When you have pain in your abdomen, it is easy to assume the problem must be coming from one of your digestive organs. After all, the pain is in your stomach area, so it seems logical that something inside must be wrong.
And sometimes it is. There are many digestive causes of stomach pain and dysfunction that are far more common than people realize. A hiatal hernia, for example, can cause reflux, burping, chest discomfort, difficulty breathing, and even symptoms that send people to the emergency room. I’ve written more about this often-overlooked problem in MTHFR & Digestion: Healing the Hiatal Hernia, which also includes a video explaining the condition and how we approach it.
But sometimes the source of the pain isn’t inside the abdomen at all. The abdominal wall itself—including muscles, fascia, tendons, and the nerves supplying those tissues—can be the source of significant pain. This is an important distinction because the treatment can be completely different depending on where the pain is actually coming from.
I recently worked with a man in his sixties who provided a great example of this.
When the Tests Don’t Explain the Pain
This gentleman works a very physical job in manufacturing. He spends long hours bending, kneeling, sitting, standing, and repeatedly moving his body in the same patterns throughout the day. He developed significant, diffuse abdominal pain and naturally wondered what was happening inside his abdomen.
He went to a walk-in clinic, and they couldn’t identify a problem. When the pain continued, he was eventually sent to the emergency room. There he had a thorough evaluation, including blood work and imaging, but nothing significant was found.
That’s actually good news. When someone has abdominal pain, we absolutely want to rule out serious problems such as inflammation, obstruction, perforation, bleeding, or another condition requiring immediate medical attention. In this case, that workup did not reveal one of those problems.
But if the organs look okay, where is the pain coming from? That’s where we have to start thinking differently.
Pay Attention to What Changes the Pain
One of the biggest clues in this case was something very simple: his pain changed when he changed position.
He described pain when moving from sitting to standing and with certain physical movements. That got my attention because pain originating from an internal organ doesn’t necessarily behave the same way as pain coming from the body’s musculoskeletal structures.
Visceral pain—pain originating from an internal organ—has its own patterns. Musculoskeletal pain, on the other hand, is often influenced by movement, position, loading, or pressure on a particular structure.
This doesn’t mean that every positional abdominal pain is automatically a muscle problem. But when the medical workup is reassuring and the pain consistently changes with movement or position, the abdominal wall deserves a closer look.
Your Abdominal Wall Is More Than a Six-Pack
When we think about the abdominal wall, most people picture the rectus abdominis—the “six-pack” muscles. But there is much more going on there.
The abdominal wall contains multiple layers of muscle, fascia, tendons, connective tissue, and nerves. The obliques, transverse abdominis, rectus abdominis, and surrounding structures all have to work together to stabilize the trunk and transfer force throughout the body.
If you repeatedly use these tissues in the same way for hours every day, they can become irritated, overworked, or develop trigger points. A trigger point is an area of muscle that becomes particularly sensitive and can reproduce pain when it is compressed. Sometimes the pain isn’t felt exactly where the trigger point is located, which can make the source surprisingly difficult to identify.
In this man’s case, there were significant trigger points throughout the abdominal wall, particularly on the right side.
Your Job May Be Part of the Problem
This is one of the reasons I always want to know what someone actually does all day. A person’s occupation can tell you a tremendous amount about what their body is being asked to do repeatedly.
This gentleman was working more than 50 hours a week in a physically demanding environment. His work involved repetitive movements, bending, kneeling, and moving objects while maintaining the same general posture for long periods. That’s a lot of repetition.
The body is remarkably adaptable, but eventually repetitive movement can become a problem when the tissues never get an opportunity to recover or when the same muscles are constantly being asked to work in the same way.
In functional medicine, we spend a lot of time thinking about nutrition, digestion, inflammation, hormones, and other biochemical factors. Those things matter. But the physical body matters, too. Sometimes the answer is in the movement patterns.
Pain Can Be Coming From the “Outside”
One of the most useful clinical lessons here is that pain doesn’t always originate from the structure nearest to where you feel it. The nervous system can create referred pain, and muscular trigger points can produce pain in areas that don’t initially make sense.
That’s why I like the concept of following the pain instead of automatically assuming its source. If someone tells me, “My stomach hurts,” I don’t want to immediately conclude that the stomach is the problem. I want to ask when it hurts, what movement makes it worse, what position makes it better or worse, whether pressing on the surrounding muscles reproduces the pain, what the person’s work or exercise routine looks like, and whether they’ve already had appropriate medical evaluation.
Those questions can completely change the clinical picture.
Don’t Skip the Medical Workup
There is an important caveat here. Abdominal pain should never automatically be assumed to be muscular.
There are serious medical conditions that can present with abdominal pain, and those need to be appropriately evaluated. If someone has severe, sudden, worsening, or otherwise concerning abdominal pain, medical evaluation is important.
But once serious causes have been appropriately investigated and the findings don’t explain the symptoms, that doesn’t mean the pain isn’t real. It means we may need to broaden our thinking.
This is where hands-on examination, movement assessment, and knowledge of anatomy can become incredibly valuable.
Sometimes the Simplest Tool Is Your Hand
One of the things I appreciate most about hands-on assessment is that it gives us another way to ask the body questions.
In this case, I could palpate the abdominal wall and identify areas that were clearly abnormal. Some of the muscles had significant trigger points, particularly along the obliques.
You don’t necessarily need an expensive machine to discover every problem. Sometimes you need to know where to look and what you’re feeling for.
Gentle palpation can provide useful information about muscle tone, tenderness, trigger points, and asymmetry. When touching a particular area reproduces the patient’s familiar pain, that can be an important clue.
The goal isn’t to hurt someone or dig into their abdomen. It’s to assess the tissue intelligently and determine whether the musculoskeletal system may be contributing to the symptoms.
What Happens Next?
Once you’ve identified the likely source, the next step is to address it. That may involve working on trigger points, improving mobility, addressing the mechanics of the hips and pelvis, changing repetitive movement patterns, and giving the person simple exercises or other strategies they can use between appointments.
In this particular case, the plan included working directly on the abdominal wall as well as giving him some simple homework involving massage and movement. But the bigger lesson is that finding the source is only half the job. If someone continues doing the same repetitive movement for 10 hours a day, we also have to help them understand how to move differently when they have the opportunity.
The Bigger Functional Medicine Lesson
This is one of the reasons I enjoy functional medicine so much. You never know what is going to walk through the door. Someone may come in with “stomach pain,” but the answer may involve their abdominal wall. Another person’s symptoms may be driven by nutrition. Someone else’s may involve sleep, stress, or structural dysfunction.
The body doesn’t divide itself into neat categories just because our healthcare system does. Structure, chemistry, and environment all interact.
When we can step back and ask better questions, we sometimes discover that the answer is much simpler than we expected. So the next time someone says, “My stomach hurts,” don’t automatically assume the problem is inside the stomach. Sometimes the problem is on the outside.
Looking for Personalized Support?
If you’re dealing with persistent pain or other symptoms that haven’t been fully explained, a broader look at your health picture may help identify contributing factors that are easy to overlook.
At Red Mountain Natural Medicine in Boise, Idaho, I work with patients to look at the bigger picture, including nutrition, lifestyle, structural factors, digestive health, and other potential contributors to chronic symptoms.
I see patients both in person and via telemedicine. To learn more or schedule a consultation, visit Red Mountain Natural Medicine.
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