The Way You Think About Pain & Injury is WRONG.
Key insights: 60-second read
- Pain location doesn't always tell you the whole story – the place where you feel pain may not be where the pain is coming from.
- The spine can be an important piece of the puzzle – changes in spinal function can sometimes influence symptoms in areas further away, even when you don't have obvious spinal pain.
- Dermatomes and myotomes provide useful clues – these anatomical maps can help clinicians understand how different areas of the body relate to particular spinal levels and nerve roots.
- Test, treat, and re-test – rather than simply guessing at the cause, use changes in symptoms and movement to help determine whether addressing another area is actually making a difference.
What if the way we usually think about pain and injury is only telling us part of the story?
When something hurts, it's completely natural to focus on the painful area. If your knee hurts, you look at your knee. If your shoulder hurts, you look at your shoulder. And, of course, that makes sense.
But sometimes the place where you feel the problem isn't necessarily the only place we should be looking.
In this article – and in the video below – I want to explain a different way of thinking about aches, pains, and musculoskeletal dysfunction, and why the spine can sometimes be an important piece of the puzzle.
On this page
1. Why We Miss the Real Cause
If you've ever had an ache, pain, injury, or movement problem, your attention naturally goes to the place that hurts. And that's exactly where it should start.
If you have a sore knee, we assess the knee. If your shoulder hurts, we assess the shoulder. We look at the movement, the surrounding tissues, your history, and – when appropriate – imaging or other investigations.
But there is another question that can sometimes be overlooked: why did this particular area become painful or dysfunctional in the first place?
That's an especially important question when there hasn't been an obvious injury.
Maybe you woke up one morning with a sore knee. Perhaps you reached for something, and your shoulder suddenly started hurting. Maybe your thumb gradually became painful despite never having done anything particularly dramatic to it.
It's easy to explain these situations with familiar phrases:
- "It's just age."
- "It's growing pains."
- "I must have slept funny."
- "It's probably overuse."
- "I must have moved the wrong way."
- "I played a lot of sport when I was younger."
Sometimes those explanations may be relevant. But they don't necessarily explain the whole story.
Key Principle: The thing that triggers your symptoms isn't necessarily the thing that created the problem. Sometimes it may simply be the last straw that exposes an issue that has been building for some time.
Think about it this way: the final event may be relatively minor, but the body may already have been adapting to changes in movement, mobility, strength, or load for days, weeks, months, or even years beforehand.
That's why simply treating the place that hurts may not always capture the whole story.
And this is where the spine becomes particularly interesting.
2. The Car Analogy: Understanding the Fuse Box
One of the simplest ways I explain this concept clinically is with a car analogy.
Imagine you're driving at night and one of your headlights suddenly stops working.
The first question would probably be pretty obvious: has the car been damaged?
If you've had an accident or hit something, that gives you an immediate potential explanation.
But what if nothing happened?
The next logical step would be to look at the headlight itself. You'd check the bulb, the housing, and the connections. If everything looked fine, you'd probably start looking elsewhere in the electrical system.
Eventually, you might end up checking the fuse.
If you've thoroughly assessed the area that hurts but haven't considered the parts of the nervous system that influence it, you may still be missing an important piece of the puzzle.
This is the concept I'm trying to illustrate.
The spine is an important part of the nervous system's wiring system. Nerves and nerve roots emerge from the spine and travel to different parts of the body, carrying information involved in movement and sensation.
That means changes in the function of the spine and surrounding tissues can sometimes influence what happens further away from the spine.
And importantly, you don't necessarily have to feel pain in your spine for the spine to be relevant.
3. Using Dermatomes and Myotomes to Find Clues
So how do we work out whether a particular spinal level might be relevant to a problem somewhere else in the body?
This is where concepts such as dermatomes and myotomes can provide useful anatomical clues.
A dermatome is an area of skin that is primarily associated with a particular spinal nerve root. Because pain and other sensory information travel through the nervous system, these patterns can sometimes help clinicians work backwards and consider which spinal levels may be relevant.
- If you develop unexplained thumb pain or symptoms around the hand, the lower cervical spine may be one area worth considering.
- If you've developed chest wall pain that has been appropriately assessed and is not cardiac in origin, the corresponding thoracic spinal levels around the back may provide another potential clue.
- If the outside of your hip is persistently uncomfortable, particularly when lying in bed, it may be worth considering whether there are contributing factors higher up through the lower thoracic or upper lumbar region.
Myotomes are another useful concept. Rather than focusing primarily on sensation, myotomes describe groups of muscles whose function is associated with particular spinal nerve roots.
This can become particularly interesting when someone's problem involves muscle weakness, altered movement, or persistent tightness.
For example, several of the muscles around the knee receive their nerve supply through the femoral nerve, which originates from nerve roots in the lower back. That doesn't mean that every knee problem comes from the lower back – far from it – but it does demonstrate why the nervous system can be relevant when we're trying to understand the full context of a given issue.
4. Test, Treat and Re-Test
Once you have an idea about which part of the spine might be relevant, the next step isn't to blindly treat it and hope for the best.
Instead, I like to use a simple test/re-test approach.
The Process
- Test: Choose a movement or activity that reproduces or highlights your symptoms. Pay attention to how it feels.
- Find the restriction: If appropriate, use a tennis ball or lacrosse ball around the relevant part of your spine, staying alongside it rather than directly on the bony prominences.
- Apply pressure: Use a comfortable amount of pressure and allow the surrounding tissues time to respond. This should not be an exercise in trying to hurt yourself.
- Notice the change: Move around and see whether the area feels different from before.
- Re-test: Go back to the original movement or activity and see whether your symptoms or movement have changed.
"We need to base what we talk about and what we do on results so that we don't have to guess."
The important part here is the re-test.
If you change something in one area of the body and the movement or symptom you're interested in immediately changes, that's incredibly useful information. It doesn't necessarily prove that you've discovered the only cause, but it gives you a reason to investigate that connection further.
There is also an important caveat. If you've genuinely torn a muscle, damaged a ligament, fractured a bone, or sustained another significant tissue injury, there is going to be a limit to how much improvement you can achieve simply by addressing a potential contributing factor elsewhere.
In those situations, the injured tissue still needs appropriate rehabilitation.
But understanding what may have contributed to the tissue becoming vulnerable in the first place can still be valuable. It may help explain the bigger story – not just what happened on the day you became injured.
5. The Hidden Role of Daily Posture
If you've identified a particular part of your spine that seems to be relevant to your symptoms, there's another question worth asking: why is that part of your spine dysfunctional in the first place?
And this is where your everyday habits become important.
Think about a typical day. You wake up, sit down for breakfast, drive to work, sit at a desk, sit in the car again, sit down for dinner, relax on the couch and eventually go to bed.
None of those things are inherently bad. But spending large amounts of time in the same positions can influence how you move and distribute load through your body.
Over time, any areas of increased load may have to adapt, stiffen, or tighten to compensate. And you might not notice it at all.
Key Point: You don't necessarily need to have pain in your spine for the spine to be relevant to a problem elsewhere in your body.
This is why looking at the bigger picture matters.
If we only treat the place that hurts but never consider how you move, sit, stand, work, exercise, sleep, and use your body throughout the day, we may be missing some of the factors that helped create or maintain the problem.
Sometimes the most important part of solving a persistent problem isn't finding another exercise to throw at it. It's often about understanding why your body has presented the way it has.
This way of thinking has completely changed the way I approach many of the problems I see clinically.
It doesn't mean that every knee problem comes from the spine, or that every painful area can be fixed by treating somewhere else. That's far too simplistic.
What it does mean is that sometimes the obvious place isn't the whole story.
When we take the time to understand how the different parts of the body communicate and work together, we can sometimes make much more sense of symptoms that otherwise seem confusing or unexplained.
And rather than simply guessing, we can use changes in movement and symptoms to help guide what we do next.
If this perspective resonates with you, I'd encourage you to watch the full video above and share it with someone who might benefit from looking at their pain from a slightly different angle.
– Grant
Frequently Asked Questions
How do I know which spinal level might be relevant to my symptoms?
Dermatome and myotome maps can provide useful anatomical clues about the relationship between different areas of the body and particular spinal nerve roots. However, these maps are best used as part of a broader clinical assessment rather than as a diagnostic tool on their own.
What if I don't have any pain in my spine?
That's entirely possible. The absence of spinal pain doesn't necessarily mean that the spine isn't relevant to your symptoms elsewhere. This is one reason why looking at movement, mobility, nerve function, and the relationship between different parts of the body can sometimes be useful.
Can spinal self-treatment immediately change my symptoms?
Sometimes you may notice an immediate change after working on a restricted area, particularly when you then re-test the movement that was bothering you. This information can help guide further assessment and treatment.
Does all pain or injury come from the spine?
No. There are many different causes of pain and injury, including direct trauma, tissue damage, inflammatory conditions, nerve disorders, and many other factors. The point of this approach isn't to assume that the spine is always responsible. It is to recognise that it may be an important part of the bigger picture.
One key insight from this video
Sometimes the place where you feel pain isn't the whole story. Looking at how the spine, nervous system, movement, and the painful area interact can provide additional clues about why a problem developed and what might be contributing to it.
Ready to Take a Closer Look at What's Driving Your Symptoms?
If you would like help making sense of your aches, pains, or ongoing movement problems, a thorough assessment can help identify the different factors that may be contributing. Learn more about our physiotherapy services in Port Macquarie.
Want personalised guidance?
If you would like help making sense of your aches, pains, or ongoing symptoms, you can book with Grant either in Port Macquarie or via an online telehealth consultation.
