First of all, it must be considered that pain 'happens' for some reason, it is not a random event. The body is expressing it for some reason and this reason is legitimate. As therapists, we should ask ourselves during treatment 'Why is the body doing this?'
The first thing to say is that the cause of the pain is not inflammation. Inflammation is the result of an insult. If you cut your finger, there is pain and inflammation. There was an insult, in this case the cut, which is the real cause of this pain. However, taking anti-inflammatories is not a remedy for the cause, they only reduce the inflammation resulting from the underlying cause.
THE CAUSE OF THE PAIN MAY NOT BE IN THE EXACT POINT WHERE IT IS PERCEIVED
Osteopaths know this. For example, irritation of the dura and the autonomic nervous system can be sources of severe pain. The causes of this pain may not be structural but also derive from nutritional deficiencies in the area.
THE MUSCULOSKELETAL SYSTEM IS NOT SEPARATED FROM OTHER SYSTEMS
The musculoskeletal system provides important informations on what's wrong and will reflexively respond to problems in every other tissue. When an organ is affected by a pathology, including not being in a correct position, then the muscles above it, surrounding it, will contract and make that area sensitive. Osteopaths with a capital O treat all structures, not just the musculoskeletal system. In addition, there will be changes, musculoskeletal variations at the level of the spinal segments associated with that organ. Many medical specialists believe that the gastrointestinal, cardiovascular systems, etc. have nothing to do with each other, including the munsculoskeletal system. This perspective is only an assumption of doctors. The musculoskeletal system can tell us where the problem may be, no matter what tissue it is.
THE PAIN IS OFTEN NOT WARNED BY THE PATIENT
Many pains are felt only during palpation. This does not mean that discomfort that is painful to the touch is less important than that actively felt by the patient. It is precisely this pain stimulated during palpation that can give important information about what is going on.
ALL STRUCTURES ARE IMPORTANT
It is important for men to categorize things in order of importance. Many therapists treat only structurally because they consider the 'structures' to be more important than other compartments (eg viscera). If we recognize that we make these classifications, then we can realize that the body does not schematize in the same way. We can say that a finger is less important than the lungs because we can live with an amputated finger. When attached, the body does not treat the finger as an inferior structure of lesser importance than other structures.
EVEN THE SMALLEST STRUCTURES CAN CAUSE PAIN
The entire medical community believes that pain can only come from structures that appear on x-ray or MRI. But this is a clear sign that pain is not evidence based.
Example: Suppose a patient comes for pain in the coracoid process of the shoulder. It may be thought that it may be a structural dysfunction in the rib cage. A thoracic spine with very pronounced kyphosis can vary the positioning of the shoulder blades on the rib cage, generally by pushing them forward. Structurally, a chest problem and the change in orientation of the scapula can lead to a small pectoral in a state of reflex contraction. Pectoralis minor pain can support this hypothesis. This can therefore be a cause of pain in the coracoid process. However, we cannot stop there. We may want to consider the state of the coracobrachialis muscle and the short head of the brachial biceps and their possible tenderness, things we might expect to find. A dysfunction of the olecranon process of the ulna can cause a contraction of the biceps, which again leads to pain in the coracoid process. It is also important to consider the influence that the collarbone can have on the coracoid process. There are ligaments between these two structures that can become dysfunctional. With this in mind, it is possible to check if there is a dysfunction in the glenohumeral joint that you can be sure there is, if there is a scapula pushed forward. Sometimes the tension of the biceps and pectoralis major can compress the humeral head into the glena. Finally, one might consider evaluating the acromioclavicular joint with shoulder dysfunction, which may have an effect on the coracoid process, given its proximity. Treatment of all these structures can relieve the patient by improving the range of motion. However, all this can sometimes only improve and not 'restore' the patient's condition, because perhaps this disorder is related to other, non-structural dysfunctions. For example, consider the autonomic nervous system and the influence of the dura on this pain, through the innervation of certain visceral systems.
Having a deep and 360-degree understanding of the problem you intend to solve can help in solving even very complex cases.