Pain at the End Range of Joints- While the Range Changes the Pain May Not

   In working with a client who is in pain in a particular movement, we must assess their range-of-motion and establish starting points for any change in order to be able to demonstrate improvement. Our client may not realize their improved movement has taken them to the point of pain.

   When we take our movements to the end range of the joint we can encounter pain, which is a feedback mechanism to protect our joints, muscle and tendons.
End range can be:
Structural:

• The limits of the bony surfaces, tendons or ligaments

Physiological:

• In response to overtraining, underuse, lack of stretching or trauma and injury
  

   When we are working with our clients it's important to explain the difference between the two and to emphasize that pain from either can be acute. Typically the client will demonstrate the restriction in movement marked by pain at the limited end range as the reason for the office visit, a sort of “test-to-pain”.


   It is vital at that point to measure or provide for the client a reproducible reminder of their end range. After we work on the area(s) there can be a significant increase in pain-free range-of-motion. This increase may not be noticed by the client as they are eager to “test to pain”. If they find the same pain at end range without being shown the difference in range they can assume there has been no improvement.


   Before the client begins their “test-to-pain” demonstrate the initial end range to give them a point of reference to assess the changes that have taken place. We may have restored 20%, 30%, 50%, even 80% of normal structural motion, but unless we help them to see their starting point, we will never convince them of the journey they have taken.


   We also will be challenged in getting them to continue on their healing journey without that proof. Asking the client to move slowly from the beginning of their range-of-motion can give them a clear idea of their enhanced status. Focusing on the new capacity and emphasizing that new movement habits are being built will serve to stabilize progress and prevent re-injury.


   These ideas are key to helping our client properly evaluate our value to them and maintain them on their healing path.