Even small, very-fixable problems can cause a lot of pain (or other symptoms). And very often that pain is magnified or compounded by fear - fear of more pain; fear of not being able to move, to work, to return to exercise; fear of the need for invasive treatment. If people had a basic understanding of how the musculoskeletal system worked, they would be better equipped to fix their problems themselves. More importantly, though, they would not have to be so afraid and anxious as they would know that almost all problems are fixable with movement.
I severely burned my hand once. Despite immediately submerging my hand into an ice bath, the pain was intense. As I cried, I repeated aloud to myself: it’s just pain, it’s just pain, it’s just pain. I intrinsically knew it wasn’t something that was going to cause any real problem and I wanted to assure myself that I had nothing to fear. In essence I wanted my cognitive brain to override my emotional center and let the facts win. I simply had to minimize the pain as much as I could, get through it, and I would be fine. People often know this when it comes to cuts, bruises, burns, and the like. They know that despite pain, they don’t have much to fear. This needs to translate to musculoskeletal problems as well. -- Laura
Let’s say I am helping someone fix her shoulder derangement. If I have the correct diagnosis, I expect significant improvement quickly with an exercise in a specific direction - and eventual 100% return to normal. Let’s say we figure out that direction (often it’s extension or functional internal rotation). By finding that positive response to that direction of movement, we confirm our diagnosis and therefore establish a reasonable prognosis.
Now, here are other factors that could affect the ability to get the problem 100% resolved: patient’s shoulder position at work, at play, while sleeping; patient’s compliance with the home program; patient’s performance of the exercise; stress level; diet; lifestyle factors (eg smoking); other health issues; environment; genetics; patient’s belief system/expectations; how the problem affects the patient’s life; and other people’s input/opinions.
For this reason, I often use the words “should,” “likely,” and “in most cases.” Yes, there are many problems that, in my head, I think are 100% fixable; but I know that, until something is 100% fixed, it’s not a given. There are numerous factors when it comes to addressing problems with the human body and mind. As a clinician, I set expectations based on interpreting all the available data. -- Laura
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