As a Physical Therapist, one of the patterns I have observed over the years is that approximately 85% of patients that arrive for an initial evaluation with active pain complaints, dread the one question I will invariably always ask them. “Was there any event that led to the pain you are having?” A vast majority of patients are confused and sometimes frustrated by the lack of an event, or a mechanism of injury that can help them understand the presence and intensity of their current pain.
In the case of overuse injuries, pain is the result of a progressive accumulation of stress or trauma on a joint or soft tissue. This trauma can be secondary to the overall amount of use, and or due to poor / inefficient body mechanics. Generally speaking, there are four stages that most overuse / overload injuries go through, and I will try to present them the way that patients explain them in clinic.
1) Stage 1: “I typically have some stiffness and soreness after activity, but it is not significant, and it does not affect my ability to perform that activity.”
2) Stage 2: “I have pain during and after activity, but it does not affect or restrict my ability or desire to perform that activity.”
3) Stage 3: “I have pain all the time, and it is severe enough that I have to modify or restrict my activities.”
4) Stage 4: “I have pain all the time, and it is severe enough that I have been unable to continue my activities.”
As a society, we tend to be very goal oriented, and therefore, most patients don’t tend to seek help from a medical provider at the first sign of distress, but rather will wait until they are some
where between a stage 3 and 4, and their performance or function is affected. This is the equivalent of having the check engine light go on in your car, and consciously making the decision that it is ok to get it checked out at the end of that 5,000 mile road trip.
Due to the fact that most overuse / overload injuries are slow and progressive in nature, stages 1 and 2 are usually dismissed as “I must have slept on it wrong” or “I must have overdone it, and it will go away on its own.” A good general rule of thumb is, it will typically take the same amount of time to overcome an overuse / overload injury as it has been present. Therefore the quicker the dysfunctional movement pattern or posture are corrected and or activity modified, the shorter the overall recovery time. The focus of a Physical Therapy intervention should be placed on helping patients understand why they developed symptoms in the first place and why they have persisted or worsened. If a patient can understand what has happened, it is then possible to help them understand how the exercises, or manual therapy provided will help them get better long term. A patient that understands why they are performing specific corrective exercises and understands how to perform them appropriately can in may circumstances do 90% of their recovery in a fairly self directed manner, thus decreasing total number of visits and healthcare dollars needed to achieve a good long term restoration of their function and activities.
PT of Costa Rican National Soccer Team for 2007 World Cup in Victoria, CAN. Clinical Instructor for University of Minnesota Doctor of Physical Therapy Affiliations
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