Pain- is it the Puppet or the String?



Most of us have experienced some sort of pain.

There is a tendency for patients and their healthcare providers to focus on the site of pain.

Approaching pain from this perspective can often be frustrating for both the patient and practitioner.

Hence the title of this week’s blog:                                   Pain- Is it the Puppet or the String?


The site of  chronic pain  can often be an  inflammatory puppet

In general,  the site of pain is where there is some sort of irritation that creates local tissue damage. In turn, the body attempts to “wall off” and heal the damaged tissue with the production of biochemicals.

This chemical cascade leads to several phases of healing, with the optimal end result being tissue remodeling and complete repair.




The problem

In many circumstances, the body’s healing process is disrupted by inadequate nutrition, poor biomechanics, lack of corrective rehabilitation and overuse of anti-inflammatory medications.

In addition, more often than not, the area being treated (especially if it is chronic)  is the “puppet”, while the underlying cause is orchestrated somewhere above, below and even possibly on the opposite side of the pain.

A good example is a typical case of tendinitis.  Most people focus on where the tendon inserts into the bone, which is usually where the pain is felt. However, as is illustrated below, it is the shortened muscle pulling on the tendon where it inserts into the bone that causes the pain.


If you have some sort of joint pain, feel the muscles leading up to and around the joint.

More than likely there will be “hot spots” or tender points (the shortened muscle as seen above).

These spots are often the “strings” that are the source of pain.

Twenty years of experience (part of which I was fooled into treating the puppet vs the string) has shown me that effective long-term resolution of chronic pain and injuries lies in treating these proximal, distal and opposite tender knots around the painful area.

A note on acute injuries

The above analogy does not apply to acutely injured areas where there is obvious trauma. It is more applicable to chronic pain, where an acute injury has not healed properly or an injury is perpetuated.


Bonus Recipe-  I have modified my Gluten Free Chocolate Chip Cookies and they are good!

Dr. Geoff’s Gluten Free Chocolate Chip Cookies


  • 1 1/2  cups ground raw almonds (in Vitamix). Trader Joe’s almond meal also works.
  • ¼ cup dried, unsweetened, shredded coconut
  • ½ tsp salt
  • ½ tsp baking soda
  • 1/2 cup extra virgin coconut oil (I like Barleans)
  • 1/4 – 1/2 cup local honey
  • 1 tbsp vanilla extract
  • 1/2 cup dark chocolate chips (70% cacao)


  • Preheat oven to 350F.
  • Mix dry ingredients
  • Melt coconut oil in a small skillet over low heat.
  • Turn off flame and add honey to the oil.
  • Add vanilla extract to the honey/oil mixture and pour into dry ingredients.
  • Allow mixture to cool
  • Add chocolate chips and mix well
  • Form small balls of the mixture and place on a cookie sheet lined with parchment paper
  • Cook at 350 degrees for 7-9 minutes (check at 7 minutes)
  • Let sit for 20 minutes to allow for hardening

Let me know what you think.


I will be teaching a Trigger Point Performance class in Seattle this June:


Myofascial Compression Techniques (8 hr) – Seattle

Saturday, June 08, 2013 9:00 AM – 5:00 PM (Pacific Time)

Elite Performance Center

413 Fairview Ave.

Seattle, Washington

United States

For registration: Trigger Point main office: (512) 300-2804


 Did you know you can now schedule online?                                                                       

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin