Where the pain is and where the problem is are often different.

Did the issue or pain start with a sudden blow or sudden onset? Then that is likely to be the location of the traumatised, damaged tissue. 

Was the force of the blow significant enough to reasonably create this much damage, this much pain? If not, then there is a good chance that this injury has been brewing underneath the surface and that the movement being blamed as the instigator was simply the straw that broke the camels back.

If there was a slower onset to the issue, something that you woke up with or seemed to come out of no where, then often the area of pain is separated from the primary issue, the underlying dysfunction.

Why would that be? That seams a bit fat fetched..

Let me explain. There are a couple of factors that can occur. One; leverage, and two; the gradual reduction in strength of tissues as we go from central to peripheral. To describe that in a little more detail if we think of our hip versus our little toe. Our centrally placed hip is a massive, strong joint with sturdy, thick tissues supporting it where as our peripherally placed little toe joints are relatively delicate, small and much smaller supportive tissues. The leverage component refers to if I was to be standing and swing my straightened, right leg forwards so that my thigh came 1 cm forwards, my knee would travel approximately 4cm forwards and my foot, 12 cm forwards. For the mathematically capable, please don’t do the trigonometry on that!

Like everything in a normally functioning body, this is an intelligent design feature as the hips require that strength where as the little toe generally does not.  

Where this can leave us confused is when we have a mild imbalance or dysfunction proximally (close to the body) which the strong tissues in that region can cope with. The tissues further down the limb experience a greater level of stress (think imbalance/torque/strain/disfunction) and are also more delicate in nature, giving them a higher chance of injury and pain. 

This is a common theme in runners, cyclists and triathletes who experience knee pain or ankle pain. Also in the desk worker who experience elbow pain and wrist pain. 

The take home from this? Treat the sore area absolutely, but not solely. Without addressing the proximal or central issue, I’ve found the peripheral issue simply returns or travels elsewhere. 

Dr Ian.

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