The Chain of Pain

The Chain of Pain

208 years ago last February Charles Darwin was born. He is, of course, famous for publishing “The Origin of the Species” in which he put forward the theory of evolution by natural selection. This simply put, said that a species adapts to its environment and the most successful adaptation gets passed down the generations to enable the species to thrive. As the environment changes, so the species evolve to its surroundings. Of course this takes generations and lots of time but then, the environment takes a long time to change. Or does it?

The Industrial and Agricultural Revolutions mean that the human species has rapidly changed parts of its environment. This rapid change has not allowed our bodies to evolve, rather we are forcing ourselves to exist in an environment we were not wholly designed for. This can cause us all sorts of issues.

Especially in the west, we are a lot less mobile than are bodies are evolved for, now spending a lot of time in a sitting, flexed position. As well as reduced efficiency in respiration, circulation and the lymphatic system, there is another issue. Our bodies adapt to long periods of sitting by shortening the muscles we use to bend over, this is known as “adaptive shortening”. This can lead to a long chain of events (the chain of pain) which may end in painful results for us. When we stand up these shortened muscles resist our body straightening. The activation of these muscles then stop the opposing muscles from working, after all, you can’t go in two opposing directions at the same time! The pelvis (the fulcrum for us bending over) is now unbalanced being tilted forward by the constant pulling of our bending over muscles, the first link in the chain is cast. If you have a “hollow” lower back you probably have this forward tilted pelvis. The tilting stretches the hamstrings and the stomach muscles whilst shortening the lower back muscles, second link in the chain. As you can imagine this is not good news for the lower back. The body has to balance this by doing the opposite with the upper back – rounded shoulders, more links in the chain and more potential issues.

The tilting of the pelvis may also have the effect of rotating the legs in towards each other which can affect how the feet work leading to possible splaying of the feet and ankle problems. You can see how the chain of pain may continue.

The main muscle used to get us straight again is the Gluteus Maximus, a large powerful muscle. However, as this is not working other muscles have to take over, doubling their workload and leaving them now open to injuries. One of the muscles that has to work harder is the Tensor Fascia Latae. Runners amongst you will probably recognise this muscle as the muscle which “tenses” the Iliotibial Band, a thickened band of connective tissue that runs down the outside part of the upper leg. If it’s not working properly it can cause pain on the outside of the knee.


You can now see how one issue can cause a chain of pain and dysfunction in other parts of the body. Many manual therapists will want to examine your pelvis even if the pain you feel is somewhere completely different. Hopefully, this will explain that apparent oddity.

There is good news, you’ll be pleased to hear. Just because you have a forward tilted pelvis does not automatically mean you will suffer from any of the above. However, some people who suffer from pain in those areas do have some sort of dysfunction of the pelvis.

Also, if you are aware of it you can often reverse the chain of pain with treatment and exercises to correct the tilt. Ensure you take regular breaks from work stations and sitting to minimise the amount of time you are in a bent position. You may even be able to get a standing desk. This then may have the effect of interrupting the chain, relieving the other issues. Take away the first link and the rest of the chain collapses, in a good way.

Don’t be hindered by the chain of pain.

Article by Simon Abbott MISRM
Soft Tissue Therapist


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Published: Sunday, December 10, 2017