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Find the Why Behind the Pain – By Mark Austin |PT

Posted 7 months ago on

Most people go to physiotherapy because something hurts. Working in downtown Calgary, I get a lot of clients who show up with pains that have developed gradually and just won’t go away. Sometimes they can’t even clearly pinpoint the exact time that the problem started. They may have tried unsuccessfully to sort it out on their own, and now they have come to the conclusion that it’s going to take an outside source to deal with it.

Despite all the uncertainty surrounding their pain, the common assumption is that to correct the problem they need to have the sore area massaged, needled, lasered, shocked, taped, ultrasounded, or scraped. Sure, these are often helpful tools in relieving pain and might even enhance recovery, but physiotherapy entails much more than just sitting back and having someone else work away at the problem area. To get you feeling better and back to doing what matters most for the long term, treatment needs to go beyond focusing on just the symptom. We must consider why the pain developed.

Why do you have pain in your shoulder? Before we spend half of your session ultrasounding where it hurts, how about we assess the surrounding areas? Perhaps there is some stiffness in your mid-back, which can lead to stress on your rotator cuff. Or maybe its actually referred pain from your neck. You might think, ‘my hip flexors are tight, so I need to stretch my hip flexors more!’ Before we start stretching, how about we figure out why your hip flexors are getting tight to begin with? Is it adaptive shorting of the muscle tissue from long days of sitting? Or are they tightening up to compensate for a weakness in your core? In the case of the latter, stretching or mashing on it will only provide temporary relief, and sometimes even make the problem worse over time. Why are you getting arthritis in your knee? Joints don’t usually become inflamed or break down for no reason. Maybe your ankle is stiff, or you have poor control of the muscles surrounding your hip. Both can result in excessive stress on the knee and may accelerate tissue breakdown, leading to pain and inflammation. These are just a few of some very common scenarios that I see in my practice. If we don’t consider the why, how can we develop an effective treatment plan and keep the chances of the problem reoccurring to a minimum?

“We must consider why the pain developed.”

Often, the ‘why’ isn’t necessarily something we want to hear because addressing the ‘why’ usually means  there is something we must take ownership over. It means there’s homework involved, like making lifestyle changes, exercise, or correcting a posture or movement pattern. This takes time, effort, consistency, and mindfulness. For the physiotherapist, homework doesn’t make for attractive marketing either. Instead, a lot of what we hear about in physiotherapy marketing is the quick fix: shockwave therapy to blast away your plantar fasciitis, dry needling to force that muscle to relax, electrodes to dull the pain, and so on. This passive approach to recovery sounds attractive because its easy for both the patient and physiotherapist, but it’s not always the most effective. The patient gets to pass the buck rather than take charge of their own well-being. This doesn’t always work, and when it does usually the problem returns.

The quick fix doesn’t often exist. Tissues don’t restructure themselves without regular movement, nerves don’t rewire overnight, and it takes more than a few quick sessions where you get to take the back seat to sort them out. Don’t get me wrong, I’m not arguing that these treatments are not of benefit. Many of the techniques I mentioned can really help you feel better. I use them myself as part of my practice. That said, if we aren’t also addressing why your pain started, we are likely only going to get a temporary recovery. Simple problems start to become chronic conditions. Costs add up. Patients start to drift from practitioner to practitioner, looking for the magic new technique that will solve everything, or lose faith in the profession altogether. They may opt instead for medications, steroid injections, or surgery.

“As a patient, if you really want to maximize your odds for success, you also need to take some responsibility for your own recovery.”

Look for a physiotherapist who is a problem solver. They should have a curious mind. They should educate you and provide you with a treatment plan that provides short-term pain relief but also addresses the why underlying your condition to keep you feeling better for the long term. As a patient, if you really want to maximize your odds for success, you also need to take some responsibility for your own recovery. This means more than just showing up at the clinic. It means making changes, following through, and moving. The effort is worth the reward, physically, psychologically, and financially. At the end of the day, you are your own best tool in recovery. As physiotherapists, yes we often do have a lot of useful skills up our sleeves, but we are also here to guide you and empower you, and with empowerment comes success, health, and happiness.