I Don't Know What's Going On!

In this newsletter, I want to talk about not knowing what's going on in our patients.

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 treatment to help it.

And I always say to this… GOOD!

That's not to be a nasty, uncaring bastard, but to reassure them that feeling uncertain about what’s going on and unsure if you're doing the right thing is a very 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 assure you that I still have these feelings often when I see patients, even after 25 years of clinical practice and as a highly specialised and skilled physiotherapist.

And despite all the arrogant idiots teaching courses and on social media claiming they know exactly the cause of someone’s issues and what the best treatment for it 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.

And that's because you don’t 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.

But you do need to know if there could be something more serious or sinister contributing to someone’s pain that needs further investigations and management.

And you do need to know 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 of you worrying about not knowing exactly what's going on or what to do about it, remember it's good to feel this way... it means you care and are thinking.

But also remember you don't need an exact pathoanatomical diagnosis, and you don't need to know an exact treatment plan either

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

As always, thanks for reading

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

Adam