What Pains You Might Not Be in Your Muscles

Most of my clients feel significant relief fairly quickly. But as the cases I take on get more and more challenging, a greater portion of these cases have confounding factors that impede recover or even cause the pain directly. It's helpful to explore differential diagnosis if your pain isn't responding to bodywork by a skilled practitioner. If your pain is not improving, it's best to see a doctor, naturopath, or chiropractor and rule out contributing causes. Please do not diagnose and treat yourself based on this or any other article.  Here are some common conditions associated with muscle, joint and fascia  pain.

• Arthritis (Rheumatoid or Osteoarthritis) - Rheumatoid Arthritis is an autoimmune condition when the body's immune system attacks itself, particularly the joints. Many joints may be affected and changing the way you use your joints may not provide relief. This  condition causes significant inflammation and pain when not treated by natural or conventional medicines. Rheumatoid arthritis is diagnosed by a blood test. Rheumatoid arthritis requires care in not aggravating symptoms with a too vigorous massage. Osteoarthritis also causes joint pain but usually just one or two joints that have experienced greater wear and tear. The physical wearing down of the joint is the source of the pain. The damage done to the joint cannot be reversed with bodywork but better alignment of joint and muscles may significantly reduce further damage. If your moving car parts are misaligned, over time they wear down faster and eventually break down similar to your joints. Misalignment is not the only cause of osteoarthritis. Injuries to the joints, high impact activities, repetitive stress on the joints, genetics and ironically lack of movement can all contribute as well. Osteoarthritis is usually determined through orthopedic tests and imaging.

 

• Injured or diseased spine- Because the spinal cord sends message to and from muscles, fascia, some joint tissue and more, restrictions in nerves can make them hyper-irritable. You can usually feel a point in your spine that is painful to the touch or swollen, that gets more painful as you compress or bend the spine, or that refers pain which is unexplainable by pathology at the referring area. Often these issues must be address by chiropractic, surgery, movement therapy such as pilates or physical therapy strengthening exercises at the same time as bodywork to ensure improvement. Symptoms may regress or may only temporarily improve due to massage treatment before the spine is in a more health or stable position.

 

• Peripheral Neuropathy- There are a number of different conditions that cause PN. However, its all nerve pain caused by inflammation, impingement or nerve damage. If you have symptoms of PN, it's important to get evaluated to treat the underlying cause. Massage may help in to improve circulation, reduce inflammation (if gentle) and to help reduce impingement. However, medical treatment may be needed if the cause is systemic, such as diabetes, infections, or toxins. Symptoms may include:
  • Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
    
  • Sharp, stabbing, throbbing, freezing or burning pain
    
  • Extreme sensitivity to touch
  • Lack of coordination and falling
    
  • Muscle weakness or paralysis if motor nerves are affected.
    

• Nutritional deficiencies- When you are regularly experiencing muscle cramps, you might have a mineral deficiency. Mineral deficiencies can be caused by an imbalanced diet, drugs or systemic health issues, including adrenal problems. Common mineral deficiencies or imbalances include: potassium, calcium, magnesium and/or sodium. Cramps due to mineral deficiencies will not be fully resolved with massage alone. Reducing tension in actively cramping muscles is challenging. However, releasing the fascial envelopes of the affected muscle changes may also reduce the likelihood of further muscle spasms.

 

• Infections- There are a number of different infections that cause joint and muscle  pain, as well as nerve pain due to inflammation. Lyme disease, Bartonella, and Mycoplasma infections, as well as some viruses can cause inflammation, nervous system issues, and hormonal imbalance. The cue here is that patients with these symptoms have mysterious undiagnosed issues such as chronic fatigue, brain fog, mental health changes, immune deficiency, insomnia, signs of infection (cough, high or low body temp, sweats, chills) in addition to aches and pains. More often than not, the pain will be "wandering pain," in one area for a short time and moving to another area for no apparent reason fairly quickly.

 

• Lymphatic congestion- When the body can not properly deal with wastes due to lymphatic congestion, pain sensitivity increases, swelling of joints may occur, and massage may actually make things worse by temporarily increasing local inflammation and releasing toxins. Lymphatic congestion can occur due to infections, surgery, injury, cancer and its treatments and simply due to lack of exercise. There are herbs that help move and clear lymphatic fluid. Exercise, particularly rebounding (formerly known as trampoline jumping) and lymphatic drainage massage are often helpful.

 

• Emotions (Stress, Trauma, PTSD, Anxiety, Depression, Negative Thinking)- One study estimated 51% of patients with low back pain had PTSD. Stress can cause muscular tension, bad posture and higher levels of inflammation which can cause increased pain. New science is finding that negative emotions change the chemistry of the body in ways that increase pain, including neurotransmitter and hormonal problems. That said, pain caused by a structural issue or injury can bring on a great deal of stress, trauma and negative thinking without emotions being the cause. But even these secondary effects should be addressed due to their role in reinforcing pain. Frozen shoulder, low back pain, and tense shoulders/neck are the most common areas of complaint in my experience related to stress and hormones. See adrenal fatigue below for more understanding of this connection.

 

• Adrenal Fatigue- Adrenal fatigue is estimated to affect approximately 80% of Americans, due to trauma, stress, drugs, lack of sleep or relaxation and unhealthy diet. Frequently, I see signs of this in people who have experienced serious car accidents and other major injuries or major trauma. Adrenal fatigue or insufficiency can cause certain muscles to go weak and others to tighten up in compensation. It is implicated in upper back pain, neck pain, low back pain and SI joint dysfunction, as well as knee, hip and ankle imbalances. The main muscles involved (by no means an exhaustive list) are sartorius, gracilis, posterior tibialis, gastrocnemius, and soleus. Because of the attachments of the sartorius and gracilis on the pelvis, (sartorius—anterior superior iliac spine; gracilis—pubic ramus), their weakness in persons with adrenal stress problems may allow the sacroiliac joint to subluxate posteriorly. The sartorius and gracilis stabilize the innominate (one side of the pelvis), holding it in an anterior direction. The sartorius and gracilis have a common insertion (along with the semitendinosis) on the medial side of the knee and rotate the tibia medially on the femur. When weakness of these muscles occurs, there is a loss of stability on the medial side of the knee. The sartorius and gracilis (along with the semitendinosis) act as dynamic ligaments, protecting and supporting the medial knee joint during various ranges of motion. Due to the relationship of the posterior tibialis, gastrocnemius, and soleus to the stability of the foot and ankle, many hypoadrenic persons will complain of symptoms of tired feet, weak ankles, or aching calves. The posterior tibialis holds up the medial longitudinal arch of the foot, especially during gait. In some persons exhibiting hypoadrenia-related weakness of the posterior tibialis, the medial arch will drop, causing a pronation problem and strain to the foot and ankle. The one common factor in persons with the above-mentioned musculoskeletal complaints will be the weakness of one or more of the five adrenal gland related muscles accompanied by improvement of their symptoms following treatment of the adrenal glands. Massage will definitely support recovery from adrenal fatigue as relaxation is key to adrenal healing. However, it may not immediately reduce muscloskeletal pain associated with adrenal fatigue until the adrenals have healed. Rest, counseling, meditation, yoga, qi gong, and support from a naturopath who treats hormonal or endocrine issues will all be helpful.

 

• Fibromyalgia syndrome- (FMS) is a chronic debilitating disorder characterized by widespread pain with tenderness in specific areas, leading to fatigue, headache and sleep disorder. Myofascial Pain Syndrome (MPS), is also a localized musculoskeletal pain producing condition whose diagnostic and management criteria differ from FMS but still considered by many only a subtype of FMS.  The wide variety of causes for these conditions range from hormonal imbalance to inflammation, injured discs, nutritional deficiencies, as well as stress. While it is often hard to find the cause, the problem is the same - abnormal pain messages in the nervous system. Fibromyalgia has a fairly clear pattern of chronic tender or trigger points as seen below. Massage can sometimes help relieve symptoms of fibromyalgia temporarily. However, long term treatment must address the cause of the fibromyalgia as well.