“Education is not the filling of a pail, but the lighting of a fire.” ~ William Butler Yeats
Victory Friday is a weekly digest of reflections, insights, and tools from the world of functional manual and performance medicine. It is a free weekly publication. To support Victory Friday with a paid subscription, click below:
It’s Friday yet again! This week’s lead-off is a well-worn saying in my office: that chiropractic knows what many of us don’t.
Treat the neck and thoracic spine well, and a surprising amount of “everywhere” pain gets better. — including stubborn knees that look orthopedic, act neurogenic, and refuse to budge until you change targets.
Preview inside: what chiros know, why the front of the neck matters, how ordinary ache can be nerve pain in costume, and three recent Victories that showed up only after conventional knee care stalled.
Saddle up!
Joe’s Saying: What Chiros Know (That Many of Us Don’t). Something I say in the office, at least weekly, helps explain to clients the importance of my whole-body, Systems-(& Dimensions1)-based treatment approach:
“There is a reason chiropractic is a successful and thriving profession:
neck, ribcage, and low back treatment gets a lot of things better, everywhere.”
In particular, mobilization and manipulation of two key areas tend to improve a lot of pain in a lot of places:
Upper cervical spine
Thoracic spine
Regular treatment to these two areas tends to fix a lot of things — not just local pain, but pain and dysfunction in both the arms and the legs. Everywhere.
There is simply no denying it. I explain further, citing economics:
“If these treatments didn’t work, people wouldn’t go back, and they’d never get new patients.”
But I add a crucial caveat:
“I like my profession better:
We can treat more things, with more time, and with more sustained improvement.”
Make no mistake: chiropractors know the importance of spinal efficiency for mobility, strength, function, and pain relief throughout the body.
But we don’t need to become them. We simply need to recognize the efficacy of their spinal-centric approach, and use it when necessary — especially when a conventional orthopedic approach fails to produce significant, quick, and sustained Victory.
For more on that, keep reading.
Cool Exercises I Like. The Neck Has a Front: Anterior Neck Release! Most neck pain occurs on the sides and back of the neck.
But this complex, sensitive area has crucial myofascial areas everywhere, including the front of the neck!
Treating the front of the neck is a crucial — yet often overlooked — strategy for resolving neck pain.
And Conor Harris shows us one easy (if a bit painful) technique, working two fascial points in the front of the neck!
If you suffer from chronic neck stiffness and pain — regardless of location — try rubbing on these two points!
Joe’s Articles. Nerve Pain Masquerade. Perhaps a reason why a spinal-based, chiropractic treatment strategy works for so many “regular” aches and pains is because…a lot more aches and pains are neurogenic than we realize.
Most patients and clinicians recognize classic nerve symptoms: tingling and numbness. Others are fairly recognizable, but less cut-and-dry neurogenic: stabbing and buzzing.
But a lot of “regular pain” — ache and tightness, but also real tissue stiffness, redness and even swelling — can be caused by nerve pain.
In response to my experience with complex nerve pain — as both clinician and patient — I came up with three different categories of neurogenic pain.
And wrote about them.
From iRunFar.com: Three Types of Nerve Pain
The three types of nerve pain:
1• Radicular: This type of pain occurs when a nerve, usually at the spinal level, becomes irritated and refers pain, tingling, or numbness to other parts of the body along the nerve’s path without causing tissue dysfunction in those areas.
This is the “Coke Classic” of nerve symptoms: easily recognizable, irrefutable.
2• Amplified: This pain involves local nerve irritation near the site of a conventional injury, such as plantar fasciitis, which amplifies the pain intensity and is accompanied by some tissue dysfunction.
Both orthopedic and nerve tissue are strained. But the combination of the two results in pain that is both amplified (more intense) and often longer-lasting, especially when the irritable nerve needs a different treatment approach than the orthopedic tissue.
And, The Final Boss:
3• Dysfunctional: This type of pain results from nerve irritation, often at a distant site like the spine, causing significant tissue dysfunction, such as swelling or stiffness, in a seemingly unrelated area with minimal activity.
The mechanism: an angry nerve both creates a pain response and literally “dumps” inflammation onto and into orthopedic tissues. This results in real orthopedic tissue changes — swelling, redness, stiffness — that mimic a mechanical tissue overload, creating real tissue dysfunction.
This is the most complex — and most difficult to treat — nerve pain. The primary difficulty is two-fold:
realizing the tissue changes are driven by nerve pain, not local “overuse”, and
finding the focal source(s) of nerve irritation2
Victory Friday. Go Big or Go…Try Something Else: Neurogenic Wins in Stubborn Ortho Pain. Over the past two weeks, I’ve achieved three crucial Victories over stubborn knee pain…all of which required a neurogenic treatment approach:
• An early 60s female with mild-but-chronic bilateral knee pain and sensitivity.
• A mid-30s female runner with bilateral knee pain.
• A late 60s female with chronic, post-total knee replacement pain.
Three different clients, with three fairly different presentations and histories. But they had one thing in common:
Each knee client presented with three of the Six Signs of Nerve Pain3:
Pain at rest. The first client, the early 60s woman with mild but persistent knee pain, sat in my office, lightly (but persistently) rubbing her knees during the subjective.
I asked, “Do your knees hurt right now, just sitting here? Is that why you’re rubbing them?”
”Yes”, she replied, and notes that she finds herself rubbing them due to pain…despite the fact she has not been on her feet, or otherwise “overused” her knees.
In addition to aching, sensitive and stiff bilateral knee pain, the 30s yo runner had another neurogenic clue: feeling aching shin pain while lying in bed4.
Pain disproportionate to activity. All three clients note, at times:
• severe pain with light (or even no) activity, yet
• minimal or no pain, at times, with more aggressive knee-loading activity
But what caused me to consider neurogenic origins in their case — despite a plethora of seemingly relevant “issues” with their knees — stiffness, mobility loss, weakness, mal-alignment and other “imperfections” — was this:Failure to respond [quickly and dramatically] to conventional treatment. Neither of the three clients experienced any significant pain relief, mobility improvement or functional capacity from my conventional (yet robust, multi-dimensional) orthopedic treatment.
The Arrogance & Impatience Payoff. I’ve written about this before5, but two negative traits that serve me well:
“I am good at what I do because I get bored and frustrated, easily.”
But let’s add a third: arrogance.
I’m really good at what I do.
My treatments are precise, thorough and robust.
Thus when I treat an area, and a patient does not feel significantly better, it often means I missed the true target.
While many orthos are content to “treat the hamstring tightness” with the same hamstring mobility, massage, strength and RICE, week after week, my “efficacy leash” is very short:
Two to three visits, max. If they’re not significantly better — big gains in pain relief, objective metrics, and/or function — I start looking elsewhere.
For each of these recent knee pain clients, I did excellent local and regional treatment:
• knee, ankle, hip and pelvis mobility and alignment
• fascial work (both in the leg and in the ribcage)
• core stability and knee control; functional loading efficiency
From each I’d hear their optimism — “I’m a little bit better!” — but no real evidence of big gains.
Thus, it was time to look elsewhere.
Big Gains or Bust. One problem for most ortho and sports medicine professionals:
They believe pain relief and functional recovery always requires “healing”.
This is true in an acute injury model, with definitive tissue strain, sprain or fracture.
But most pain — at least the majority of what I treat in my office — isn’t acute. It’s persistent.
And it isn’t tissue damage. It is dysfunction: some aspect of the system isn’t functioning correctly.
Thus, when you can identify and treat the relevant deficits in a dysfunctional system, rapid improvement is the norm. The standard.
Big gains happen, quickly.
This is the biggest difference between me and most orthopedists. They are content with doing the same, symptom-based treatment, content to wait for “healing” to happen.
Not me. Improve quickly or keep looking.
Make the Nervous System Happy. In each case, the combination of:
• a lack of improvement from orthopedic treatment, and
• the presentation of “nerve signs”
caused me to pivot and look for neurogenic causes.
When I looked, I found.
Each woman had most of the following signs:
• Positive femoral nerve tension. The femoral nerve — the primary innervation of the knee — had abnormal tension.
• Mobility loss (compression) in the mid-lumbar spine, at levels consistent with L3-4 nerve roots.
• A trauma history: falls, accidents or surgeries affecting the head/neck, low back and pelvis, and/or abdomen.
Treatment approach. For each we performed:
• 3D soft tissue mobility: mobilizing soft tissue on both the back and front (viscera) of the lumbar spine
• Spinal mobilization: vertebral mobilization of the lumbar (and/or the cervical spine).
• Neural mobilization: freeing of the femoral nerve (at the lower abdomen, inguinal area and anterior thigh)
And the result?
For each client:
• significant improvement: in pain, mobility, and/or function, and
• immediate and sustained: major and lasting gains within 24 hours
🎯
Takeaways. Look for the Big Gains. When you hit the root cause bullseye, you’ll see big gains, quickly.
Anything else — “Well… I’m a little better…” — often indicates you did a good thing to a person’s painful area, yet missed the root cause bullseye.
And only when you are open to looking elsewhere do you find the true root cause (the top of The Pyramid6). And in that exploratory work do you begin to develop a far better understanding of the beautiful complexity of our bodies.
And that accumulated knowledge and experience allows you unlock increasingly complex — and rewarding — challenges, resulting in big Victories.
Issue 153 is a wrap!
Help people move, function and feel better: please share this publication!
Thanks for reading, and have a great weekend,
Issue 41: Systems & Dimensions. Full and sustained pain relief and recovery of function often requires a comprehensive treatment approach of multiple Systems (body areas: spine, pelvis, abdomen, pelvis, hip, knee, etc) and Dimensions (types of tissue: muscle, tendon, bone/joint, fascia, nerves, blood vessels, etc).
Spoiler: the primary nerve irritation is often in the cervical spine.
Issue 101: Nerve Pain, Part I: Stubborn, Intractable Pain Likely Has Nerve Origins. Patients with stubborn, intractable pain that persists despite mobility, strength, efficiency treatment often have a neurogenic origin. The six signs of neurogenic pain include:
• a dull ache, pins and needles, tingling, or numbness
• pain that is difficult or not possible to ‘feel’
• pain at rest
• failure to respond to conventional treatment
• pain that is extremely variable and disproportionate to activity level
• diagnostic imaging that fails to find any pathology.
Even when the picture looks “hard orthopedic”—tenderness, stiffness, redness, swelling—resolving the irritated nerve is what produces full, sustained resolution.
While this isn’t focal knee pain, the upper and mid shin shares a similar dermatome — L4 — to the knee.
Issue 116: Speedy Unicorn: Zero-to-Weird Success in Three Visits. A 60+ client with persistent left medial elbow pain saw no lasting relief from initial orthopedic treatments (soft tissue/joint mobilizations, stretching) or subsequent neck/nerve approaches. Only after identifying and treating major abdominal surgical adhesions (with paired upper extremity motion) did she gain immediate, significant elbow pain relief, as well as better neck mobility. The case underscores the power of quickly abandoning marginal results to systematically uncover rare distant causes like visceral-fascial connections instead of persisting with “logical” care.
Issue 5: The Pyramid of Why. Describes how potentially multiple different — and often disparate complaints (pain, stiffness, movement issues, dysfunctions — both orthopedic and non-) are driven by a singular — and often distal and “quiet” — root cause. And only by treating “the Top of the Pyramid”, are all those issues sustainably resolved.