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Locate and address the source of pain

July 28, 2013
By Matthew Goodemote , The Leader Herald

Dear Mr. Goodemote: I was reading your article on tendonosis on the Internet yesterday. I have been battling a tendonosis in my right hip area for 14 months now. It started without notice, and I hurt 24-7.

I have had scans, X-rays, blood work, cortisone injections for a hip bursitis and two months of physiotherapy.

I was told to do Pilates to strengthen my core, and now I am working on my quads, inner thighs and hamstrings. I stretch twice a day for about 20 minutes.

I am yet to see any real improvement since April 2012. Can you advise me in any way? I am desperate.

- Robynne,

Durban, South Africa

Robynne:?I am sorry to hear about your struggles. It is hard when it seems like you have tried everything, but there is hope - keep trying.

I would like to share an example: When I bend my right index finger backward using my left finger, I have pain at the base of my right index finger. This pain is a "symptom," not a "source," of pain. My left index is the source, and if I take it away, I have no pain in the right finger.

It is very important to make sure the location of your pain is also the "source" of your pain. If it's not the source, you will only treat the symptoms and likely have limited success.

It is important to remember that pain is not the enemy, it is merely pointing out that there is something we need to take note of. Too often, we focus solely on the pain and do everything to make the pain better, which is reasonable, but it may not actually address the "source" of the problem. This means you are treating the symptoms and the problem will likely persist, continuing to cause you pain.

At this stage start, keeping track of what specifically causes your pain to increase and remain increased. Pain that comes and goes quickly is not as big of a concern as pain that lasts. The longer it lasts, the more relevant it is. Once you identify what makes the pain last, then start looking at what activities or positions are similar.

For example, sitting and climbing up stairs require hip flexion. So if both cause increased pain that lasts, you can start to piece together what exactly is provoking your pain -?in this case, hip flexion.

Now, I would narrow down the possibilities - is it muscle or joint, for example?

In my example above, walking up stairs and sitting cause the same motion (hip flexion), but when sitting, the muscles are relaxed, and when climbing stairs, the muscles are active.

So if both hurt, then I would start leaning toward a problem with the joint, because muscles are typically worse with activity or stretching. So if the muscles are relaxed and not being used (like when we are sitting), then I would be skeptical that the source is the muscle.

If you have not found relief with what you have done to this point, it would lead me away from continuing to do it to get relief. Too often, we pursue things that simply don't work because we are afraid that if we do nothing, it will get worse. But at the same time, doing so many things without really knowing for sure what the source is will only lead to more confusion. So, sometimes, even after all this time, it is more appropriate to stop what you are doing and take a step back to look at it differently. This will allow you to identify activities that are safe to continue and the ones that you need to stop or modify.

Identify the true source of your problem and what specifically is the "worst" activity or position for your hip. That will lead you to what the offensive structure is. Then, begin using that structure in a range of motion, an intensity and a duration that doesn't result in lasting pain. Gradually increase how far, how intense and how long you use it until you have retrained it to do what it was created to do.

So far, from what you have told me, you have been working around the painful muscle group. This is valid, initially. But if you have a muscle that is constantly causing you pain and you continue to avoid using it, how exactly is it supposed to regain its normal function? There will have to come a time, maybe after you are sure of the source of the problem, when you will have to retrain the muscle so it can restore its rightful place by doing what it was designed to do - and do it pain free.

Good luck, and email me again if you have further questions.

Gloversville native Matthew Goodemote is the owner of Goodemote Physical Therapy in Saratoga Springs and Community Physical Therapy & Wellness in Gloversville. Readers are welcome to send him questions at



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