort of trauma or surgery, these areas lack normal glide and will be painful.
CCs in traumatized fascia can be identified though dysfunctional/painful movements followed by palpation of the painful densified tissue.
There are also other points within MFUs called Centers of Fusion, which are located over tendons and provide feedback by receptors called Golgi tendon organs. These can also be identified through movement and palpation.
Effective treatment of these points involves manual therapies to restore gliding, in combination with home exercises such as Foam Rolling and stretching.
In my experience, therapy is most effective when the area being treated is either moving and reproducing the pain or in a position of provocation.
Stecco also identified myofascial chains that describe anatomical continuity between the various muscles and joints. Therefore examination of proximal and distal joints to the area of complaint, followed by treatment, is essential.
- Local pain is not necessarily the cause or source of the problem and may in fact be a compensation
- Alleviating a painful point may relieve symptoms temporarily
- It is often more effective to identify when or what makes an area hurt and then treat with movement or provocation
- Fascia is a sensory organ surrounding literally all the tissues in the body and serves as a communicating system
- The “key” to musculoskeletal pain may lie in identifying fascial adhesions affecting fascial glide and spindle function
- A biomechanical model of the fascial system includes myofascial units (MFU), Segments, Centers of Coordination (CC) in the muscle belly and Centers of Fusion located over tendons
- Many CCs are acupuncture points located in the fascia
- Dysfunctional CCs represent densified fascia that can be identified though dysfunctional/painful movements followed by palpation of the painful area
- Effective treatment of these points involves manual therapies to restore gliding. and home exercises such as Foam Rolling and stretching
- Myofascial chains represent anatomical continuity between the myofascial units
- Examination of proximal and distal joints (up and down the chain) to the area of complaint for dysfunctional movement and densified fascia followed by their treatment is essential
- Effective treatment should ideally involve movement or a position of provocation
What makes you hurt________? (Fill In The Blank)
Mukaino, Y. (2008). Sports Acupuncture: The Meridian Test and Its Applications.
Stecco, L. (2004). Fascial manipulation for musculoskeletal pain (pp. 88-299). Padova: Piccin.