Your Pain’s Location May Not Be Its Source

Pain is a confusing topic. And there’s lots of advice out there on what to do about it.

Should you rest? Should you exercise? Apply heat or ice? Do you see a doctor? Or let it go away on its own? 

Before you can even think about a solution to your pain, you must first accurately determine where it’s coming from. If you have pain in your knee, and it’s coming from your back, for example, the best treatment in the world isn’t going to fix it. Inaccurate diagnosis of pain is one of the biggest reasons why so many people suffer longer than they need to, and why they undergo unnecessary surgeries. You must accurately determine the source of your pain for treatment to be effective. And the location of your pain is not a reliable way to figure out where it’s coming from. 

For example,

I’ve met people who’ve suffered from unrelenting tennis elbow for years, only to find out it was coming from their neck. It’s why all the elbow and arm treatment in the world wasn’t solving their problem. I’ve met people who’ve undergone major knee surgery and it failed – only to find out later they never actually had a knee problem. Their pain was coming from their lower back – it just got missed – or was never even considered.

Isolated extremity pain (knees, elbows, shoulders) is one of the most mis-diagnosed problems in the musculoskeletal world. In a study published in the Journal of Manipulative Therapy, Richard Rosedale, et al found that over 40% of people suffering from isolated extremity pain had a spinal source responsible for their symptoms. In other words, the pain they were feeling in their knee or shoulder was actually coming from their back or neck (respectively).

Confused? I don’t blame you. But more importantly, how do you reliably figure out the source of your pain when it’s not always where you’re feeling it?

As already mentioned, the most common place for this to happen is with extremities.

If you’ve got shoulder, elbow, or knee pain, and you don’t recall having a specific injury to it, you must consider that it could be coming from your spine. There’s a 44% chance that it is. Where this gets really confusing is that typically, when you’ve got isolated knee or shoulder pain that won’t go away, your doctor will order an MRI. And if you’re over 40 years old, the MRI will almost always show “something”. It could be a torn rotator cuff, torn meniscus, arthritis, or wear and tear.

What most people don’t realize is that these findings are quite normal and happen naturally as you age. Just because they show up in your MRI – doesn’t mean they are responsible for your pain. Despite studies showing this to be true, doctors continue to order these tests and rely on them to make important decisions about treatment. It’s how people end up undergoing unnecessary procedures or surgery.

Whenever I meet someone with isolated extremity pain, especially if it came out of nowhere, I always consider that it could be coming from their spine. How can you figure this out? Well, it’s challenging to figure it out on your own. But if you work with a movement specialist who understands this concept – you’ll be able to figure this out accurately. The basic premise is that if you can move your spine in specific directions – repeatedly – and influence the symptoms you feel in your extremity – then there is a very good chance your problem is coming from your spine. Or at the very least, your spine is involved. And whenever your spine is responsible solely or partially for pain elsewhere – and it’s ignored – your problem will persist and likely get worse over time. 

If you’ve had pain in one of your extremities for a while now, and it’s not going away, it’s possible you’ve missed the source.

That source could be your spine. And if you’re considering some kind of surgery or procedure, you definitely want to rule this out first. Specialized movement exams are one of the most reliable ways to figure this out – studies have proven it. If you’ve had unexplained pain in your knee or shoulder that isn’t going away, look for someone who understands this and can give you a proper movement exam to accurately identify the source of your pain.

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Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group.