The Onion: Why Pain Sometimes Moves Around as It Gets Better

What’s happening when a new spot speaks up

Bodies prioritize. When one problem is loud enough, it drowns out quieter ones. The nervous system can only process so much at once, so it ranks its complaints and puts an emphasis on the worst one. That becomes what you feel. The rest are still there, but they’re running in the background.

When we reduce the sensitivity of the loudest spot — the trigger point that was referring pain into your shoulder, say — the ranking changes. A sore spot in your rhomboids that had been sitting at a four out of ten can suddenly register as a six, simply because it no longer has an eight to compete with.

The sensation feels new, but the spot isn’t new at al. It was there all along.

Central sensitization: why a body can be loud everywhere at once

There is a related piece to this worth knowing. Sustained pain — AKA Chronic Pain — can actually change the way the nervous system itself processes pain. The system gets more sensitive. Things that shouldn’t hurt start to hurt. Ordinary “light” pressure slowly becomes painful. This is called central sensitization, and it is well-documented in the pain science literature (Woolf, 2010; Mense, 2008). It is not imagined, and it is not a character flaw.

Central sensitization is part of why clients with one clearly identified problem often report that they seem to ache all over. Their “amplifier” has been turned up for so long that a lot of minor input feels major.

When we reduce the overall input — when the loudest source calms down — the amplifier often comes down too. That can produce what feels like widespread relief, even though we only worked on a specific area. It can also make quieter spots more noticeable for a while, because your nervous system now has more capacity to pay attention to them.

What this looks like in practice

A few patterns we see regularly at Brooklyn Body Mechanic:

• A client comes in for what they thought was rotator cuff pain. After work on the back of the shoulder blade, the front of the shoulder calms down. One week later, they notice soreness in the neck on the same side that they had not registered before. On palpation, the neck spot behaves the same way the original one did.
• A client with low back pain gets meaningful relief after work on the quadratus lumborum muscle. During their next visit, they mention that the opposite hip is now annoying them. That hip had been compensating for months. It is now the loudest thing in the room.
• A client with tension headaches gets a run of good sleep after a session that calmed the suboccipitals. In the following week, they notice jaw soreness they had never paid attention to. The jaw had always been there. The headache was just always bigger.

In all three cases, the pattern shift is a signal. It tells us that the treatment plan is working, and we now have a clearer picture of what to address next in order to get to lasting relief.

How to tell the onion from an actual problem

The onion is not a license to ignore everything. Not every new sore spot is part of the same progression. Two rules to hold onto:

1. The 50% rule. If a session leaves you more than about fifty percent worse than you came in, something went wrong and we want to know. What I normally tell clients is: “You might be a bit sore, but that should clear up in 24-36 hours. If not, email me!” Mild post-session soreness is normal. Significant aggravation is not.
2. The good / bad distinction. Good pain is the satisfying ache of pressure on a real trigger point or tender spot — the “hurts so good” feeling. Bad pain is uncomfortable without being useful. It is sharp, electric, or alarming. Nerve pain, inflammation, or something we have not identified yet. This pain is not part of the onion. It is a stop-and-reassess moment, and sometimes a reason to see a physician.

If the new spot behaves like a trigger point — a sore band, consistent referral pattern, sensitive to slow pressure — it is very likely part of the progression. If it behaves like something else, tell us!

What progress actually looks like

A lot of clients come in expecting progress to feel like a straight line. I hate to be the bearer of bad news, but It is rarely linear. What we look for instead:

• The same pressure hurts less on the spots we have been working.
• The local twitch response to precise palpation gets smaller.
• New spots become the priority — onion-peeling — which usually means the earlier ones are calming down.
• You sleep better, move more easily, or return to an activity you had been avoiding.

Notably absent from that list: the felt “softening” of tissue under the hand. The idea that muscle texture tells you how much has changed is popular… it’s also insanely unreliable. We pay more attention to sensitivity and pattern than to whether something feels like a different kind of Play-Doh.

The short version: if the loudest problem has quieted down and a quieter one is now speaking up, the plan is working. Bring the new spot with you to the next session and we’ll fold it in.

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References: Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-S15. 

Mense S. Algesic agents exciting muscle nociceptors. Exp Brain Res. 2009;196(1):89-100.