It’s strange, but you would think that for someone experiencing neck, back, shoulder or any other type of musculoskeletal pain in his body, he would know exactly when it started, and how.

But surprisingly, this is not the case for a majority of patients I have seen over the years.  Most cases of pain I see are idiopathic; meaning, “with no apparent cause (at least in the eyes of the patient).”

A typical history of such a patient goes something like this:

Me:  “Ok Sue, I understand you are experiencing pain in your upper back, right side.  When did it start, and how, to your knowledge?”

Patient:  “At least the past five or so years.  I don’t know what started it; it just seemed to have appeared gradually.  It is good some days, then bad, and lately it has been getting worse, so I decided to  get it checked.”

At this point, I continue with the history by asking questions related to the patient’s occupational, social/recreational, and past medical history.  Usually there is something in the history that can be linked to the complaint, like a past car accident, a particular sports activity during college, or something about the physical requirements of her occupation.  But in some cases, there still is nothing in the history that can explain the pain.

But where there is a problem, there is an answer.  It’s just that sometimes the answer requires some smart detective work.

If you suffer from pain that can’t seem to be traced to a specific cause, realize that musculoskeletal pain, aside from systemic related disorders such as rheumatoid arthritis, lupus, bone disease, and others, develops from some kind of mechanical breakdown  in the musculoskeletal system.  It can be something obvious like a hard fall that injures and misaligns a joint; something seemingly innocuous like sleeping on your right side for most of your adult life;  or something very subtle, like a subluxated heel bone that does its damage via a drip effect.

So, your best bet is to find a practitioner who is very experienced in human biomechanics.     Chiropractors or physical therapists such as Craig Liebenson, DC who emphasize body kinematics and targeted exercise rehabilitation  will typically have a keen eye for abnormal or dysfunctional movement.  The course of treatment will involve identifying and acknowledging the problem; aggressive rehabilitative exercise regimen, and lifestyle modifications.  Manual therapies may be employed, such as spinal manipulation; and orthotics may be required, at least during the initial phase of treatment.

This applies to conditions including unilateral hip or knee pain, TMJ pain, neck pain with right or left rotation, rib or sternum pain, and many others.  Oftentimes the condition is secondary to a primary cause, so the doctor should not jump to conclusions and direct all treatment to the site of pain.  A thorough investigation and inspection is required.



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