The current state of physical therapy and pain rehabilitation is one centered around tissues and movement. Patients expect tissues and movement to be addressed as the primary root of their pain. Clinicians spend the majority of their time focused here.
If something is tight, is should be loosened.
If something is weak, it should be strengthened.
If someone is moving/standing/sitting incorrectly, it should be re-educated.
Etc., etc., etc....
The recent success of the "Explain Pain" revolution has, for the majority of clinicians, forced them to acknowledge (often through forced smiles) that pain is indeed a construct of the brain. And yet this inconvenient truth has done little to change the paradigm under which the vast majority of our profession operates.
"Phantom limb pain is crazy! Pain is actually coming from your brain. Now let's fix your posture and stretch those hamstrings..."
The sad truth, I believe, is that the wealth of work detailing the role of the brain in the construction of pain has improved the average clinician's understanding of neuroscience, but has done little to alter the modus operandi of the the therapist-patient interaction. Despite the evidence, we are failing to understand the interplay between the numerous factors implicated in the production of pain. How can the clinician be expected to apply something they don't fundamentally understand?
These factors, broadly, are contained within the realms of the physical, the cognitive, the emotional, the social, and the behavioral (per the definition of pain. I've added the behavioral category to include lifestyle factors and choices). Each factor is relevant, in unique amounts, to each and every patient experiencing pain.
EXAMPLE:
Two hypothetical patients sprain their ankle. The mechanism, situation, and subsequent tissue damage is identical. Patient 1 is a former patient with whom you have already established a therapeutic alliance. He is anxious to get back to sport, is not distressed by his injury, and is confident it will improve. He has a desk job. He is financially stable. I've illustrated his pain-contributing factors and reported pain below:
Patient 2 has had poor success with physical therapy in the past. He verbalizes concern that the injury may sideline him for an extended period of time. He is fearful of re-injury and distressed over the potential for a fracture. He explains that a close friend was "never quite the same" after her ankle sprain. He is a waiter at a local restaurant. He lives paycheck to paycheck. I've illustrated his pain-contributing factors and reported pain below:
It is my hope that this overly simplistic example illustrates my point: that there are a multitude of factors underlying the pain response. That these two patients, despite identical injuries, can have very different responses. That their unique response requires unique rehabilitation.
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The goal of this website is to discuss the application of the principles discussed above, both in analysis/evaluation and in treatment. In turn, I hope to help promote a paradigm shift in the way rehabilitation professionals approach people experiencing pain.