This is a typical patient-therapist conversation that I have come across many times
Therapist: Your back pain persists despite many different types of treatment over a prolonged period of time, simply because the root cause of the pain is not being addressed. The therapist and doctor are working on alleviating the symptoms rather than addressing the source of the complaint. I come across this all of the time; therapists and doctors often do not understand why someone is having pain, they are often only focused on the short term gains.
Patient: I understand, but what is the root cause of my pain then?
Therapist: Well, first off, I am guessing that you are right-handed, since your symptomatic pain is right-sided. Maybe I should explain why this is important. Muscles attach to at least two bones in your body – they provide us with the mechanisms to allow us to move. So, if a muscle is pulling on one side of a bone , say your shoulder blade, then the muscles that attach on the other side of the bone will also be pulled on.
Patient: ok
Therapist: What I’m getting at is that , when a muscle contracts, or gets short and tight, it pulls on a bone. This moves the bone out of the its neutral position. Because the other muscles that attach to the bone also get stretched, and this is something that muscles don’t like, they go into their own type of contraction—and you get a spasm. This of course causes you pain, sometimes a great deal of pain. But that pain is your body’s defence mechanism, it is what indicates that there is a problem and hopefully prevents you from overstretching the muscles and tearing them or causing permanent damage.
Patient: I see, so the pain is only the end product of a deeper problem?
Therapist: Correct, you see the shortened muscles don't usually complain, but their counterparts, the ones being stretched do. So, what you are feeling is pain from tautness in the overstretched muscles. Those are your "knots."
Patient: I understand now, but why does massaging seem to get rid of them then, at least in the short term/
Therapist: Well, if those painful spasms are massaged deeply, or injected with steroids for example to relax them, they may relax for a short time. But, remember the reason they can't stay relaxed is because the other muscles and bones that originally pulled on them are still pulling! It is just a given fact that taut muscles cannot relax until the pulling muscles are relaxed. It is, in fact the pulling muscles that are the root cause of your pain, and it is them that must be released or relaxed if you are to address the real cause. Simply put your therapist or doctor has been looking in the wrong place. It is okay to also massage the "knots" to help release them, after the pulling muscles are released. Then your knots will be able to relax and be released.
Patient: wow, yes it all makes sense now. Thank you
