Pain vs. Function?

Many clients ask me why I work on certain areas when their pain is in a different location. In the physical therapy world there are two main ways of thinking about patients and treatment. Both have their time and place.

One philosophy concentrates on pain, what structure in the body is painful, and applying direct treatment to that area. In this type of approach modalities such as ultrasound, electrical stimulation, cold laser, and others are used directly on the pain producing structure. Manual therapy techniques including massage, joint mobilization, and stretching may be used. This type of treatment is useful when someone has a new injury and the body has not compensated by becoming tight or weak in other areas. This type of treatment is straightforward and when the correct structure is identified, usually effective.

In other situations, however, such as a chronic or recurring injury, treatment directed to the pain producing structure may only give temporary relief. Other structures in the body may be tight or weak, yet not painful. These dysfunctional structures may place an undue strain on the painful area not allowing it to fully heal or making it vulnerable to reinjury. In this case it is important to evaluate how the rest of the body may be affecting the injured area. Treatment to these other areas is important. Equally important is educating the patient in the type of problem they have and what changes they can make in posture, work habits, and exercise to avoid reoccurrences. This type of treatment focuses on function. By improving function, painful areas no longer have irritating stress placed on them and can remain pain free.

By taking into account the length of time the injury has been present, the predisposing factors affecting the injury, and the way a body functions as a whole, the therapist can determine which type of treatment would be most useful. Many times a combination of the two treatment philosophies is indicated.