That nagging pain in your shoulder, the burning shoulder blades, the lower back that feels good half the time and awful the rest, the knees that hurt when the weather changes or you walk down stairs and when you first get up; these are all signs that one or more of your muscles are imbalanced or dysfunctional, perhaps both! Pain – be it subtle or sharp, chronic or acute – is your body’s way of flashing the Check Engine light at you. And, as with your cars warning, sometimes something minor that needs addressing, and sometimes a massive overhaul is needed.

To keep these articles readably brief, this article, the first in a series of pain relief segments, will cover what to look for, and how to determine if the problems are actually bone/joint or soft tissue (muscle/tendon). The following segments will go more in depth into each area and cover how to reduce the pain.

Lower back

Since lower back pain is a condition that eight out of ten Americans will experience at some point, it’s no surprise that my requests for an article on this subject outweigh all others. It’s also easily the most complicated area to address, especially from an on-line or distance perspective. Fear not though, there are ways to tell if the pain being experienced is go-see-the-doctor-for-surgery bad, or start doing some pre- and rehab work. Quickest way to tell if your back is injured at the joint level with a severe intervertebral disc subluxation is by taking a very deep breath and bearing down, as though bracing to be struck in the midsection. If doing this causes increased pain, especially of the sharp variety, it’s important that you go see a medical professional and get some pictures taken. The increased IAP (intra-abdominal pressure) generated when performing that maneuver will cause a disc that slipped out of place to press harder on any nerves it may be impinging, thus the increase in pain. If there isn’t an increase (or even a decrease, since sometimes bearing down when you have a nonsurgical injury can sometimes not only not hurt, but even relieve pain), then good news: you can probably make giant strides towards healing your back pain without expensive, intrusive, and unnecessary surgery and medication. The next segment in this series will deal more in depth with how to relieve and start realigning your hips and back so as to bring about a harmonious and cooperative balance to the muscles in and around your lower back, but for now you should be able to tell into which category you fall. Pain that is worse after sitting too long, standing too long, jogging, lifting weights, and other scenarios, is usually readily mitigated with intelligent program (stretching, soft tissue work, and strengthening) design.

Knees

The knees are one of the most common areas in which people incorrectly believe they have an injury. While there are genuine knee problems that need medical and/or surgical attention, such as ligament or menisci tears, a great majority of the knee pain people experience can be attributed exclusively to knots and scar tissue in the quadriceps and iliotibial band. Essentially, muscles can shorten or lengthen in response to lifestyle factors like inactivity, strength training, and stretching, but a tendon is set at a fixed length. Therefore, if a muscle becomes shortened due to aggressive weight training, knots, or being taught to be in a shortened position (think hamstrings while seated), the tendon to which it’s attached will feel a greater pull on it when the muscle is used. Since the quadriceps join in a common patellar tendon that crosses the tibiofemoral (knee) joint, any tightening of the quadriceps muscles will result in a greater pull on the tendon, which itself can cause pain, but also brings about cramping or tightening of the joint space, which is the pain most people refer to as their knee injury. Another common cause of knee pain is a strength imbalance between the hamstrings and quadriceps. An ideal strength ratio for the anterior and posterior muscles of the upper leg is .8/1, hamstring/quad. That is, the hamstrings should be at least 80% as strong as the quadriceps for not only optimal athletic performance but healthy and pain free knees as well. The quickest way to tell if the pain being experienced is more likely a joint injury or soft tissue dysfunction is to lie on your back with your knee pointed toward the ceiling and your leg relaxed from the knee down/quadriceps not tensing. While you make every effort not to flex or assist, have a partner move your lower leg from its relaxed position to a fully extended toward the ceiling position, and back down to resting. Remember, any tensing by you will void the test. If they can do this without causing you discomfort, it’s highly likely that most or all of your knee pain can be resolved with soft tissue work and proper strength training.

Shoulders

It can be extremely aggravating to feel pain every time you reach for a bowl high in the cupboard, apply deodorant, or change your shirt, and when you can’t get through half a work day without your upper back burning and craving touch – or, for you lifters, bench press, overhead press, overhead squat, upright row, snatch, etc. While there are true causes for concern within the shoulder joint, again it’s often the case that muscle imbalances are the cause of the pain rather than any joint structure condition. Labrum tears, bone spurs, dislocations, and adhesive capsulitis (frozen shoulder) are actual structural abnormalities that require medical intervention and those same cool pictures from the doc.

Our shoulder girdle works best when, at rest, our posture has two key components: tops of shoulders low and away from the ears, shoulder blades comfortably and naturally pulled toward each other. In trainer speak – depressed and retracted. Most people fight to maintain this position, when they can remember to do so, but find themselves failing again and again. They know somehow that it feels better when they streeeetch backwards and overhead, and that their shoulders and upper back pain diminish for a time afterwards.

Since this article is based on assessment, here’s a test to help determine if your pain is likely structural or soft tissue: in essence, we need to get you mechanically (as opposed to muscularly) in proper posture, and then check for pain in a full ROM (range of motion). Lifters should already be familiar with this position. Lying on your back on a flat bench, push down with your head and up with your feet to arch your upper back off the bench. The floor will work in a pinch, but it will limit the testing aspect of this position. While your upper back is off the bench, pull your shoulders back and together, trying to make them touch, and at the same time pull them down away from your ears, creating as much space as possible between the top of your shoulders and the bottom of your ears, as mentioned earlier. Once in place, try to push yourself farther up the bench while leaving the shoulders in place, this should create a larger arch in your back and push your head even farther from your shoulders. It can be very helpful to have a partner assist with this one, since most of us have a lifestyle that makes this an unnatural position. If you’re able to get help, have your partner reach under you to your shoulder blades, and pull them down and back as described above. After you feel you’re in position to your best ability, perform a jumping jack-type movement – slowly – with your arms, bringing them from your hips upward towards your head.

Since this test is more complicated than the others, you may want to try it several times before concluding your assessment. If you’re able to take the arms from the hips to the head and back down without much or any pain, there’s a good chance that the culprit to your everyday discomfort is improper shoulder girdle alignment. Good news, right?

Feel free to post a comment, ask a question, or provide feedback! Stay tuned for the following 4 articles in this series: fixes for the lower back; fixes for the knees; fixes for the shoulders; and a final piece on pain with tips, tricks, and dispelling of myths.

Charles Bean, CPT, OR LMT #17797