Top 5 Fridays! 5 Recent Pain Stories and How Patients Got Their A-Ha Moment

Explaining pain is an art and science, like anything else in our profession. It's certainly not the panacea some make it out to be, but then again, nothing is.

However, when present something in a novel way, with an analogy, humorous story, or metaphor, sometimes things just click and BAM, fear avoidance lowers. Here are 5 recent cases I have evaluated and things I said that made it click

1) Gymnast with wrist pain after fracture

at the end of her season, she fell off a scooter, landed on out stretched wrist, but did not think anything of it
after an entire day of practice the next day, she complained of wrist pain
she wore a brace for 2 weeks, then after no improvement, had an MRI, diagnosed with distal radius fracture, and was immobilized for 6 weeks
currently c/o stiffness and pain with active wrist extension and WB wrist extension (very important for gymnastics)
I told her about pain/threat, etc, then said, when you fell and fractured your wrist, you had no pain, not until you actually practiced using your wrist
it hurt worse after you got your MRI and were immobilized, and now you are clear after x-ray and you still have pain
hurt does not equal harm - this she got because of the lack of pain immediately after fracturing it - no threat, no pain

2) Left shoulder pain

patient in mid 50s, saw me 8 years ago (when I was a much different PT) for chronic lumbar pain
currently had insidious onset of severe and painful loss of shoulder elevation
after explaining pain as an output related to perceived threat, I said, "One of the best pain researchers in the world asks if you can feel two pains at once."
this immediately clicked because it turns out, her chronic lumbar pain went completely away upon fracturing her foot - which she now knew as her brain doing threat prioritizing

3) Full thickness rotator cuff tear with shoulder pain

was recommended surgery but did not want it
very worried and anxious about his surgery
is a 5 star chef
I explained a full thickness tear as a piece of steak, and a knife happens to go all the way through, possibly in the middle, and leaving the rest of the steak intact
thus it's full thickness, but overall the muscle can still function, and why PT can work to restore movement and function
he said this explanation was why these 2 visits of PT worked, and his previous 8 weeks of PT did not

4) Chronic pain patient

I have been working at restoring her function and her gradual threat reduction for 3 years now
after repeated visits, sometimes weekly, sometimes less, she finally "got it" regarding pain as a threat and not as harm or damage
she actually needed to read a similar message on a CRPS website and newsletter for it to click - so it was not just me
the lesson learned here is, if you are not reaching the patient, you may want to have them view one of these videos, read Why Do I Hurt, or this ebook by Dr. Greg Lehman, so you're not beating a dead horse
but an A-Ha moment we both had when I was recently doing some PNF on her hip in a fully flexed position to reduce the threat of an FAI like pain, she said, "This would hurt if I did not trust you."
so she even knew that the pain was an output, and not based on position or movement

5) Chronic TMJ and cervical pain patient

tried to do his own cervical retraction and self treatment, was working on breaking up prolonged sitting etc
no relief with any self treatment
I had about 20 minute pain science session with him, also describing that sometimes patients need hands on treatment to reduce threat and dissociate pain with movement/position
after demonstrating improvement in cervical and mandible motion, and making it so he could perform cervical retractions without irradiation of scalenes and upper trap, he felt much better
turns out he is a OT/CHT who does GMI, is into pain science, uses mirror boxes, but said, "Even though I explain pain daily, I couldn't get it out of my head!"
I told him even Lorimer Moseley had a very painful frozen shoulder experience he blogged about - even though he more found it fascinating rather than disabling

The last case will be published in the coming weeks on Modern Manual Therapy, sign up now for only $4.99/month or $49.99 year, 280 videos and counting with partners providing additional content!

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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