Why can't I quite get rid of that last niggling feeling after an injury? Why does the original pain feel fixed, but now I have something new? Is this something I just have to live with now?
Some clients end up on my table after sessions with previous practitioners to get those 'last little bits of treatment' done and relief from a 'niggle thats still there' or the body part 'just doesn't quite feel right'. A lot of this is not due to the primary pain of an injury or condition, but the 'secondary pain' that occurs when a body adapts to an injury.
One of the advantages I find as a Remedial Therapist is that I have more time to spend on a client. For me, 45min is mandatory to work on an issue or a particular injury. However to really get full results and 100% recovery and attention to detail, I not only require one or two appointments but also like to have a full hour or 70minutes working on a body to get the complete release or postural alignment.
With any injury, there is associated compensation. The body is very good at adapting. What this means is that the body will 'find a solution' if it cannot perform a movement utilising the known or 'normal' means of activation/contraction. (biomechanics) If a hamstring is not firing properly or is compromised, the body will utilise the power of adductors to complete a movement. If a shoulder stabiliser goes 'down', the body will recruit from another muscle in the chain to stabilise the shoulder for movement.
The issue becomes a problem when those muscles that are recruited, begin to fatigue. This is often due to the fact that 'it ain't my job'. Like any good worker, a muscle will perform when asked to and take up 'the slack' at times to get the job done. But as we all understand and have probably experienced, this is unsustainable over a long period of time. Eventually, a worker will begin to suffer under a heavier workload and their primary jobs begin to fail or become inadequately performed. No-one can maintain a dual workload and continue to perform at their best.
So too with muscles. So sometimes, I find myself constantly working on the 'Secondary Chain' or the muscles that may not be presenting immediately in an injury, but are contributing to it. Most joints have multiple muscular attachments. This means many muscles 'work' on a singular joint or action. If an alignment issue occurs with movement, a singular muscle may be to blame but a secondary element may be contributing to the action or in-adequate alignment. This is easily demonstrated when a client presents with a pain in the gluteal, and the therapist begins to work on the inside leg which immediately evokes the response of "oh my god, I didn't realise how sore that was". These 'secondary chains' are often where you can begin to make great progress quickly and alleviate pain effectively, sometimes when the pain has been presenting for some time after initial recovery.
This is also one of the advantages of working with injuries that are stubborn or conditions that have been a problem for a long period of time. The acute pain is often dealt with initially but sometimes, working on that secondary chain is the key to ensuring that the pain is held at bay. Ensuring secondary muscles are ready to 'take on' the extra workload, as well as maintaining that all important alignment of a joint or movement.
I talk to my clients a lot about the body being 'eliptical' or spherical. This is in relation to 'lines of contraction'. Those who are aware of the work of Thomas Myers and the Myofascial Release techniques will understand this well. The body is not up and down. Contractions and lines of 'force' envelope our body and travel in an eliptical pattern like a big 'on ramp' to a freeway. This is why you will often find a 'triangle of pain' in the body. A bad Right shoulder can result in pain and compensation in the Left neck and Left lower back. Forces in the Right shoulder pull on these points and the 'lines of contraction' compensate usually both above and below the original point of pain and 'on the other side'. This is due to the spherical nature of 'force' that travels through our body.
It may be a hard concept to grasp but the body is a great solution maker. It will find solutions to issues so that you can keep going. As a therapist, its our job to identify where and when these issues occur and ALL the compensatory patterns and contractions that occur throughout the body and not just at the original site of injury.
So in an assessment, when someone starts looking at your hip instead of treating your shoulder, they may be doing you a good service in addressing 'true causes' of pain. I believe it's an advantage we have when we have more then 30-40min with a client. We get to work on EVERYTHING that is presenting the injury and not just the acute stuff.
The Secondary Stuff is just as important.