Terms and Definitions
Acute pain references pain that has lasted 2-12 weeks. The pain typically happens suddenly, and can have both a specific cause and an unknown cause. A proper examination will help to determine the pain generators.
Chronic pain references pain that has lasted 3-6 months or longer. The causes of chronic pain continue to grow in number.
Some examples of what someone with chronic pain may experience, but are not limited to are listed below:
- You receive treatments such as massage, physical therapy, or chiropractic; you experience relief for a few days; but the pain pattern returns within a week
- You feel like you need to stretch, foam roll, or perform other types of self-care routinely or else your muscles will feel extremely tight and/or painful
- You stretch weekly or daily, and the stretches are uncomfortable or painful, but your range of motion does not seem to improve
- During massages or other treatments (including self-care), you feel like there are rocks or pebbles underneath your skin; the texture of the muscles seems “gritty” in nature
- You have seen multiple providers (medical, chiropractic, physical therapy, acupuncture, and/or specialists), but nobody has been able to identify a specific cause of your pain and/or tightness
- You have received a recommendation for surgery despite not having a true understanding of your pain
- You have “tried everything,” and you are feeling hopeless
Muscular imbalances are often easily treated with a combination of fascial manipulation, post facilitation stretching, and target activation and strengthening exercises.
Restricted mobility will be caused by one or both of two major factors: lack of joint mobility or lack of muscle flexibility
In the case of lack of joint mobility, the joint capsule is restricting movement. This issue will most often present with a feeling of intense tightness, pinching, or pain that is deep in the area of the specific joint. At the same time, the lack of mobility will not likely allow any of the surrounding muscles to reach a full stretch.
For lack of muscle flexibility, there are actually two possible causes. One issue may be that the muscle, itself, is short. However, this problem is extremely uncommon. The more likely issue is a muscle that is chronically hypertonic or overactive. In this case, the muscle is constantly in a low-grade contraction, and so you are not reaching the muscle’s full length. Instead, you are fighting against a contracting muscle.
Basic, static stretching will never release the tension or improve the muscle’s flexibility if the issue is chronic hypertonicity. Instead, you must decrease the activation to the target muscle. The best ways to achieve this goal are through post facilitation stretching or PAILs/RAILs.
Tendinopathy is the appropriate term for what most people—including many medical providers—mistakenly call “tendinitis.” Tendinopathies are often categorized as overuse injuries, and this is another, potentially misleading identifier.
If you experience pain in a tendon during movements—in particular, movements against resistance—then you may be experiencing a tendinopathy. Other hallmark signs of a tendinopathy include pain that becomes less intense after a warm-up or during physical activity, pain that worsens following periods of rest, and significant pain when the tendon is pulling against resistance.
Common tendinopathies include:
- Tennis elbow (lateral epicodylosis): outer portion of the elbow
- Golfer’s elbow (medial epicondylosis): inner portion of the elbow
- Proximal or distal biceps brachii: front of the shoulder or in the elbow crease
- Hip flexors (iliopsoas and/or rectus femoris): front of the hip
- Proximal or distal hamstrings: gluteal region or back of the knee
- Achilles tendinopathy: behind the heel
- Patellar tendinopathy: just below the knee cap
Nerve impingements are when a nerve or bundle of nerves is being compressed. There are many different causes of nerve impingement, and a lot of them are not caused by issues with fascia.
One example of a non-fascial nerve impingement is one that occurs due to bony stenosis (narrowing); this is particularly dangerous in the spine when the spinal cord or nerve roots become compressed by the crowding of bone growth. Other non-fascial nerve impingements include inflammation and external compression.
Nerve impingements will most often cause numbness, tingling, or weakness in a particular area of the body. Other symptoms of nerve impingement may include altered sensitivity, either increased or decreased, compared to normal touch sensation.
Common nerve impingements that may be caused or exacerbated by fascial ailments include:
- Carpal tunnel syndrome: symptoms on the palm side of the thumb, index, and middle finger
- Cubital tunnel syndrome: symptoms in the pinky finger, ring finger, and the pinky side of the entire hand
- Radial nerve impingement: symptoms in the back of the upper arm, top of the forearm, or the back of the hand (thumb, index, and middle finger, only)
- Brachial plexus impingement: symptoms may present anywhere in the entire upper extremity in non-specific patterns
- Sciatica: symptoms down the back of the thigh, back and outer portion of the lower leg and foot
- Common peroneal nerve impingement: symptoms down the outer portion of the lower leg and foot
- Tarsal tunnel syndrome or posterior tibial nerve impingement: symptoms on the bottom of the foot in the big toe, 2nd and 3rd toes.