You may have wondered – why does my foot/shoulder/hip/low back hurt? What is the source of the problem and what can I do about it? Most people assume that if the shoulder hurts, the shoulder is to blame, but many experienced therapists have cautioned against this assumption. In fact, a world famous therapist named Karel Lewit said that he who treats the site of pain is lost. Why is this?
In trying to understand why a certain joint is sore, it is helpful to take the perspective that the body is a whole, and that everything in the body affects everything else. A useful analogy is that the body is like a team composed of many different players performing fabulously coordinated actions. If any team member is compromised in its ability to move or stabilize, additional demands are placed on other team members which causes impaired function and increased susceptibility to pain and injury. In other words, each joint is so intimately related to every other joint that if any one joint has a problem performing its functions, this affects the functioning and performance of almost every other joint.
Let’s say you want to move your spine to twist or bend. In a healthy coordinated spine, each of the 24 vertebrae in the spine will move a little (some more than others) to accomplish the desired range of motion. The movement will be experienced as easy and smooth. If on the other hand one or more of the segments have lost their ability to move, through lack of use or poor coordination or sensory motor amnesia, other vertebrae will be asked to move further and work harder to accomplish the desired movement. The movement will be experienced as stiff and awkward. The overworked vertebrae may exceed their normal range of motion, which over time could cause pain.
The above example, although very common, is extremely simple. The interactions of the body are extraordinarily complex, and extend from head to toe. So lets imagine you have injured your big toe and now try walking without moving it at all. You will notice a very pronounced limp which affects the movement of almost every joint in your body. You will notice that your right side is moving very differently from the left, particularly in the hips and even the shoulders. This means that improper function of the big toe can affect functioning of the shoulder.
Does this mean that the shoulder will now be injured? Probably not. But the shoulder now has taken on some strange motor patterns that might be repeated thousands of times a day, while the other shoulder takes on the opposite pattern. The shoulder now has additional compensation work to do – it must do work to make sure the big toe doesn’t bend during walking. As the amount of compensations in the body increase, the demands on each joint increase and the options for safe and easy movement decrease. At some point, the amount of work placed on a particular joint exceeds its adaptive potential or capacity for safe movement, and pain results. The point to remember is that a problem at any joint increases the demands on all other joints to at least some degree.
Yet another example – lets say you have pain in your foot along the sole of your arch. Maybe the problem is a fallen arch. However, the fallen arch might be caused by actions at the hip. If the hip for some reason likes to stay in internal rotation too much, the leg spins inward, which will naturally cause the foot to pronate and the arch to collapse. (Try it, your arch will start immediately collapse when you spin your leg inward – spin it out and the arch increases.) It is also possible that the hip wants to internally rotate because for some reason this helps protect the low back from a position that causes it pain. And so on. The point is that the interactions of the body are so incredibly complex; it is often not possible to identify the exact cause of a pain complaint.
So, why does your shoulder hurt? Unless there’s knife sticking into it, it’s not that easy to asses. But there will be a coordination issue at almost any other joint could be contributing to the problem. Although this sounds pessimistic, remember that the converse is also true – improvement of the functioning of any joint can cause improvement of the functioning of any other joint. This is an easy way to treat a sore shoulder – improve the functioning of other nearby joints and even far away joints and thereby decrease the demands on the shoulder.
This is why at Rē, our therapists, utilizing movement as well as massage & bodywork, focus on mobilizing and coordinating ALL the joints in the body, not just the ones that are drawing our attention. To understand this fully, yet rather abstractly, in the western (European/American) mindset, the body is a machine – separate motors, wheels & cogs; in the Eastern view (Ayurvedic & Oriental), the body is a garden – each element dependant on each other. In reality, the truth lies somewhere between – more or less, the body is a garden with independent motors and motives. If we strive to facilitate one specific joint or muscle group, at the expense of ignoring those that are in a supporting role, we run the risk of not making a pronounced difference within the entire body.
Sensory Motor Amnesia
Sensory Motor Amnesia is a term coined by Thomas Hanna, the inventor of Somatics – a procedure for teaching voluntary conscious control of the neuromuscular system to persons suffering muscular disorders of an involuntary or unconscious nature. Sensory Motor Amnesia describes inefficient patterns of muscular activation that are so habitual you can’t sense or control them. For example, you might have simply forgotten how to relax areas such as the neck, low back and shoulders, or how to activate muscles like the glutes or abs. This can be due to holding an individual tension pattern for too long or a repetitive movement pattern not being interrupted often enough. This then leads to weakness, inefficient movement, poor coordination and eventually, pain and/or discomfort.
How does SMA develop? The first way is simply lack of movement. Our movement skill, like other things, will fade if it is not used. Modern life for most people can mean hours of sitting in chairs, cars, or couches, instead of the highly physical environment in which our bodies evolved. Your body was designed to be constantly squatting, lunging, twisting, turning, reaching, carrying, throwing, fighting, running, and climbing on a daily basis. If you stop doing these things, you can develop some Sensory Motor Amnesia. Over the years your body can simply forget about movement possibilities and can fall into a pattern from which it cannot escape.
Another common way to develop Sensory Motor Amnesia is with an injury, such as a sprained ankle or a torqued shoulder. A sprained ankle requires the whole body to develop a new movement pattern (e.g. a limp) to protect the injury. Even after the ankle has healed, a subtle form of the limp may persist as a deeply ingrained unconscious compensatory movement pattern throughout numerous joints. In the case of a shoulder, the body will also adapt its movement to compensate for a weakened or compromised action, resulting in Sensory Motor Amnesia for not only the shoulder, but possibly also the entire upper extremity.
Let’s say you have some pain in the shoulder when you push your arm overhead. It is possible that the reason for the pain is that the rotator cuff muscles located along the shoulder blade are not doing their job of pulling down on the top of the humerus and preventing it from sliding into the acromion process directly above it. This causes an impingement of soft tissues between the two bones which causes pain. Why aren’t the rotator cuff muscles ‘turning on’ at the right time and doing their job? As discussed above, one possibility is that the person has simply failed to do any significant work with their arm overhead for a while, and the muscles of the rotator cuff have simply become uncoordinated in doing this job. Another possibility is that a previous shoulder injury from years past at one time required those muscles to rest to avoid further injury, and they got into a habit of being lazy that was never corrected after the injury healed.
So how do we address Sensory Motor Amnesia? Well we can do some massage after a comprehensive movement analysis. Movement analysis can diagnose the muscular components that are in need of attention, and show you how to address these with exercises, and massage can provide the interruption to the pain-spasm-pain cycle so that your pain and/or discomfort is lessened. Then, after the initial pain issue is addressed, another movement analysis can validate the bodywork and show you better possibilities for proper movement! It takes concentration and attention to recover them without deviating into a pathologic compensatory pattern. After the movement is recovered, it can be integrated back into your natural movement patterns, leading to increased performance and a noticeable reduction in pain.
Conact us at Nina@ReTulsa.net for more information about how we can help your body function as a unit!!
