There's no question that the human body is complex. So complex that our understanding of the complete system is quite limited. When it comes to musculoskeletal pain the source of the pain is often not where the patient feels their symptoms. Referral pain is a classic example we encounter daily in the clinic. A client tells you they have pain in their gluteal region but you find that a quadratus lumborum trigger point recreates their pain and most importantly resolves treating it resolves their symptoms.
As PNMT therapists understanding this complexity is important in making progress with complicated cases. But sometimes....that can lead you into a trap: not all pain is referral pain, and not all cases are complicated.
A friend of mine recently starting having pretty severe leg pain down the front of the thigh. It was keeping him up at night, and they were feeling it on a daily basis to the point it was distracting him at work. As he described his symptoms and I asked him loads of questions my brain began to list all the possible sources (suspects) of his pain. I remembered the iliolumbar ligament could refer to the thigh. I knew iliacus referral pattern is to the front of the thigh as well. I knew he was describing part of the path of the femoral nerve. I considered SI joint dysfunction as a possible source of part of his groin pain. The list of sources far from the place of symptoms is quite long.
As I started treating him over multiple sessions I went through my list testing and retesting, treating my suspect list thoroughly and receiving feedback on progress...or in this case...lack thereof. Nothing was working. Both him and I were getting quite frustrated and as I continued to struggle it made me think that the case was EVEN more complicated than I first thought. On the most recent session we had I thought of another suspect to treat, the sartorius. I remembered perhaps it's not referral at all, maybe he just hurts where he says he hurts. Well sure enough treating his sartorius not only recreated the very sharp pain he was experiencing but also got the resolution he was looking for.
I felt silly, I had forgotten to treat for localized pain because I was caught up in complexity. In some ways remembering to validate the person's symptoms with touch, i.e. massage them where they hurt, may have saved myself some time and frustration. The lesson learned is that although it is important to remember that a lot of symptoms are caused by structures far away, and cases can be quite complex, there are also moments that linear thinking can lead you to the answer. A further lesson, and always the most important for a clinician to learn, you need to keep thinking of options. If you're dealing with pain the sources are endless and so it is paramount to keep thinking of possibilities.
If you're struggling with a client you may not only need to consider the possibility it's even more complex than you thought, but also the possibility that it is simpler than you're making it out to be.
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