"Nothing really happened. It just started hurting out of the blue."

My Pilates and Myofascial Release clients are always surprised when pain shows up out of the blue. And they always think it's very unusual.

It's generally a relief for them when I tell them that "nothing really happened" to at least 70% of the patients who've come to see me over the past 25+ years I've been a physical therapist! It's really the minority that had a car accident, or a slip on ice, or a collision in sports. And then it's time for a little detective work.

Then we start talking more about what's been going on and getting curious about looking back to see if there were any signs before things really started hurting. You can think of physical feelings are the bodies way of communicating, and pain is kind of like shouting. I don't know about you, but one of the things that ALWAYS makes me raise my voice at home is when I feel like I'm not being heard. So if a little stiffness or soreness doesn't get your attention - your body may just have to start shouting to get your attention. When that happens, it's not necessarily a four alarm fire. It's really more of a call for a check in. Most of the time as we go back in time to before things started really hurting, there were some clues. And sometimes those clues lead us back to a time when my clients usual routine changed. Maybe they started walking more, or stopped walking as much. Or they got a new office chair, or one of those fancy cervical contour pillows, or a new pair of shoes they've been wearing all the time (Hello Flip flops and sandals.). Or they had a little misstep, or slip, or near fall - nothing major and they felt fine after.

Last year I had a client with severe buttock and leg pain that came on "out of the blue". She'd seen her chiropractor for several months and was about 50% better, but this 20 something woman still had a lot of pain every day. It hurt at work. She had a hard time getting dressed in the morning. And she definitely was not able to workout at the gym, hike with friends, or go rollerblading. She went for an ortho consult and had an MRI which was relatively negative (I'll write more about that another time and the fear created by MRI's because there are a lot of normal age related changes that we expect to see that scare the heck out of folks who don't know that, and these normal age related changes likely have NOTHING TO DO with your back or leg pain but they sound super scary!) By the time my client came to me she had been in pain for about 8 months.

She had a lot of relief after her first session, and I taught her some daily self release tools using a tennis ball so she could keep herself feeling better. (You would be amazed what you can do with high bounce pinky balls, tennis balls, and super balls of various sizes!!). We checked in at every session to see how her pain was behaving over the week, what she could do with more ease, what was still difficult, and what was most important to get back to. Over the next several sessions she continued to improve. It was not until several weeks into treatment when I was working on the muscles that attach near her sacrum and tailbone that she asked if falling hard onto her butt while rollerblading could have caused this severe pain to start a couple of weeks after her fall. The answer is 100% yes! It is very common to have a fall, feel "fine" initially after, and then have pain show up a few weeks or even months later. As a result of her fall, she likely had some MILD discomfort that changed the way she was walking and moving and developed into pain over time.

Just recently this happened to me. I don't have to sit much during the day, but Friday after school I was driving around picking up and dropping off kiddo's for about an hour, and my butt and right leg really started aching. So much so that I had to keep shifting around in my seat. I just this month drove from Beverly, MA to Wilmington, DE and back for another myofascial release training without any pain - so this is not typical for me. So I started thinking through what I'd been doing the last couple of days (because that's what I teach my clients to do, so it is very natural for me). It didn't occur to me right away, but after some mulling over and pondering I remembered that I fell at softball on Thursday. It didn't stand out in my mind because it was a very slow easy fall onto soft dirt (my feet just sort of slipped out from under me if you must know. Not graceful. Not pretty. Not dramatic. But there you have it.) I landed directly on my right butt (or right ischial tuberosity, for the anatomy geeks in the house). I got up, totally fine. Played the rest of the game, totally fine. Slept fine, did my day fine, walked for an hour with a friend no problem. Maybe the teeniest tiniest little bit of soreness. It wasn't until I was sitting for a prolonged period of time that it really started aching. That deep, throbbing ache from sitting bone down the back of my leg into the pit of my knee.

So all of the soft tissues that got crushed between the ground and my bone by a not insignificant amount of weight are a little inflamed and irritated. Fortunately I know how to self treat, cause that's my job! And I may have been enough force to drive the one half of my pelvis that took all of the weight into an upslip - but I get regular treatment so my therapist can help me with that if my self treatment doesn't work. Because I made the connection, I don't feel surprised or scared, or worried that I'm getting old and weird sh&t is starting to hurt. And I know what to do about it, so I can take care of it. Before it goes on for weeks, or months, or years. I won't have to miss any games (and these games are precious to us older folk in New England, what with the short season and then sometimes winter decides to pop in and say hello for a week when it is officially not winter anymore). And I won't have to miss any Pilates classes, or walks or hikes with friends or my kids.

Those are just a couple of examples of when "pain shows up out of the blue". And they were both the result of falls - not big, glamourous ambulance calling falls, just kinda little falls. And there are tons of similar stories. Maybe you've experienced something just like this. There are also loads of times when "pain shows up out of the blue" and it's not related to a fall, but to a repetetive or sustained activity. I'll try to write up a few examples of that next time.

Please know that it's not uncommon for pain to show up out of the blue. Please don't just live with it, because honestly things that aren't feeling overall better within 2 weeks generally get worse over time. Maybe slowly, maybe quickly, but typically worse. Please know that if you can't figure it out on your own, it doesn't mean you're not smart - it just means its not your area of expertise and you need a little help and guidance.

If you're ready to start feeling better, you can learn more about working with me at New England Myofascial Release

Hoping summer returns soon and I can put my boots and winter coat away again real soon!

XOX

Angela