Pain - A diagnosis or a collection of influences

When people suffer with pain, particularly when there is no obvious trigger, there is, naturally, a worry that the underlying problem could be serious. To reduce this concern we look for a diagnosis that allows us to rationalise why we are suffering but also to help us to manage the pain more effectively. In many cases this is possible. Examples of a diagnosis could be a tendonitis (inflammation of a tendon), appendicitis (severe abdominal pain) or a fractured bone.

However, many problems that arise from the musculo-skeletal system (ie joints, muscles, ligaments or tendons etc) do not occur as a result of injury or trauma. For many, pain starts as a result of the accumulative effect of normal day to day activities. If we look at our normal daily routines much of what we do is repetitive, especially at work. Although for many they would not described their normal activities as traumatic the repetitive nature can, over time lead to pain.  For others, pain can start due to a biomechanical problem, such as flat feet. People who have flat feet have altered working mechanics of the whole body especially the legs and this can lead to pain.

A good example of a pain that can not be given an accurate diagnostic title is low back pain. The term low back pain is not a diagnosis but a description of where the pain is being felt or arising from, however, it does not give any clue as to the structures involved or the influencing factors that are giving the pain. In such cases a thorough assessment is carried out to ascertain the various factors that are contributing. A typical example would be someone who has restricted hip movement which in turn can restrict the buttock muscles. This can lead to a movement restriction in the sacro-iliac joint (the joint where the pelvis attaches to the spine) which can lead to pain in the low back. In this instance there is little point just treating the spine if the hip is restricted.  Attention to the hip would need also to be included. Lifestyle and postural influences would also need to be addressed.

Although we all prefer to be given a diagnostic label when pain occurs, in many cases of musculo-skeletal pain it is a collection of influencing factors that needs to be identified so that accurate and effective treatment can commence.