We make wheels round because square ones don’t work that well. The tiniest departure from the roundness of a wheel would spell noticeable effect on its efficiency. You just have to ride a bicycle with a warped wheel to be convinced of this fact. If I am talking about wheels it’s to illustrate the relationship that exists between shape and function: shape conditions and determines function.

This law is valid as much in the inanimate as in the animate world. For human beings, a departure from the normal shape will always be followed by malfunction. And malfunction means pain.

The onset of pain and its characteristic in a given individual will depend on certain factors that are useful to know about if we want to have a chance to prevent or alleviate pains of a musculo-skeletal origin.

Let’s start with the cause of our physical distortions. Apart from those that are congenital or caused by traumas such as fractures, distortions are the result of the shortening of some muscles which pull our bodies out of shape.

Some muscles overlap like tiles on a roof to form what F. Mezieres called ‘muscular chains’. Through this linkage, these chains of muscles acquire an amazing power which is the sum of the strength of all their components. It is this formidable force and readiness to shorten that cause much undue compression on articulating surfaces which results in strain and discomfort.

To avoid this discomfort turning into full-blown pain the body distorts itself. This is the paradox – persistent faulty alignment or misshape is an attempt to find some slack which will prevent pain. We become distorted in order to avoid pain. Unfortunately, this pain-avoidance mechanism is not sustainable, for faulty alignment will eventually lead to undue wear and tear and have an eroding effect on the articulating surfaces. This analgesic mechanism is just a way to put off the evil day, in other words to postpone the onset of pain.

Imagine for example that you have tight muscles both in the nape and front of the neck. This would create conflicting pulls – a kind of muscle tug of war – where a group of muscles pulls your head backward while the other pulls it forward. In this scenario, this muscular conflict in the sagittal plane would give rise to compressive forces that would soon become painful. To avoid this unpleasant situation the body can escape in the coronal plane (tilting the head on one side), in the transverse plane (turning the head on one side), or in both planes. No pain – but the gains are only of a palliative nature since the cause has only been dodged, not removed.

The body cannot always escape in this way from the compression forces of tight muscles – either no distortions are developed or the distortions are not sufficient to give the necessary slack in the muscular system. In these cases, there will be an early onset of pain.

To recapitulate, pains of a musculo-skeletal origin can be divided into two types: early-onset pains and late-onset pains.

Early-onset pains appear when a muscular conflict between tight antagonist muscles cannot find a resolution through distortions or when the distortions are insufficient to dilute the tightness and obtain some slack. However, malfunction of the musculo-skeletal system may or may not be present.

Late-onset pains are the result of long standing and persistent faulty alignment (distortions) which have damaged tissue structures. In this case, malfunction will be present.

This classification however is not necessarily clear-cut and a patient can suffer from both early and late-onset pains.

The time at which pain will be felt in life will determine the characteristics of this pain.

Early-onset pains are of a muscular nature. They are bound to appear or to worsen when muscles are cold. This is the reason why they have the unpleasant tendency to be felt in the second half of the night. While they are worst upon awakening, they tend to decrease during the day thanks to the warming-up effect of day time activities. For obvious reasons, heat has a soothing and calming effect on early-onset pains.

Late-onset pains are of an inflammatory nature. They are usually not present or only mildly present at the beginning of the day. The patient feels rather better on waking up and does not feel the need for a warming up to loosen up. Pains start to appear during the day and are worst at the end of it. The patient is keen to go to bed. Late-onset pains are usually joint pains although vertebral joints are rarely affected. These pains are associated with the usual symptoms of inflammation (swelling, redness, heat). Cold applications give some relief.

Late-onset pains with a strong inflammatory component are the most recalcitrant.

What matters is the condition of the muscular chains. If they become hypertonic and too tight (they always do), good shape will not make you immune from pain; on the contrary, it will give you early-onset pains. If you are in bad shape and don’t feel any pains yet – don’t get complacent – pain will catch up with you eventually. But don’t shoot the messenger: it’s too painful.