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What's the Real Cause of My Pain: Primary Versus Compensatory Pain

Woman on fancy couch with back painBeing in pain is an extremely frustrating experience, especially when you don’t know what is causing it. Understandably, most people’s top priority is getting pain to stop.

However, to best treat your pain, it is important to find its root cause. This includes understanding if your pain is primary – meaning that you have a medical issue that is directly causing your pain – or compensatory – meaning that the pain is secondary to something else.

As a licensed chiropractor in Virginia for more than 20 years, I have extensive experience helping patients with both primary and compensatory pain. Educating patients on the difference between these types of pain is vital to their recovery from pain.

In this article, I will explain the differences between primary and compensatory pain, and how they are managed.

What is Primary Pain?

Primary pain is the easiest type of pain to understand and for your doctor to diagnose. It occurs as a direct result of an injury or problem with the muscle, bone, or joint. The pain you experience is, therefore, directly linked to the injury you have.

Example of Primary Pain: Imagine you have been in a car accident and experienced whiplash when your head jerked forward during the crash. The neck pain from whiplash is a direct result of damage to the tendons and muscles in your neck.

What is Compensatory Pain?

Compensatory pain is different from primary pain. It occurs because your body is very good at adapting to challenges. For example, if you have an injury to your muscles or joints but are still trying to perform an activity, your body will try to help you.

The way your body attempts to overcome this injury is by compensating for it. That is, using different joints, bones, tissues, and groups of muscles to help you. In turn, this lessens the strain on your injury in the short term.

Unfortunately, these other, compensatory joints and muscles are not usually designed to carry this burden. As a result, they too can become painful or even get injured with overuse. Compensatory pain is pain that results from this situation.

Failing to address compensatory pain can lead to debility and chronic, painful symptoms.

Example of Compensatory Pain: imagine you have a foot injury. You start walking differently to ease the burden on your injured foot. In turn, this changes your posture. After a few days of walking differently, you may notice knee pain, hip pain, and even back pain. All of this pain is indirectly the result of changes you’ve made because of your foot injury and is called compensatory pain.

What are Signs of Compensatory Pain?

Your body will often try to let you know when it is struggling to compensate. Signs of compensatory pain can be similar to other signs of pain, although there are some key differences. You may have compensatory pain if you have symptoms like:

Chronic muscle tightness: When muscles are carrying a burden that they are not meant to carry, they often feel strained and tight, no matter how much you stretch them. If you experience chronic muscle tightness, tenderness, or soreness despite your best efforts at stretching or relaxing them, this could be a sign that you have compensatory pain.

A single muscle or joint that gives you a problem: If you have a recurring, isolated problem with a single muscle or joint, this could be a sign that it is getting overused from compensation.

Common Compensatory Causes of Low Back Pain

Several common problems in your body can cause a domino effect, ending up in compensatory low back pain. All of these problems can be prevented or treated, stopping the compensatory low back pain at its source. They include:

  • Flat feet: Otherwise known as pronation distortion syndrome, flat feet are often accompanied by ankles that roll inward. This changes your posture and can cause your hip flexors to compress your lower (lumbar) spine, leading to low back pain in some cases.
  • Anterior Pelvic Tilt: Those with short hip flexors often have a pelvis that tilts forward, leading to an arch in the lower back. This can directly impact your hamstring muscles by lengthening and weakening them and can lead to low back pain.
  • Lower Cross Syndrome: Also linked to short, tight hip flexors, this condition is a pattern of overused and underused muscles in the hip region, which can lead to low back pain. Lower cross syndrome is linked to prolonged sitting.
  • Upper Cross Syndrome: This condition is a pattern of overused and underused muscles in the neck, shoulders, and chest which can cause back pain. Upper cross syndrome is linked to poor posture.
  • Butt Wink: Having an excessively rounded back while squatting is called butt wink. This over-stretches the back and can lead to back pain as well as back injury and herniated discs.
  • Sway Back: Also known as excessive lordotic extension of the spine, sway back is characterized by the pelvis tilting too far forward and the chest tilting too far backward. It is often caused by muscle imbalances in the hips, spine and pelvis.
  • Flared Rib Cage: Flared ribs are visible and protrude out from the body. This condition is linked to muscle imbalances in the spine that can lead to low back pain.

Managing Primary and Compensatory Pain With Precision Spinal Care

As a certified NUCCA chiropractor and credentialed spine care specialist, I make sure to evaluate the root cause of your pain before coming up with a treatment plan. This includes determining whether your back pain is due to a primary or compensatory cause.

To this end, during your first visit, I will do a thorough examination of your spine. Afterwards, I will go over my evaluation with you in detail. Together, we will set reasonable expectations and milestones for recovery and further evaluation. I will reevaluate you to make sure you are meeting these goals.

If we determine that chiropractic is not the best solution for your needs, I will recommend the type of specialist who is most appropriate for you.

We understand that you need to explore all your options when you are trying to treat your pain. At Precision Spinal Care, we are happy to help you determine the best way to address your specific needs and discuss all the options with you and your family.

Call our office at (757) 382-5555 to speak to the doctor or set up a consultation. You can also set up an appointment through our webpage.

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