One of the defining characteristics of connective tissue related pain is that it fluctuates widely, in intensity and in location (if multiple sources are present).   People who have this problem are already very familiar with these fluctuations. This symptom variation is often a prominent part of the treatment course as well.  People will note improvement in symptoms at times, then they will note bad days, bad week, and occasionally a bad month, during a several month course of treatment.  People are encouraged when symptoms are improving, but we often get calls and comments when the symptoms flare up again ‘wondering if this stuff is really working’.  The most important determinant of the success of this treatment is whether or not the healing system is ‘triggering’.  We focus on symptom changes over the first treatment or two, to determine whether this is happening or not.  Even subtle changes in symptoms can mean that the patient is getting a very acceptable clinical response.  And if they are not, we begin trying different solutions, and/or move to evaluation of the healing system per se.

For most people, their ‘baseline’ symptoms have been fluctuating in a certain ‘range’ of good days and bad days.  During the course of treatment, they will begin to have more ‘good’ days, fewer ‘bad’ days.  It may take more activity to ‘cause’ the worst pains.  Recovery from a symptom flare after increased activity may be much ‘faster’.  Sleep may improve.  People may begin to feel more energetic as their burden of pain begins to lift.  Stability in joints may be noticeably better.  Range of motion and flexibility may improve.  Headaches and other referred symptoms may begin to wane, or to disappear.  Toward the very end of the course, symptoms may even be ‘intermittent’—there may be days that are entirely symptom free.  At the next visit we will examine carefully to see if there are any remaining markedly tender structures.  If there are, these should be treated, but if there are prolonged symptom-free intervals, the course is almost complete.