If you have peered into this particular blog, let me start by saying that pain is NOT a weakness. Across a lifetime, it is an inevitable thing we face – ALL of us – to some degree or another, for various reasons. As it pertains to physical therapy, perhaps the most appropriate definition of pain is this: “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” – From Nolan, 1990 – after Mersky, 1979. Let’s examine that a bit closer. It is both sensory AND emotional, and relates to both actual AND potential tissue damage.
Some of us who have ventured into the office of a doctor or other health care professional only to learn, by way of x-ray or some other imaging or diagnostic tool, that there does not seem to be a reason, at least anatomically speaking, for the pain that is being experienced. Upon hearing this news, a variety of different feelings can emerge, but unfortunately, feeling validated is too often NOT one of them. This is especially true when an individual is either told directly, or it is implied that the pain is “all in their head.” And this might lead one to think “if it IS all in the head then I must be weak for struggling with this.” While it’s true that the pain in fact, IS all in the head, that does NOT mean what most people think. In short, it means that it is a central phenomenon and that the signals originate in the brain even though they are experienced at a specific region of the body. This is where the experienced and compassionate physical therapist comes into play as one who understands that if it is real to the individual, then it is in fact real, regardless of what the imaging may tell the individual. The good news is that pain is NOT necessarily indicative of tissue damage. The bad news is that the pain can be perceived as a cruel or dreadful fate that is closing in to systematically rid the person of their quality of life. To paraphrase Stanley Paris, known widely as one of the greatest advocates for the physical therapy profession: “pain is when something is hurting, but suffering is when you are hurting and have no idea WHY!” I suspect most all of us have been there at some point.
So how can a physical therapy regimen treat the pain which encroaches on quality of life and even threaten one’s livelihood? Well, it goes something like this in my experience. Physical therapy is a wonderful art and science in which the individual being treated and the therapist are making a collaborative effort to OPTIMIZE FUNCTION. To reference Stanley Paris once again: “Joint injury, including such conditions referred to as osteoarthrosis, instability, and the effects of sprains and strains, are DYSFUNCTIONS, rather than diseases.” In breaking complex, every day movement patterns down into their constituent parts (and then re-integrating them as a whole), skilled physical therapy will train the individual to discontinue maladaptive movement patterns and diligently learn the proper ones. This is accompanied by skilled manual therapy interventions to optimize joint and soft tissue (i.e. muscle) mobility. Once the dysfunction is addressed people are very often surprised to see pain begin to fall by the wayside.
This is often not a linear progression, however. There are certainly “good days’’ and “bad days” in the rehabilitation process. Over time, as one sees that the “good days” are better, and the “bad days” are not nearly as bad, it is then that person sees the benefit of physical therapy. Pain can be deceptive! A classic example of this involves radicular symptoms to the legs (commonly referred to as “sciatica”). There are several causes of “sciatica” but for this example we will refer to the kind that originates in the spine. As things are improving, the symptoms do not radiate as far down the legs, rather they will “centralize” towards the low back from where they came from. This IS progress though it can be accompanied by a more focused and localized (therefore intense) pain.
We at Mobility Fit get excited about doing what we do. Because pain is more than just a number to be checked off on a 0 to 10 scale. It has context – whether that be work hours lost or confidence broken, pain is real and it has played a role in your story. DON’T LET IT DEFINE YOUR STORY. Let’s get to work, set the body in motion and don’t look back. The time is now to optimize function!
**For a more detailed look at the complex nature of pain, please read the blog from Dr. Matthew Sigler RE: Pain Science.