Physical examination is centered to the area of pain but should not be misguided by referred patterns of pains. For example, hepatic metastases refer pain to the shoulder. Anatomic examination is followed by maneuvers to elicit or ameliorate pain. Bone metastases are common, local palpation and manipulation elicit pain. Spinal cord compression from epidural tumor extension is most feared by physicians. Hence, a neurologic examination, manual muscle testing, percussion tenderness and joint mobility, and inspection for muscle symmetry are important parts of the physical examination. Assessment of psychiatric and psychosocial comorbidities is important to address factors that may adversely affect pain perception and worsen distress. 17
Digging a metal tool into a painful spot, such as the bottom of your foot if you’re dealing with plantar fasciitis, sounds like some sort of medieval torture practice. The Graston technique is an instrument-aided manual therapy that serves as a noninvasive way to deal with soft tissue ailments like achilles tendonitis, carpal tunnel syndrome, fibromyalgia, shin splints, back and shoulder pain, and other ailments. It’s even been proven to help relieve pain associated with chronic conditions like trigger finger and post-surgery pain in a way that can reduce the amount of painkillers administered.