Why the Painful Area May Not Be the Source of the Problem
When a new client points to a painful area, that location is important—but it may not tell the entire story.
A person may feel pain in the neck while another part of the body is contributing to how the neck is moving. Knee discomfort may be influenced by the hip, ankle, or foot. A painful shoulder may be working harder because of limited movement through the ribs, thoracic spine, pelvis, or core.
This does not mean that pain is imaginary or that every problem begins somewhere else. It means the body works as a connected system, and examining only the location of the symptoms can sometimes leave important information undiscovered.
Where You Feel Pain Matters
I always begin by listening.
Where does it hurt? When did it begin? What movements make it better or worse? Did it appear suddenly, gradually, or after an injury? Does the discomfort remain in one place, or does it travel?
The painful area deserves to be evaluated and treated appropriately. However, I also want to understand what the rest of the body is doing.
If I only work where a client hurts, I may be addressing the area that is complaining without understanding why it became overloaded.
The Body Does Not Move as a Collection of Separate Parts
Walking, running, reaching, lifting, breathing, and turning require multiple regions to work together.
When you take a step, movement and force travel through the foot, ankle, knee, hip, pelvis, and spine. When you reach overhead, the shoulder joint is only one part of the movement. The shoulder blade, rib cage, thoracic spine, core, pelvis, and legs may all participate.
This relationship is sometimes described as the kinetic chain. Research supports considering connected body regions during movement and rehabilitation, particularly in athletic activities. However, these relationships differ among individuals and do not prove that one distant area caused another area’s pain.
My role is to observe, assess, and determine whether working with a related region changes the client’s comfort or movement.
Knee Pain May Involve More Than the Knee
The knee is positioned between the hip and ankle. Changes above or below it can affect how the knee manages movement and pressure.
For example, I may observe:
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How the foot contacts the floor
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Ankle mobility
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Whether one leg rotates differently
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Hip mobility and stability
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Tension through the quadriceps and hamstrings
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Pelvic position
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Balance between the two sides
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Previous injuries involving the foot, ankle, hip, or lower back
This does not mean that every painful knee is caused by the hip or ankle. The knee itself may need medical evaluation, especially following trauma, swelling, instability, locking, or an inability to bear weight.
A whole-body assessment simply helps me avoid assuming that the location of the pain is the only area involved.
Shoulder Pain May Be Connected to the Trunk
The shoulder is highly mobile, but it depends on support from the shoulder blade, rib cage, thoracic spine, and trunk.
If the thoracic spine is not moving comfortably, the shoulder may need to do more work during reaching or lifting. If the pelvis and trunk are not transferring force efficiently during sports, the shoulder and elbow may absorb additional demand.
Research involving people with shoulder pain has identified possible changes in mobility, endurance, and neuromuscular control in other parts of the kinetic chain. The certainty of this evidence is low, so it should guide thoughtful assessment rather than be used to make broad claims about every person with shoulder pain.
This is especially relevant for throwing athletes, swimmers, gymnasts, tennis players, and people whose work requires repetitive reaching.
Neck Pain Can Involve the Upper Back, Ribs, and Breathing
A sore neck may be influenced by more than the neck muscles.
The head, cervical spine, shoulders, clavicles, upper ribs, and thoracic spine all have to work together. Breathing patterns may also affect how much work the muscles around the neck and upper chest are performing.
If someone breathes primarily by lifting the upper chest, the neck’s accessory breathing muscles may be working more than necessary. Limited movement in the thoracic spine or ribs may also change how the neck turns and supports the head.
I may therefore assess:
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Shoulder and shoulder-blade movement
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Thoracic rotation
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Upper and lower rib movement
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The diaphragm region
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Clavicle mobility
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Breathing patterns
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Pelvic and trunk positioning
I am not claiming that these areas caused the neck pain. I am looking for relationships that may be useful during treatment.
Pain Can Also Be Referred
In some situations, discomfort is felt in a different area from the tissue or structure involved. This is called referred pain.
Research has shown that stimulation of certain sensitive muscular areas can reproduce pain patterns felt elsewhere. However, pain can also be referred from joints, nerves, or internal organs, which is one reason unexplained symptoms should never automatically be labeled as muscular.
As a licensed massage therapist, I do not diagnose referred pain or medical conditions. When a person’s symptoms are unusual, severe, or outside my professional scope, I recommend an appropriate medical evaluation.
Old Injuries Can Change Current Movement
A previous injury may continue to influence movement after the original pain has disappeared.
A person who once injured an ankle may have learned to place more weight on the opposite side. Someone with a past hip injury may rotate or bend differently. Following surgery, the person may have guarded the area during recovery and developed a new movement strategy.
The body is adaptable. Compensation is not automatically bad—it may help someone continue functioning while an area heals. However, a temporary strategy can sometimes remain long after it is needed.
That is why I ask about injuries and surgeries from years ago, even when they seem unrelated to the client’s present complaint.
The Core and Pelvis Can Influence the Upper Body
The core includes more than the abdominal muscles. It involves the diaphragm, abdominal wall, pelvic floor, spinal muscles, quadratus lumborum, and other structures that help manage pressure and transfer force.
The iliacus and psoas also participate in the relationship between the hips, pelvis, and lumbar spine.
If one area is guarded or moving differently, other areas may increase their effort. In some clients, examining the pelvis, hips, lower ribs, diaphragm, or core helps explain part of a neck, thoracic, or shoulder pattern.
Core function is recognized as important for force generation and movement efficiency, especially during athletic activity. Still, the presence of a “weak core” should not be assumed simply because someone is experiencing pain.
Assessment and Reassessment Are Important
I do not want to rely only on assumptions about how the body should work.
During an orthopedic massage session, I may observe a movement before treatment, work gently with a particular area, and then reassess the same movement. If it feels or moves differently, that provides useful information. If there is no change, I may need to reconsider the pattern.
The process is individual. Two people with discomfort in the same location may need very different approaches.
Pain-Free, Respectful Treatment
Treatment does not need to be painful to be meaningful.
My work is designed to help the client relax rather than guard against aggressive pressure. I explain what I am doing, ask permission, and encourage communication throughout the session.
Clients wear athletic shorts and a tank top so they can remain comfortable and covered while changing between face-up, face-down, and side-lying positions. My Stronglite Premier massage table and body-support system allow me to adjust the position to the individual.
The person on the table should always feel respected, appropriately covered, and able to stop or change the treatment at any time.
When Medical Evaluation Comes First
I am a therapist, not a doctor. I do not diagnose injuries or diseases, and orthopedic massage therapy is not a replacement for medical care.
A person should seek prompt medical attention for symptoms such as:
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Severe or rapidly worsening pain
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Pain following significant trauma
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New numbness, tingling, or weakness
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Chest pain or difficulty breathing
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Fever or signs of infection
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Unexplained swelling, redness, or warmth
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Loss of balance or coordination
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Loss of bladder or bowel control
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Symptoms that spread or do not improve
Respecting my license also means respecting the knowledge and responsibilities of physicians, physical therapists, chiropractors, nurses, and other licensed professionals. The best care may involve more than one provider.
Treating the Person, Not Just the Painful Spot
The location of pain gives us valuable information, but it may not provide the entire answer.
My approach is to listen, evaluate the painful area, look above and below it, consider previous injuries and daily movement patterns, and reassess how the body responds to gentle treatment.
The goal is not to claim that everything is connected to everything else. The goal is to avoid overlooking a meaningful relationship that may help the client move, rest, and function more comfortably.
Orthopedic Massage Therapy
Steven Valenzuela, LMT
110 S Barton Street, Suite #6
Grapevine, Texas 76051
Text: 817-305-6548
Website: OmassageT.com
This article is for general educational purposes and is not medical advice. Massage therapy does not diagnose, treat, or cure medical conditions. Please consult an appropriate licensed healthcare professional regarding persistent, severe, or concerning symptoms.
