X marks the spot- or does it?

Lady holding shoulder and neck with pained look on her face

It is a common misconception that the site of pain is the source of pain. Pain can be caused by a number of sources, including physical trauma, nerve damage, and illness. It is important to understand that the site of pain may not necessarily be the source of pain.

Those whom have seen a physical therapist be it an Osteopath, Massage Therapist, Physiotherapist and the like, you’ve most likely been given a body chart to mark ‘where it hurts’.

The majority of spots marked on the chart, are areas that ‘hurt’ and more often than not, it is due to referred pain. Except for joint issues and a problem with your deltoid, most ‘pain’ areas are actually referred pain coming from somewhere else.

Pain referral is a phenomenon where pain originating from one area of the body is felt in another area. It is a common occurrence in the body, and can be caused by a variety of factors.

The most common cause of pain referral is nerve impingement. When a nerve is entrapped, it can cause pain to radiate to other parts of the body. This can occur due to a variety of reasons, including tight muscles, scar tissue, or direct pressure on the nerve.

For example, a person may experience pain in the shoulder due to a pinched nerve in the neck. In this case, the source of the pain is the pinched nerve in the neck, but the site of the pain is the shoulder. This is why it is important to have a thorough medical examination to determine the source of the pain, rather than simply relying on the site of the pain as a diagnostic tool.

Pain referral can also be caused by pain from an internal organ. For example, pain originating in the gallbladder can be felt in the right shoulder. This is due to the fact that both the gallbladder and the shoulder are innervated by the same nerve.

Finally, pain referral can be caused by a “trigger point.” Trigger points are centralised points of tension within muscle tissue that can cause pain in other areas of the body. They are said to be ‘active’ when there is a sensation/pain without any pressure or palpation to the causative muscle. A tell tale sign that the pain sensations felt are from a trigger point, is when the sensation increases in intensity or is reproduced when pressed. Trigger points can be caused by poor posture, overuse, or trauma.

In all cases, pain referral can be a confusing and frustrating experience. If you are experiencing pain referral, it is important to seek medical attention to properly diagnose and treat the underlying cause.

In conclusion, it is important to understand that the site of pain is not necessarily the source of pain. Learning where the sensations are coming from, applying lifestyle measures to alleviate the issues, as well as manual/tactile therapies to help the true cause of the pain are necessary. This can be achieved with the release of overly tight tissues, decompressing spinal joints, relieving nerves and ultimately finding balance for the entire structure.

This is why when you go to a Massage Therapist, an Acupuncturist, a Kinesiologist and the like you may be receiving treatment in areas that don’t actually hurt. Be sure to ask questions and learn about your body. Learn what your body needs and how to prevent things getting into a state of pain and dysfunction again. And always seek a qualified, registered practitioner.



J, Travell; D, Simons; L, Simons. 2nd Ed (1999) Myofascial Pain and Dysfunction. The Trigger Point Manual. Vol 1 & 2. USA Williams & Wilkins.

E, Goodman. (2016) True to Form. N.Y Harper Wave.

I, Segal. (2008) The Secret Language of your Body. Vic Blue Angel Gallery.

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Living Well With Lipoedema

Have you ever heard the term Lipoedema? Chances are you haven’t, but I’m sure you’ve seen women who suffer with this condition and noticed the unusual characteristics of its presentation.

What is Lipoedema?

Lipoedema is a chronic disease which affects up to 11% of the female population (you read that right!), yet it is barely recognised by the medical fraternity and is often misdiagnosed as obesity or Lymphoedema. It is a symmetrical build-up of fat tissue predominantly in the legs and arms, though it can present in almost any part of the body.

What are the symptoms of Lipoedema?

  • Symmetrical accumulation of fatty tissue in the legs and/or arms, not including feet/hands. There can be fat rings around the ankles or wrists (cankles)
  • Texture of skin is soft, like a baby’s
  • Legs can be very sensitive to touch
  • Easy bruising
  • Fat pads can occur at the hips and knees
  • Hypermobility
  • Aching and pain, especially on the inner thighs and knees
  • Decreased mobility
  • Diet and exercise have little effect on the affected areas
  • Symptoms generally start at times of hormonal change, ie, puberty, pregnancy and menopause
  • Small waist and upper body in comparison to the lower half

When I first learnt about Lipoedema in 2006 there was little research, if any, and we were taught that Lipoedema was a condition where there were too many fat cells which were diseased and continued to grow. Now there is research which suggests that these diseased fat cells are encased by connective tissue.  This is important because it could be part of the explanation as to why diet does not reduce the size and appearance of the fat.

How to Live Well With Lipoedema?

Getting a diagnosis is difficult.  Sufferers of Lipoedema are often told by their GPs they are fat and need to diet and exercise more, even when they explain that they have been doing these things already with no result.  There is often fat shaming, which can lead to depression, anxiety and loss of self-esteem.

A physio or OT who specialises in lymphatics will be able to diagnose.  There are a few GPs, vascular specialists, podiatrists and plastic surgeons who may be able to identify it, but these are few and far between.

You don’t need a diagnosis to start conservatively treating Lipoedema if you suspect you have it.  Here a few things that are recommended:

  • Psychological/emotional support
  • Following an anti-inflammatory way of eating. While this doesn’t alter the shape of the legs it can help with pain management and general health
  • Exercise in whatever way you can manage – walking in water is one of the best ways to manage the condition but whatever exercise you enjoy is best, as long as it doesn’t cause you pain
  • Compression therapy – stockings and pumps
  • Manual Lymphatic Drainage
  • Dry brushing/opening lymph nodes

Gather a team of natural therapists to help manage your Lipoedema:

  • Remedial Massage Therapist with training in Manual Lymphatic Drainage – ask them about their qualifications and experience with Lipoedema
  • Physiotherapist/OT with training in Manual Lymphatic Drainage
  • Nutritionist
  • Psychotherapist
  • Podiatrist
  • Osteopath/chiropractor

There are numerous Support Groups available online, some of whom hold regular catch ups.

The 4th Lipoedema Australia National Conference is being held in Sydney from 17-19 June 2022.  This is a fantastic opportunity to meet other Lipoedema sufferers and hear the latest in research and treatment options.

What is Myofascial Release?

Woman being massaged

Are you one of the many people who sustained various sporting injuries in your youth, played on regardless and somehow got over them in time? Did you eventually develop seemingly unrelated pains and aches or stiffness that limited your range of motion and vitality, leading you to seek assistance at the gym or in clinic? You may have heard the term “myofascial release” as it is one of the many new buzz words bandied about in the health and fitness arena today.

You might however come to a point where the gym training, boot camp or cross training has landed you in the clinic because the old injuries have returned along with new more complex and serious problems elsewhere in the body. Drugs may mask pain in the short term but you need to look deeper to find the way back to health and fitness.

The first question you need to ask yourself is why did I injure myself in the first place? I thought I was fit and flexible, but my reflexes were not quick enough to allow me to recover when I was thrown off balance by that flying object/tackle/wave etc, or that unforeseen obstacle in the path of my legs/bike/skateboard/horse… What is it that threw me off balance?

Balance involves a special process that relays information from several of our senses such as sight, hearing and touch, to parts of the brain where split-second calculations initiate responses around the body, known as reflex actions. Speed of the reflex is crucial to saving you from injury on the sporting field. The process I’m talking about here is called proprioception – another buzz word in the health and fitness arena today.

We have all heard the old saying “the hip bone’s connected to the thigh bone, the thigh bone’s connected to the shin bone, the shin bone…”. But what is it that connects our bones and our muscles together? It’s fascia. When they talk about myofascia they mean the fascia connecting muscles (myo means muscle). So when we want to free up the muscles we need to release the fascia that connects muscle to muscle. But just like the song, this picture is too simplistic because fascia also connects muscle to bone, bone to bone, fascia to fascia, fascia to organs, cells to cells etc.

In fact fascia connects everything to everything else in the body, sort of like a bodywide web. Now there is more than one body wide web – in fact there are many layers. When we are talking about releasing the myofascia you could imagine a number of bodystockings layered under and over each other with gel in between allowing them to slide around in response to tension. Due to scarring from injuries, some parts have been glued together so they can’t slide anymore and they start to pull on each other. The nerve endings that live in between those layers are now being squeezed. The restriction to the nerves may cause pain and inflammation every time you try to move the muscles connected via those layers.

Eventually the whole fascial system starts to thicken and stiffen, it takes more energy to move the muscles and you lose your range of motion. You also lose your sense of proprioception so the split second calculations are not happening properly in the brain and your balance is further impaired. At this point strength training or active stretching will only complicate matters. You need to have proper myofascial release therapy and you need to do passive stretching. Passive stretching uses body weight and time …. ZERO effort. Remember hanging from the monkey bars as a kid? That’s the kind of stretching I’m talking about. Proper myofascial release is very specific, very directional, should not push through pain and takes time to reset your proprioception system. The foam roller does not solve your problems in the long run.

I spend a lot of time showing my clients how to do passive stretching, what it should feel like and types of exercise that can help maintain a healthy balance in the fascial system. A myofascial massage will take between 60 and 90 minutes and I would suggest you have three treatments in sequence over the first two months. After that the ball is really in your court because you need to be in control of your own health and fitness regime with follow up yoga, swimming, dancing or some other form of exercise to keep the fascia supple.

If you have any questions about this form of remedial massage you can always email me on: jarnie@me.com

Good Life Satisfaction Helps Keep Bones Healthy

Woman with face in sunlight

Women aged 60 to 70 who are satisfied with their lives have a higher bone density and are less likely to suffer from osteoporosis than their unsatisfied peers, a new study from the University of Eastern Finland found.


Age brings about decreases in bone density, with menopause constituting a significant risk factor for osteoporosis, a disease we know easily results in bone fractures, with hip fractures in particular causing serious consequences. Other risk factors include:


  • Low levels of physical activity
  • Light body composition
  • Smoking
  • Low intake of calcium and vitamin D
  • Certain pharmaceutical drugs


Some medical conditions are also implicated. As an example, long-term stress associated with depression can have detrimental effects on metabolism and, in turn, on bone health. The health behaviour of a depressed person may also increase their risk of osteoporosis, as they might smoke or take too little exercise.


Subjective wellbeing is an extensive indicator of mental health – and depression in particular. This study used life satisfaction to measure subjective wellbeing, with the objective of determining whether life satisfaction is also associated with bone health.


The data were drawn from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) Study, which since 1989 has been investigating the effects of various risk and protective factors on bone density and bone fractures. Participants responded to mail surveys designed to assess life satisfaction through four questions relating to the interest in and easiness of life; happiness; and loneliness. Based on the answers, the study participants were divided into three groups:


  • the satisfied
  • the middle group, and
  • the unsatisfied


Participants also underwent bone-density measurements. The present sub-study included 2167 women whose bone density was measured in 1999; of these, 1147 took part in follow-up measurements a decade later, in 2009.


During the 10-year follow-up, the bone density of all study participants weakened by an average of four percent. However, the difference between the satisfied and the unsatisfied was as much as 52 per cent.


Bone density was also affected by changes in life satisfaction during the 10-year follow-up: in people whose life satisfaction deteriorated, bone density weakened by 85 percent in comparison to those whose life satisfaction improved.


Hence, life satisfaction is an important resource and an indicator of wellbeing. Life satisfaction has been linked to health, and dissatisfaction is a predictor of incapacity for work, illness and mortality. This study shows it’s also associated with bone health, as good life satisfaction diminishes age-induced osteoporosis.


The study researchers say that promoting good life satisfaction and good spirits in older people is as important as promoting healthy lifestyle choices. Individual factors maintaining and improving life satisfaction also have beneficial effects on bone health.


Written for the Australian Traditional-Medicine Society (ATMS) by Rosemary Ann Ogilvie from materials released by the University of Eastern Finland.