If treating the painful spot doesn't cure it

Your back hurt, so you treated your back. It eased for a moment, then hurt again. Your calf felt tight, so you released the calf. A few days later it's the same.

People who have been through this several times come into my clinic. And most of them say something like this: "Is there something wrong with my body?"

There is nothing wrong. If you treat the painful spot and it doesn't get better, the painful spot may not be the cause.

The body uses other places to endure a problem

When you sprain an ankle, you put less weight on that leg. The opposite knee and pelvis then work harder. A few days on, the opposite pelvis hurts more than the ankle does.

This is called compensation. It is a countermeasure the body works out on its own so that it won't collapse. The trouble is that when the countermeasure goes on long enough, the place that mounted it wears down.

So the place that feels painful is usually the end of the chain. Not where the problem first arose, but the place that carried that problem for a long time.

The pain can turn up somewhere else

This isn't an impression of mine. It has been confirmed in people.

In one study, an acidic solution was infused into the shin muscle of 72 healthy volunteers. That the infused spot hurts is no surprise. But pain also appeared at the ankle, some distance away — in 80% of the women and 40% of the men.

The conditions at one site were all that had changed, and yet the pain came out at another.

That the tissue itself is altered has been measured too. Comparing 71 people with chronic low back pain against 50 without, the sliding between fascial layers was about 20% lower in those with pain. Not the bone, but the tissue beside it that ought to slide and stretch, had changed.

So I read it with my hands

The parts of the body don't act on their own. When one place stiffens, the place next to it stretches in its stead; when one place moves less, another moves more.

• When the lower belly is taut → the lower back holds the load
• When the lower back keeps holding → the nerves running to the leg get pressed
• When the diaphragm stiffens → breathing turns shallow → the neck and shoulders work harder
• When one side of the pelvis twists → the opposite shoulder keeps the balance

But this chain doesn't show up well on a photograph. Imaging shows where the bone sits and how far the disc protrudes; it doesn't show where force is being pushed from and to.

So I read it with my hands. Where it is stiff and where it is soft, which side defends first when I press, where the tension sits on one side only. And I retrace the sequence. When it started hurting, and what had been going on before that. A patient's memory often tells me more than the imaging does.

That is why I feel the abdomen of someone who came in for neck pain, and why I look at the lower back of someone who came in for knee pain. People coming for the first time find it puzzling. That's a natural reaction.

So the order of treatment changes

Release the end of the chain first and there is brief relief. If the front of the chain stays as it is, it soon comes back. This is why people say, "It only feels good while I'm being treated."

Release the front, on the other hand, and the end sometimes loosens on its own. Keeping to that order does take time, since it means starting at a place that looks beside the point rather than the place that hurts right now. So I always explain why I start there. Treatment that doesn't make sense to you is hard to keep up.

What I'm dealing with here is one axis among several — the physical one. Chemistry, metabolism, and immunity stand alongside it, and none of them plays boss over the rest. (What herbal medicine does)

There are also plain injuries, and there are signs that need to be confirmed by testing. In those cases I recommend testing first.

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Finding the front of the chain doesn't always succeed. Several chains can be tangled together, and sometimes so much time has passed that the sequence has blurred.

Still, if you've treated the painful spot several times and it hasn't gotten better, that isn't because something is wrong with your body. The front just hasn't been found yet.

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References

• Infusing an acidic solution into muscle produced pain not only at that spot but at the ankle some distance away — Pain, 2008
• Comparing 71 people with chronic low back pain against 50 without, sliding between fascial layers was about 20% lower in those with pain — BMC Musculoskeletal Disorders, 2011

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)