Have you ever gone to a practitioner for pain in one spot and been surprised when they started treating somewhere completely different? If you've come to my acupuncture clinic for foot pain and I've spent a good portion of the appointment working on your calves, or you've come in for shoulder pain and I've treated your neck, back, or chest, there's a reason for that.
Pain doesn't always originate where you feel it, and sometimes the best way to treat a painful area is to look beyond it.
As an acupuncturist and dry needling practitioner, I look at how muscles, connective tissue, joints, and movement patterns work together. Rather than focusing exclusively on the spot that hurts, I consider what might be contributing to the problem and how different parts of the body influence one another.
Referred Pain: When the Problem Isn't Where You Feel It
Referred pain occurs when you experience pain in an area that is different from its source. This happens because the nervous system processes signals from different tissues through overlapping pathways, making it possible for the brain to perceive pain somewhere other than where the irritation originates.
For example, trigger points in certain shoulder and neck muscles can contribute to pain felt in the head, producing headache symptoms. Irritation or dysfunction in the muscles surrounding the hip can sometimes contribute to discomfort felt farther down the leg.
Trigger Points: Those Tender Spots That Seem to Have a Mind of Their Own
Have you ever had someone press on a muscle and suddenly felt a familiar ache somewhere else? You might have found a trigger point.
Myofascial trigger points are commonly described as sensitive areas within muscle and surrounding connective tissue. When pressure is applied, they may produce local tenderness or pain that radiates into another area.
For instance, certain muscles in the upper back and neck can contribute to pain around the temples, behind the eyes, or along the head. Treating the relevant muscles may help reduce symptoms even when those muscles aren't where you originally noticed the pain.
Your Muscles Don't Work in Isolation
Your body isn't a collection of unrelated parts. Muscles and connective tissues work together to produce movement, stabilize joints, and distribute loads throughout the body.
Consider the posterior chain, a general term for the interconnected muscles along the back of the body, including the calves, hamstrings, glutes, and back muscles. These tissues coordinate during activities such as walking, running, lifting, and climbing stairs.
If one area becomes painful or less tolerant of load, you may unconsciously change how you move. Other muscles may have to work harder, or you may begin avoiding certain movements altogether. Over time, these changes can contribute to discomfort in other areas.
This doesn't mean that every muscle is mechanically connected in a way that causes pain elsewhere. It means that movement is coordinated, and an assessment of one painful area can benefit from looking at the surrounding joints, muscles, and movement patterns.
Example: Why I Might Treat Your Calves for Plantar Fasciitis
Plantar fasciitis is a common cause of pain around the bottom of the heel and foot, especially with the first steps in the morning or after sitting for a while.
When someone comes to see me for plantar fasciitis, I'm not just thinking about the bottom of the foot. I'm also interested in calf flexibility, ankle mobility, activity levels, footwear, and how the foot tolerates loading.
The calf muscles connect to the Achilles tendon, which attaches to the heel bone. Calf function and ankle mobility can influence the forces experienced by the foot during walking and running.
If the calf muscles are particularly tender or restricted, treating them with acupuncture or dry needling may be a useful part of the treatment plan. I may also recommend appropriate exercises, load modifications, or other strategies to help the foot tolerate activity.
The goal is to address the foot pain while considering the factors that may be contributing to it, rather than assuming the painful spot is the only area that needs attention.
Why Your Shoulder Pain Might Involve Your Neck or Chest
The same principle applies to shoulder pain.
The shoulder depends on coordinated movement between the upper arm, shoulder blade, collarbone, and surrounding muscles. The neck and upper back also influence how the shoulder moves and how much muscular work is required during everyday activities.
Depending on your symptoms and assessment, I may examine the upper trapezius, levator scapulae, rotator cuff muscles, or muscles around the chest and shoulder blade.
Sometimes the shoulder itself needs direct treatment. In other cases, surrounding muscle tension, restricted movement, or changes in how the shoulder blade moves may also deserve attention.
I don't assume every shoulder problem comes from the neck or that every painful shoulder needs the same treatment. I use your history, symptoms, movement, and examination findings to decide where to focus.
Acupuncture and Dry Needling: Choosing Where to Treat
Acupuncture and dry needling can involve the insertion of fine needles into selected tissues, but practitioners may use different assessment frameworks and treatment goals depending on their training and approach.
In my practice, I consider both the location of your symptoms and the broader clinical picture. I may select local points near the painful area, points in related muscles, or more distant acupuncture points based on your presentation.
For muscular pain, dry needling may be used to target specific muscles or sensitive areas. Acupuncture treatment may incorporate local and distal points, and I may use electroacupuncture when appropriate.
Treating the Person, Not Just the Painful Spot
When you come in for treatment, I want to understand more than where it hurts. I want to know when the pain started, what makes it better or worse, how it affects your daily activities, and whether anything else seems connected to it.
Sometimes the most appropriate treatment is right at the painful site. Sometimes the surrounding muscles or movement patterns deserve attention, too. Often, a combination makes the most sense.
The goal isn't to needle as many places as possible. It's to choose the areas most likely to help, based on your individual presentation.
If you've been dealing with persistent muscle tension, recurring injuries, plantar fasciitis, neck pain, or shoulder discomfort, acupuncture and dry needling may be options worth exploring as part of a personalized treatment plan.
