I Don't Know What's Going On!

A quick 4-minute read...

I get a lot of emails and questions from therapists telling me they constantly struggle with feelings of self-doubt and uncertainty about why someone has pain and if what they are doing is the best thing to help it.

And I always say to these therapists… "GOOD, I'M GLAD YOU DO!"

That's not to be a nasty, uncaring bastard, but to help them understand that feeling uncertain about what’s going on and unsure if you're doing the right thing is a normal and very good feeling to have.

Although it feels awkward and uncomfortable not knowing exactly what’s going on or what to do, it means you are caring about your patients’ issues and outcomes and thinking hard about them.

If you don’t have these feelings, then perhaps you are not thinking or caring as much as you should be.

And if it's any reassurance, I can tell you that I have these same feelings very often when I see patients, even after 25 years of clinical practice and now as a so-called highly specialised and skilled physiotherapist.

And despite all the arrogant idiots on social media or teaching their courses claiming they know exactly the cause of someone’s issues and what the best treatment is... THEY DON'T

Often, we can not know with any certainty what is causing someone’s pain because there are always multiple factors contributing to everyone's pain.

Even with something as clear and simple as a broken bone, the pain a person feels is not only related to their broken bone.

Pain is never as simple as a broken bone or torn tendon, a tight or weak muscle, a stiff or loose joint, or even fear and anxiety.

Pain is messy, confusing, complex, and uncertain, and all our treatments for pain work differently on different people for many different reasons.

However, just because we have a lot of uncertainty a lot of the time, this doesn’t mean we can’t and don’t help people in pain.

Because rarely do you need diagnostic certainty to help someone with back, neck, shoulder or knee pain.

You also don’t need diagnostic certainty to help choose the best treatment for someone’s back, neck, shoulder or knee pain, because none of our treatments work specifically or better for specific pathologies.

However, that's not to say you never can have diagnostic certainty, because sometimes you can and sometimes you absolutely need to.

For example, if there is something more seriously pathological or sinister contributing to someone’s pain, then it's going to need further investigation and management other than physiotherapy.

But again, having diagnostic certainty about whether they do or dont have these more serious or sinister issues is also often incredibly difficult.

But what you do need to know with far more certainty, other than what pathological diagnosis they have, is what movements, tasks and other factors are contributing to someone’s pain, and what issues and concerns they may have about them.

So to all therapists worrying about not knowing exactly what's going on or what to do about it, remember it's common, normal and good to feel this way.

Also, remember you don't need an exact pathoanatomical diagnosis, and you don't need an exact treatment plan all figured out either

Becuase at the end of the day, we don't just treat pathology, we manage people with problems far more.

As always, thanks for reading

And until next time, stay uncertain and keep on keeping on!

Adam