Playing Detective And Assessing Chronic Pain By Tissue Type

Today I attended the ABMP CE Summit on pain, and one of the courses I took was "Assessing Pain by Tissue Type and Underlying Cause" with Ann and Lynn Teachworth of Trunamics. Here are the parts of it I'm taking back to my Las Vegas massage table.

The course walked through the tissues that can send pain signals, which are muscle, tendon, fascia, ligament, nerve, bursa and joint capsule. The visuals for the demo were perfect and I'm going to immediately go out and get them for my next anatomy and physiology cohort that I teach.

For each tissue, Ann covered what kind of injuries it tends to get, what the pain tends to feel like, how it heals and what the treatment goal is. A tendon has a limited blood supply and heals slowly, so the goal is to find out why it's overloaded and what the muscles attached to it are doing. A nerve can be compressed or stretched, and the goal is to find out where and why, then reduce that compression and improve its slide along its whole pathway. Fascia needs its load balanced and better sliding and hydration between its layers, and a joint capsule that's fixated needs its motion and proprioception restored.

Continuing Education certification from Ann and Lynn Teachworth's class "Assessing Pain by Tissue Type and Underlying Cause"

The structural piece was tensegrity, which means "tensional integrity." On the model shown, the wooden pieces were like the bones and the cords are like the muscles, then there's fascia and tendons, with force moving in multiple directions through all of it. When some of those cords get restricted, the whole system morphs and the load becomes imbalanced, and the areas being pulled on the most may be the ones that hurt, so as massage therapists we work the shortened tissue to restore balance. The course also looked at relationships in the body, like pelvis to lumbar spine, front of the body to back, and tibialis to the feet. We live in a flexion-based society, and tension and tightness in the front of the body can create pain in the back.

One of the assessments in the course was to assume your client's posture so you can feel it in your own body. For classic low back pain that means tightening your hip flexors, quads, and adductors, putting your pelvis in an anterior tilt, holding that structure and standing up to notice what it does to your lower back. Then you watch them move: arms overhead and leaning back, bending forward, side bending, rotating with arms out to the sides, and stepping into a lunge while raising the arms, looking for fluid hip extension and thoracic spine movement. The structural and functional findings go together to build the treatment plan.

The case study they covered was for a client with pain and stiffness in their lower back, sharp pain that comes and goes down the leg, tension in the hamstring and calf on one side, and shoulder pain when lifting the arm. From that report the instructors pointed to possible myofascial involvement in the low back and to a nerve that's compressed or not gliding well. They went on to demonstrate how an anterior pelvic tilt, thoracic kyphosis and a forward head can show up in the structural assessment, and how a lunge might reveal limited hip extension, limited thoracic mobility and limited movement at the glenohumeral joint. The treatment plan in the handout for that scenario covers the adductors, quads, glutes, tibialis anterior, hip flexors, abdominals, obliques and piriformis.

Intake matters as much as any technique here, so when I take on a new client I'm asking about pain along with sleep, previous injury or surgery, diet, stress and movement, and then asking which structures could be sending the signals, what matches the quality of the pain, as well as what forces tend to aggravate that tissue. It's an honor to sit in vulnerability with a client while assessing them and uncovering the different factors that may be influencing their patterns.

Final Words About Chronic Pain

I also want to acknowledge what a privilege it is for me to get to work with people in chronic pain and collaborate on a plan together. The human to human connection is everything, and we grow as practitioners too, through that reconnection with humanity and vulnerability. That authenticity is something AI can never replace.

If you want to learn more, about my process, subscribe to my YouTube channel where you'll fine POV videos, pain protocols, classroom videos, and my community work.