Principles
Systems thinking for pain that won't resolve
These principles apply beyond SI pain. They provide frameworks for thinking about persistent musculoskeletal problems that haven't responded to standard approaches.
Symptom location is not cause location
Pain shows up where capacity fails or load exceeds tolerance. That location may not be the source of the problem.
Example: Hip pain may come from a knee control failure. SI pain may come from a hip extension failure. Shoulder pain may come from thoracic mobility or scapular control issues.
Treating the pain site without addressing the control or capacity failure elsewhere often fails.
Load transfer, timing, and tolerance
Musculoskeletal systems transmit force. Problems arise when:
- Load transfer fails: force takes an inefficient or unsupported path
- Timing is off: structures yield when they should be stiff, or stay rigid when they should yield
- Tolerance is exceeded: the system can't handle the load volume, intensity, or duration
Standard advice often focuses on strength or flexibility without addressing timing or load management. Building capacity requires all three: tissue tolerance, motor control, and appropriate dosing.
Relief versus capacity
Many interventions provide temporary relief without building capacity:
- Stretching reduces tone but does not improve control under load
- Manual therapy feels good but does not teach the system to stabilize
- Realignment fixes position but does not build stability
- Rest eliminates symptoms but does not increase tolerance
Relief is valuable. But if the problem returns when you reload, you need capacity-building interventions, not just relief.
Capacity-building takes time. Expect weeks to months, not days.
Asymmetry as a feature
Most people are asymmetric. The problem is not asymmetry itself, but when one side cannot handle its share of the load or when the system cannot adapt to changing demands.
Chasing perfect symmetry often fails. The goal is adequate capacity on both sides and the ability to transfer load efficiently under real-world conditions.
Fatigue reveals failure
If symptoms appear or worsen with fatigue, the problem is likely control or capacity, not structure.
- Pain that shows up late in a walk or run
- Symptoms that worsen after a long day on your feet
- Pain after sitting for a long time, then standing
These patterns suggest the system compensates initially but fails when fatigued. Interventions should build capacity and improve load distribution, not just reduce symptoms at rest.
Multipliers: sleep, stress, fueling
Pain is not just biomechanical. The nervous system amplifies or dampens signals based on context:
- Poor sleep lowers pain thresholds and reduces recovery capacity
- High stress increases muscle tone, sympathetic drive, and sensitization
- Inadequate fueling or hydration reduces tissue tolerance and recovery
Addressing these multipliers does not replace capacity-building work, but it can lower the volume on pain signals and improve recovery. A bad night often means a worse day symptom-wise. This is normal and expected.
When to stop self-experimenting and seek evaluation
Self-management is appropriate for mechanical, control-based pain patterns without red flags. Stop and get evaluated if:
- You have any red flags
- Symptoms worsen despite consistent, graded interventions over 6–8 weeks
- Pain limits daily function significantly
- You're unsure whether your pattern matches these principles
- Symptoms are confusing, inconsistent, or not responding as expected
When in doubt, seek professional evaluation. These principles are frameworks, not substitutes for medical assessment.
Summary
- Pain location ≠ cause location
- Load transfer, timing, and tolerance all matter
- Relief ≠ capacity; capacity-building takes time
- Asymmetry is common; adequate capacity on both sides is the goal
- Fatigue reveals control and capacity failures
- Sleep, stress, and fueling multiply pain but are not sole causes
- Seek evaluation when symptoms don't match these patterns or don't improve
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Last updated: 2026-01-15