Pain but no trauma?
MSK Pain but no trauma
We have all suffered from an onset of physical pain and wondered where it came from, asking ourselves ‘what did I do to cause this?’. Many times if you go to see an osteopath (other physical therapists are available) you will be asked if there was any obvious cause at the time of onset. Many times we therapist hear the answer ‘no’.
There are a number of things that it is worth bearing in mind in such circumstances:
In the absence of trauma do not assume that this is tissue damage: you may not have torn muscle or ligament. Ideally you should not receive the advice that it is repetitive strain or micro trauma particularly if there is no identifiable pathology. You may instead be provided with a label that the problem is ‘gardening related back pain’ rather than an injury, for example. This enables the practitioner to explore and target modifiable factors that are relevant to the patient’s pain experience.
You should not be referred for imaging (X-Ray, MRI, US) unless the therapist believes that this will directly influence care or if there is a suspicion of serious pathology. This is because many images come up with false positives, for example disc bulges in the spine, or evidence of wear and tear or tearing of certain structures). This leads to the risk of mislabelling and identifying these as the source of the pain. All this can impact the person and lead to unnecessary surgical procedures.
A clinician should always reassure the patient and provide ‘evidence-based’ explanations for the symptoms.
One significant model for treatment that clinicians of all types are beginning to consider is the biopsychosocial model of care. Pain is modulated by the interplay of the biological, the psychological and the social factors of each individual. The latter two include things like sleep, attitude to work and social life and the types of support from friends and family.
The use of this model ensures that the treatment approach is patient centred and there are screening tools that can be used as part of the assessment.
What is particularly important is that the practitioner delivers positive messages about pain during the examination and treatment. It validates the experience of the patient but reduces the perception of threat. Pain during the examination and treatment should be identified as tissue sensitivity rather than tissue damage.
It is essential to reinforce the fact that the body is strong and adaptable. The patient may be encouraged to try certain movements that may otherwise cause fear or avoidance strategies.
A slow steady programme of loading based on timing not pain experience will promote confidence and reinforce the idea that movement and loading are protective.
Adapted from: Caneiro JP, Alaiti RK, Fukusawa L, et al There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport British Journal of Sports Medicine 2021;55:75-77.