The Relationship Between the SITE and SOURCE of Pain

Today we are going to discuss how pain that presents for a patient in a specific area can sometimes be a problem related to an entirely different region of the body.  The easiest way to understand this concept is if you are familiar with a symptom like sciatica. With sciatica, a patient may or may not describe lumbar region pain. They probably describe more of their discomfort radiating into their buttock or posterior leg. What has to be explained to most patients is that the symptoms they are experiencing in their posterior leg is usually about dysfunction, compression, and neurologic or disc compromise at the lower lumbar region. This is especially difficult to understand for those patients who do not happen to be experiencing discomfort in the lumbar spine region along with their sciatic symptom presentation. When given instructions to work on supporting and decompressing the lumbar spine region, many patients are hesitant to focus rehabilitative exercises to that region because they cannot connect and make sense of the site vs. source ideology. They can be confused about why the recommended exercises are not always targeting exactly where they are experiencing their symptoms and instead focused on a neighboring asymptomatic region. 

Understanding that, many times, the radiating pain that a patient experiences down their leg can be as a result of lower lumbar disc compression and/or neural encroachment, focusing on the pain down the leg will not help to alleviate that compressive effect at the lumbar spine region. Placing an emphasis on reducing compressive load on the lumbar spine and attempting to create more space at the joint/disc complex can significantly improve the patient's sciatic symptoms. 

Moving into a more general way of understanding the site/source complex, if you have been a patient of mine for any period of time, you understand that I usually educate a heavy emphasis on the functionality and performance of the thoracic spine region as it relates to that region's specific ability to move in extension and rotation. In a similar way as described above, the site and source ideology can be applied here as well. If the thoracic (mid back) region is stiff and rigid, lacking movement (specifically in extension), generally the trunk position will remain in a "slumped" or in a flexion dominant position. This "poor posture" of the thoracic region can then position the head in front of the body. Hours, weeks, months and years of this body position can put significant strain on the cervical spine region and the surrounding musculature that is responsible for supporting the head. This can lead to the loss of the normal cervical curvature, subsequently leading to cervical region pain, suboccipital and migraine headaches, TMJ dysfunction,  and potentially more complicated symptoms like cervical radiculopathy and degenerative disc disease. Without focusing on and changing the bio-mechanic deficiencies and poor movement quality of the thoracic spine, a patient is likely to continue to experience continued cervical region symptoms. 

Understanding the regions in your body that are functioning poorly, regardless of whether symptoms are present and focusing on the potential source of pain instead of simply the site of pain, may be the answer you are looking for to finally see long-term symptomatic improvement. 

Thanks for reading! And check out this link for my favorite thoracic foam roll extension drill that can help improve your cervical position.