Truth bomb: We don’t always know what is causing your pain!

Libby O'Sullivan

When you have pain or discomfort, it is perfectly natural to seek answers. You might see your choice of health professional and ask:

’What is wrong with me? Why has this happened? How can I fix it?’. This is because “one of the principal qualities of pain is that it demands an explanation” (‘Plainwater’, Anne Carson)

In response, we will ask you a series of questions, do a few tests and give you our best, educated theory.

Acute injuries (like sprains, strains and fractures) can be quite straightforward to diagnose and can usually be confirmed with imaging (like xray, MRI etc).

hand fracture

However, in the case of persistent conditions, like lower back pain, diagnosis isn’t always as simple.

woman back painWhat you might find is that the ‘diagnosis’ will differ, depending on who you speak to. For your back pain for example:

  • a physio might say your deep abdominals are weak and not supporting your spine properly
  • a chiro might say your spinal or sacroiliac joints are ‘out’
  • an osteo might say you have abnormal rotation in your pelvis and
  • an acupuncturist might say your ‘Qi’ is impeded.

You might even get three different answers from three different physios! And this is all in response to the SAME PAIN! No wonder people are confused about what is causing their pain…

The truth of the matter is, these are all theories based on our understanding of the body within the context of how we were trained.
So which one is right?

Possibly none of them! All of the examples given above are structural explanations for pain, which are difficult to confirm and even more difficult to agree on. Even if you have a disc ‘bulge’ on MRI, or ‘degeneration’ in your knee on XRay, it may not be relevant to your pain. Numerous studies using XRays, CT scans & MRIs have shown that the presence of pathology (like a disc ‘bulge’ or joint degeneration) does not reliably correlate with that person’s pain. That means you can have 3 disc bulges on a scan and NO back pain. On the other hand, you could have no changes on MRI and still have persistent back pain that just won’t settle.

So what is really causing your pain?

To understand this, we must really understand what pain is and how it works. Generally speaking, pain is an unpleasant feeling in our body that makes us want to stop and change our behaviour. It is not always a measure of tissue damage, but a complex and highly sophisticated protective mechanism (Moseley, 2015).

The most important things to remember are that:

  • Pain is a survival mechanism designed to protect the body
  • Pain is an output from the brain, not an input from the body and is not a reliable indication of what is happening in the body.
  • Pain does not always equal harm and harm does not always cause pain
  • The brain can think the body is in danger, even when it isn’t (eg phantom limb pain, where the perceived ‘threat’ does no exist)
  • Pain can be increased when the nervous system becomes more ‘sensitive’ to stimuli from the body. This is often the case in persistent or ‘chronic’ pain.

So, all we REALLY know about your persistent pain is that your brain thinks your body is under threat and that something has to be done about it. Anything else is just a theory and not always relevant to your recovery.

* The topic of pain is BIG one. For some more great info, check out this article by Better Movement or this one by Lorimer Moseley

So how should you treat your pain?

Essentially, your pain will often be improved by:

  1. working out what is causing the brain to feel threatened
  2. reducing the threat.

This doesn’t mean that techniques we use like mobilisation, manipulation, massage, dry needling, taping etc shouldn’t help. Often they do! Just not for the reasons you might think. For example, a manipulation isn’t putting anything back into place and massage isn’t increasing length in your muscles BUT they might be providing non-threatening stimuli to the brain to help reduce perceived threat and thus reduce pain!

So, the best health professional to treat you is someone who:

  • understands pain and where it comes from
  • you like and you feel comfortable with
  • listens to you and understands the impact your pain is having on your life
  • understands your goals for treatment

GLOW Physio understands pain and is committed to getting you back to all of the things you need & enjoy to do as quickly as possible. To check out the benefits of choosing GLOW Physio, click here.