Don’t Look for the Smoke. Look for the Fire

Dr. Steven Scappaticci, B.Sc. (Hons.), CSCS, DC, FRCms

​              Many times people from afar will see smoke billowing up from the trees in the distance. It doesn’t take a genius to know that there’s a strong probability that beneath that smoke, is a fire.
            If someone were to only clear the smoke, they’ll eventually realize that the problem still remains and that the smoke will return. What does any of this have to do with musculoskeletal health? Well often times when it comes to muscle and joint aches/pains the metaphor of the smoke and fire applies. 
 
            Let’s take for example that a patient presents with right shoulder pain. The patient tells you that they have trouble lifting their arm and they keep pointing to the side of their shoulder (think middle deltoid) where they usually feel the pain (the smoke). After asking some questions to rule out any major conditions, you move onto the physical exam and find that there is no pain with actual palpation of the area where they feel the pain. You have just read a fantastic article about not looking for the smoke; rather you decide to look for the fire. This leads you to move away from where they feel the pain and check out a few muscles higher up and find that the source of their pain is coming from their supraspinatus – a muscle that often refers pain to the spot they’re complaining about.
            Great! You think you’ve found the source but you check a few other things and find the true source. They have trouble moving their shoulder blade on the same side that they feel the pain. This is causing the shoulder to have less room to move and is the true source of their pain (the fire!). You then work with them to control for their pain and improve their movement capabilities.
 
            Another classic example is someone presenting with pain on the inside of his or her knee. They say they haven’t injured it in any way but the pain has progressively come about more recently in the last few weeks. Your physical exam is pretty unremarkable with regards to their knee with the exception of some direct tenderness on the inside of their knee. No foot or ankle issues are found so you decide to check out the function of their hip. You find a key piece of the puzzle, as their gluteus medius is considerably weaker on the same side. They are surprised by this but you explain to them in your report of findings that the hip muscle in question has a large role in hip stabilization, particularly not allowing the lower limb to move too far inward (aka abduction). You then work with them to control for their pain and improve their movement capabilities.
  
            There’s a fantastic quote by Ida Rolf, “Where you think it is, it ain’t!” Hopefully these examples have shown that where the pain is most evident is not actually the true source of the pain.
 
            Do you have pain similar to these examples? Perhaps you’re looking for a second opinion! If I can help in any way, I’m just one click away!