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What are Those Nagging Aches?

hip problems

By Mike Bills, MS PT

What are those nagging aches and pains we feel? To start, what is pain? Pain is defined as a distressing sensation in a particular part of the body. So let’s do a little self-assessment. How many times during the day or your week do you have some sort of pain or ache or stiffness in any particular part of your body? As we age, it’s common for us to think it’s okay or normal for us to feel aches or pains especially in our joints and muscles.


When we look at pain we can break it down to 3 main things that are happening in some combination that are causing pain.


Muscle tightness occurs when there is an increase in activity, overuse or when you are using muscles in a way that you haven’t before. Some example of this might be walking more than normal or bending over incorrectly or even twisting your ankle. Your muscles are like rubber bands meaning they need to be to stretch out. But every muscle has a limit to the how much it can stretch meaning when it has to stretch too quickly, further than it’s capable of doing or in a direction that it’s not meant to, the muscle gets stressed. When a muscle gets stressed, it will automatically respond by tightening up or shortening which is what we think of and feel as knots in our muscles. So in a nutshell, muscle tightness occurs after a muscle is  overstretched, overworked or strained. This causes a reaction in different receptors in that stressed muscle. This releases a chemical or enzyme into the surrounding tissue and also sends an electronic message to the brain that is processed and the “pain” sensation is then perceived. Another things that happens in that there is reduced blood flow to the area. So at a time when you would really need increased blood flow to flush out the chemical, you are actually getting less blood flow to the muscle. This causes an increased reaction of the receptors meaning more signal is going to the brain meaning there is more perception of pain. This is why when you ‘twist incorrectly’, you have a little bit of soreness in that area and the next day you have a much more difficult time moving and the pain is worse.

Inflammation and swelling happens in your joints or soft tissues. Inflammation is typically thought of as fluid somewhere that can be seen. However, most frequently, you cant actually see the fluid or swelling. Most times, inflammation causes a tissue to thicken which then causes it to take up room and possibly push on surrounding tissue and restrict blood flow. When tissue is swollen or when there is inflammation in an area, the potential for friction increases. Let’s think about a joint. The reason that arthritis is painful is due to inflammation. The inflammation of the cartilage in the tissue that’s in the arthritic joint allows for increased potential for the cartilage to rub on the rough arthritic bone. This friction causes the receptors in the cartilage to send a signal to the brain. This signal is an abnormal signal and therefore is perceived as pain

When you overuse an area or have an injury to the tissue in that area, it will generally protect itself by swelling the area. For example, let’s talk about tennis elbow. You don’t have to play tennis to experience the symptoms for this condition. It’s actually a very common problem we see in people who drive a lot, type or use a mouse a lot or do a lot of repetitive lifting. The repetitive use and or the heavy load causes a perception in what is called the mechanoreceptors of your elbow that something is wrong. Those mecahnoreceptors respond by increasing the size of the tissue and flood them with fluid. Your body is not a perfect machine because this is actually the wrong thing for the body to do. Flooding the area with swelling makes it much more difficult for the tissue to move, stretch and do its job. Additionally, it increases the friction and the release of the message to the brain. When you do something like twist your ankle, you actually see swelling in that area. You are seeing the tissue respond to the excessive force or movement. The swelling is the tissue’s attempt to protect itself from further injury. So in this case, swelling is okay but only at the exact moment of the injury.

Pain can come from pinching or pressure on nerves, tendons, skin, tissue etc. Most people we talk to think that pain means that there is pressure on a nerve and that that is the only cause for pain. However, while this is generally the cause, ultimately there is a pressure of a lot more than just a nerve. Let’s use a back problem as an example. There can be any number of things that are pressing on a nerve that cause pain: disc, muscle, vertebra (bone). But in most cases this would cause what is called referred pain or pain that radiates to another area. So this brings us back to the concept that the pressure is actually ending up on soft tissue, tendons, muscles in the local area. This in turn causes the receptors to send the signal to the brain and thus the sensation of pain.

Referred pain: Pressure on a nerve by something that causes the signal in the nerve to alter (either higher or lower) to the area below the nerve.  This altered signal is perceived as pain.

Localized pain: Muscle tightness, inflammation, pressure or pinching on something. This is most typically what is happening when we are experiencing pain.

HOW DOES PAIN MEDICATION PLAY A ROLE IN FIXING MY PROBLEM? While we think there are times when pain medication is needed, it’s important to remember that all medication does is alter your symptoms. They don’t determine what is causing your pain. Pain medications work to reduce the intensity of the signal and the speed with which it makes it from the area to the brain. So regardless of whether you have a pinched nerve in your back or an overworked muscle, pain medicine will help there to be less pain but they do so by reducing the signal intensity and thus the perceived level of pain is less. They don’t handle the cause of your pain. What is causing that tightness in the tissue, that swelling or inflammation, or better yet that pressure?

At Loudoun Sports Therapy Center, our physical therapists are trained to determine the cause of your pain. They will determine whether you have localized pain or referred pain. They will assess your movement patterns, feel the tissue, look at your reactions to things all geared at determining the answer to that question: what is causing your pain and how to handle it. If you’re dealing with any kind of pain or discomfort, CALL OUR OFFICE AT 703-450-4300 TODAY. We can get you in the road to recovery so you can start living the pain-free lifestyle you want and need.


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