Understanding Patient’s Pain
Thoughts from: Dr. Michael Reinhardt, DPT, OCS: Performance Physical Therapist, Resilient Performance & PT & R2P Academy Instructor
Why Does My _____ Hurt?! This is a question I hear countless times per day.
“I just don’t understand why this hurts so much!?”
Pain is highly complex, multifactorial, and unique to the individual dealing with it.
The first step in managing pain is often to determine what type(s) of pain is being experienced.
The approach to addressing pain that has a clear mechanical and chemical causation (which is the case with most acute and traumatic injuries such as a ankle sprain or muscle strain) is very different than when dealing with a chronic pain presentation that does not follow a clean and reproducible mechanical pattern.
Tactically, it makes a tremendous amount of sense to approach chemical, tissue, and acute nerve injuries through the lens of protecting the area from subsequent injury, re-introducing non-provocative movements as tolerated, and using pain as a fairly reliable barometer of how much is too much. In this instance, pressing into significant pain is inadvisable and counterproductive to the natural healing processes.
However, the same tactics should not be deployed when dealing with more chronic and inconsistent pain presentations. In such cases, the limiting factor is most often not the mechanical integrity of the painful area, but rather due to a heightened sensitivity and responsiveness of the brain and the nervous system. This is often described as “learned pain,” in which the brain more readily senses pain due to the frequency and duration of past pain signals.
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