Your Pain Often Isn’t Where Your Problem Is Part 2

When we are treating someone experiencing pain, it’s crucial to know two things. The first is to have an idea of what hurts. You don’t have to be exact, in fact therapists are known to be terrible at identifying the structure causing back pain, for example (See Citation below). You just need to have a general “working diagnosis” of what is going on. If a problem in the leg is coming from the back you need to know that much, as discussed in our last post, here.

The second and more important thing to know is why it hurts in the first place. If you know why something hurts, you can treat it. Sometimes this involves a LOT of problem solving, but this is much safer to problem solve than a diagnosis of what hurts. For example if sitting hurts, can I sit in a different position? If running hurts, can I change the way I run? Can I strengthen my core to reduce unwanted movements? These are all testable theories.

In our last article we talked about figuring out “why” something is causing pain. Building on that, we can talk about subtle mechanisms of injury or micro trauma as one of those causes. We know micro trauma doesn’t cause all persistent or chronic pains. Some may be caused by central sensitization (see this post) but other pain can be caused by repeated activities that can be hard to figure out.

If you sprain your ankle, that’s easy to diagnose. That’s one big injury which causes one course of pain. But what if it’s more complex than that? For example, if every time you sit your back hurts then it may be best to change the way you sit. The example I give here is “well Doc, every time I go to the bar I get punched in the face” my advice is usually “Don’t go to that bar” A bit over simplified, but making simple changes when there’s pain can help. In the case of sitting it’s unavoidable and part of life. Instead of never sitting again we need to change how you are sitting to avoid your pain getting worse again.

Citations:

Vining RD, Shannon ZK, Minkalis AL, Twist EJ. Current evidence for diagnosis of common conditions causing low back pain: systematic review and standardized terminology recommendations. Journal of manipulative and physiological therapeutics. 2019 Nov 1;42(9):651-64.