One of my clients had pointed to where the pain was in her back and side soon after arrival. A chat and a number of assessments later, I felt that I had a good clue where the body wasn’t sitting right.
I started with my first moves, the lower stoppers near the lumbar spine that begin to calm the body. “No”, she said. “That’s not where it hurts, it hurts here”. “I know”, I assured her.
I moved to next calming moves, on the gluteal area. Again she says, “no, it doesn’t hurt there, it hurts here”, as she reaches her arm around to point to the spot again.
Pain is a funny thing.
Pain is the body’s way of letting people know that something is wrong. And that’s great !
Sometimes it is obvious. That cut on the finger or bruise on the knee that you banged into the table has an obvious marker that matches where you feel the pain.
But, for many other pains, the location it hurts is not necessarily where the problem is.
Pain from spinal nerves
Dermatomes are areas of skin that receives sensory nerve supply from a single spinal nerve, and therefore a single segment of the spinal cord.
Nerve supply to the skin has been mapped out in bands from each of the vertebrae, covering all areas of the body. Symptoms that follow a dermatome – such as pain or numbness – may indicate a problem in the related nerve from the spine.
Doctors will often test for spinal cord damage by giving a sharp pin prick to areas of the body, to assess whether a particular segment of the spine is working properly.
Bowen therapists and other manual therapists use some other tests, such as a slump test or a straight leg raise. These give an indication whether it’s likely that pain is being referred from the spine through nerves and dermatomes.
A classic example of pain presenting along dermatomes is sciatica. Pain or aches are felt through the lower back or buttock and down the leg, often making itself known along one or two dermatomes. If the area down the back of the leg is more painful, the nerves from the sacral area are likely involved. Painful sensations down the outside of the leg indicates more likely originating from lower lumbar vertebrae.
Treating the source of the pain – around the spine – is key to giving relief.
Pain from muscle tension
The body is a finely balanced machine, with fascia throughout the body in a constant state of tension, holding everything in place. Tensegrity, as it’s known, looks at the tensional integrity of the body, it’s interconnectedness. If the body has injury in one area, it can impact the overall structure of the body, pulling things out of place.
A key take from a tensegrity course I attended remains stuck in my mind: “Pain is felt where the structure is locked long. Treat where the structure is locked short.”
Where muscles are stretched long, pulled like a tightrope and unable to spring back, that’s where the pain is felt. But they’re in that long, stretched state because they’re being pulled by another stronger, short, contracted muscle. And that contracted muscle is not painful.
Treating the muscle that’s contracted and restricted, rather than the taut painful one, is key.
How many people have been sitting at a computer or desk for an extended time and feel that ache between the shoulder blades ?
The hunching over the keyboard, head peering at the screen, and arms extended forward result in the upper back feeling “tight” and sore. A back or neck rub will help for a while, but soon enough the ache returns. Where is hurst and where the problem is are different places.
The front of the body – the chest, the neck – are contracted and short, holding the body in that hunched posture. The upper body and neck have muscles stretched long like a tightrope.
A back rub may feel nice because the painful area is touched, but treating or stretching the chest and neck is what will best relieve that pain.
Pain patterns from muscles
Sensitive spots in muscles are known to produce patterns of pain in the body. These sensitive spots are known as trigger points, or what many think of as “knots” when they get a massage.
The pattern of discomfort produced by the muscle is sometimes obvious – roughly where the muscle is. But often, the muscle contraction refers pain to a different location in the body.
Taking note of the patterns felt by clients may give an indication where muscles are in a state of tension. While Bowen Therapists don’t treat trigger points, many find the pain patterns useful in helping determine the source of muscular ache.
Discomfort in the lumbar area of the back shows in patterns from the psoas or quadratus lumborum. But muscles in other parts of the body – the obliques and rectus abdominus – can also show as aches in the lumbar area.
Many aches down arms may actually be referring from muscles in the neck. Similarly, muscles in the neck can also refer pain into the head.
Referred pain from organs
The body’s organs are also known to refer aches in different areas of the body. And if you google “referred pain”, it’s this type that generally discussed.
The mechanism for why and how this happens is on the complex side. The most common theory I found is that nerve fibres from one region (eg organs) converge at the spinal cord with nerve fibres from elsewhere, with the central nervous system misinterpreting the source of the pain.
An example of this type of referred pain to watch out for is when pain is felt in the neck or jaw and down the left shoulder and arm. Angina, brought on by a heart attack, often causes referred pain in these area – the chest area may not feel painful.
Lung and diaphragm problems can cause discomfort in the left-side neck and shoulder area. Right side neck and shoulder aches can be caused by liver and gall bladder issues. The gall bladder can also result in soreness at the right shoulder blade. And other organs can also result in aches where you may not expect.
On a lighter note, “brain freeze” is an example of referred pain. Coldness in the throat from eating ice cream or a icy drink sometimes transmits signals to the forehead and sinus area.
Bowen for pain
A Bowen treatment will always involve some moves to relax the entire body, usually with specific moves to help address the problem areas.
Bowen moves are done in very specific locations to elicit a response in the body. Many Bowen move locations correspond with acupuncture points, while others are clearly designed to influence particular muscle areas. Doing Bowen moves in a different location – because that’s where pain is felt – simply won’t yield the desired result.
Bowen moves are also gentle. Pushing firmly into the painful area, such as in a deep massage, may give temporary relief. However, that’s not the goal of Bowen. Bowen moves trigger responses in specific nerve receptors, and these require a gentle touch to be effective.
If your Bowen Therapist is not touching the spots where you feel the pain, don’t be alarmed. We’re aiming to treat the source of the pain, rather than the location that pain is felt.
A video version of this blog can be found on YouTube.
OpenStax College [CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons
Fascia lines courtesy of Anatomy Trains.