“Why are you looking at my hip, I have knee pain?”
“Why are we doing repeated motions on my neck, I have shoulder pain?”
“Why are we needling my shoulder blade, the pain is in my arm?”
These are typical questions we see and you may see as well. How do you explain these to your patients. Do we go into research on regional interdependence? Do we go into a thorough explanation into pain sciences?
A good therapist understands the importance of pain science and for their patients to understand their issue. However, a recent post that was linked by the Erson (the manual therapist) encouraged me that simple use of analogies may be just as useful. One applicable point is the importance of being able to “condense concepts and reduce challenges into simpler ideas.”
Can you explain why you're looking up and down the kinematic chain simply? can we have them go “ well that makes sense” consistently?
Well i'm not sure if these are great and consistent but I like to always keep things simple. Here are a couple of my pain explanation analogies:
Purpose: explain that pain is an output/response to chemical stimulus.
“Imagine you're by a campfire. you put your hands near the fire to warm them and it feels great. However you either keep your hands there for too long (posture) or move to close (repetitive movement) and feel a quick sharp pain that makes you pull away. Are you mad at your body for feeling this? Of course not; it was there to protect you! Additionally, your body is responding like it did for the fire by causing pain because of the chemical and mechanical stresses sent to it from the muscle. Pain is just a response, like just pulling away from the fire. If we put out the fire (movement dysfunction), we will stop the pain!
Purpose: explain referral of pain
“Imagine you're driving your car over a bridge or through a tunnel (not hard for people to understand in Hampton Roads). A nearby car cuts into your lane and is about to hit your side. How do you respond? You swerve, hit the brakes, hit the horn. But what else happens? Your heart rate jumps, you begin to sweat, time seems to slow. Any why? Your body is performing several mechanisms to respond to the potential risk of injury and then it tries to protect you. Its the same for the muscles! Your body will have several strategies to protect the muscle from potential or further injury. It will stiffen, weaken (inhibit), and send more pain to other areas, sometimes much further away, as a response to the risk of injury. Your muscles have the predicted response as to the risk of injury. It “alerts with pain tenderness and referral (think of the referral of a heart attack), weakness (secondary to inhibition), and distributed motor function. Lets stop the risk of injury and we can remove the deficits with it!
“River Dance Analogy”
Purpose: motor control deficits and influence of synergistic muscles and treating other, non painful muscles
“When our shoulder (or insert joint) raises, several muscles are becoming engaged even down to the deep core and breathing muscles. In fact 18 muscles alone attach, and have influence, on the scapula. That’s like 18 river dancers moving in perfect rhythm. And if one dancer falls out of rhythm it will affect the rest of the dancers potentially or at least ruin the sound (kinematics). So just because one dancer is off, other muscles will begin to be disrupted. Likewise, one muscle is off and other muscles will have dysfunction as well as proper scapular positioning being incorrect.”