It's strange, but you would think that for someone experiencing neck, back, shoulder or any other similar 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 taking 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 an old whiplash car accident, 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 disorders likerheumatoid arthritis (RA), lupus, bone disease, and others, develops from some kind of mechanical breakdown, somewhere in the musculoskeletal system. And it does not have to be in the area of pain, because the pain can be compensatory to that breakdown, wherever it may be. It can be a misaligned vertebra in the spine forcing the one above it to work more; something seemingly innocuous like sleeping on your right side for most of your adult life; or even an old foot injury that twists the knee when walking, which then fatigues the lower back causing pain and stiffness.
So, your best bet is to find a practitioner who is experienced in human biomechanics. Chiropractors or physical therapists who are knowledgeable in biomechanics (movement patterns) and targeted exercise rehabilitation will typically have a keen eye for abnormal or dysfunctional movement in any of your joints. The course of treatment will involve identifying the source of the problem; an aggressive rehabilitative exercise regimen, manual therapy like spinal or extremity manipulation, and sometimes supports such as orthotics or kinesiotaping.
So if you are bothered by one-sided hip or knee pain, TMJ pain, neck pain with right or left rotation, rib or sternum pain, or similar condition that seemed to appear on its own and keeps returning despite rest and time off, you most likely have a breakdown happening somewhere in your musculoskeletal system that you aren't aware of. Do your body a favor, and get checked.
Dan Perez, DC
