Hey, Where is that Pain From?

Have you ever asked someone where they are from?  Sure, you have.  Have you noticed a breadth of answers in terms of history time-line?

For example: Some might say

  • “Oh, I’m from Hillcrest Neighborhood” (immediate History)
  • “I’m from Virginia” (current History)
  • “I grew up in Boston” (Childhood / Distant History)
  • “My family-line is from Poland” (Distant History)
  • etc… and on.

How far back do we normally go?  Perhaps it depends on who is asking the question, and what the context of the conversation is about.  We could keep going, no doubt, but we might loose the context of the communication at some point.

We could, instead of Poland, say “I’m German” (depending on the time frame you wish to stop and associate with).  Or you could say Roman, or Ottoman, or Mesopotamian, or, depending on your religious preference, I’m from Jellyfish. The point being, we stop and associate at some point in the past with “where are you from.”

Relating to Physical Therapy: “What is this pain?” (As current up-to-date PTs/SPTs, we all know that pain is an output and a perception… so I will not elaborate on that) Often patient’s feel pain in their muscles, a tightness, a burn or ache, etc. Or perhaps it is a joint pain.  This can be termed ‘Immediate History’ as it relates to “where are you from.”

We can answer the “what is this pain?” in many ways, depending on who we are speaking to, and the context of the conversation.  How far back do you want to go…?

For example: we could say…

  • That is muscle pain, I will treat the muscle: rub it, stretch it, ice it, etc.
  • That is joint pain.  I will mob it, manip it, rub it, stretch it, ice it, etc.
  • That is neurogenic pain.  The nerves supplying that muscle/joint are irritated for ‘x,y,z’ reasons.
  • That is pain as an output, neurogenic, and involves beliefs and fears, emotions, etc.  We can treat that with education and positive input to the system, etc.
  • That pain is Na+ bouncing down an axon in your anterior cingulate gyrus… etc, and on.

What’s the point here? The point is that we need to know and understand where people and pain are coming from.  We’ve got to get to the source, input/output, injury at some level along the spectrum… and this answer depends on who you are talking to, and what the context is.  Some patients will just not get behind the idea of pain as an output, others will embrace it and come back having scoured YouTube for Lorimer Mosley vids between sessions.

We are not trying to treat the symptom, the muscle tightness for example. (tight paraspinal muscle from a protective reaction of the spinal nerves from a decision made by the brain…)  If we think the muscle is the cause, we perhaps are missing the point (if the muscle is ripped/torn, well then, please don’t assume the muscle needs to be ignored… although the feeling still comes from the brain.) 

In the same sense, however, we must remain in context.  We may not be able to solve a problem with the ‘Hillcrest Neighborhod’ by addressing the ‘Jellyfish.’

How far back do you go?  What do you think you are treating?  Are you looking for a Driver, a tissue? If someone is muscle-centric, will they not get as good results as you, who is neuro-centric?  I suppose it comes down to your ‘Why?

I tend to see the source, or the great inter-actor, as the nervous system, brain, perception, etc. But that doesn’t mean I don’t treat muscles that are tight.

Searching for the right historical balance…

Matt D

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2 thoughts on “Hey, Where is that Pain From?

  1. Pingback: Tell me a story: A metaphor for understanding analogies | PTbraintrust

  2. Pingback: A Year in Review | PTbraintrust

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