Why does pain keep coming back?
Lumbar radiculopathy
Pain is one of the main reasons people come into physical therapy. Hands-on work which typically includes soft tissue or joint mobilizations will help along with exercise, but there are times pain will return. For some this will be a short time after the visit or for others it could be days or weeks after. With soft tissue pathologies like a strain or sprain or with post-operative situations healing in the tissue could take time, but if that’s not the case there may be other things to consider that are contributing to the pain.
RADICULOPATHY OR REFERRED PAIN
Radiculopathy typically indicates pain that is coming from a nerve being pinched in the spine. If there is a disc herniation that affects the nerve, for example, the pain could present itself in the extremities even as far distally as the ankle or the hands. The most common radiculopathy is ‘sciatica’ which is when the sciatic nerve is affected. So even though the pain feels like it’s directly coming from an area of the body and treatment is applied there, like say the buttock or hip region, it could actually be coming from the lumbar spine. The same could be true for shoulder or scapular pain that’s coming from the cervical spine.
Myofascial trigger point referral pattern
There is also something called referred pain. Muscle fibers may have trigger points that refer pain to another area. For example, trigger points in the infraspinatus muscle will oftentimes refer pain to the front of the shoulder or down the arm which is where the person may feel it most. So if you treat the forearm or anterior shoulder with hands-on treatment it may feel better temporarily but pain could return since the trigger points in the infraspinatus muscle were not treated. Referred pain could also come from visceral organs as well due to common nerve signal pathways. The most well known is left arm or jaw pain that’s coming from a heart issue.
COMPENSATIONS AND FAULTY MOVEMENT PATTERNS
Other times, compensation may be occuring from a different region of the body that alters proper control and causes a faulty movement pattern. For example, if someone had a bad ankle sprain in the past and never fully recovered, a lot of times there will be limited mobility compared to the good side. This could cause a host of compensations up the chain — overpronation in the foot, less hip extension with ambulation, more motion (extension) at the lumbar spine. In turn the lack of hip extension could also cause an underactivation of the gluteal muscles, which along with the pronation in the foot, would cause increased strain in the knee. The increased motion present in the lumbar spine could contribute to overloading in the joints and strain to passive structures over time. So someone may eventually come into physical therapy for low back pain or knee pain and get treatment in those areas, but without addressing the ankle mobility problem and/or faulty movement patterns, the pain could keep coming back.
Example of compensations up the chain
No matter how much soft tissue or joint work that is done to a certain area, it may not address the issue as a whole so a thorough, whole body assessment is strongly recommended to get to the root of the problem. Radiculopathy, referred pain, compensations, or movement pattern issues are common factors that could contribute to a person’s pain. Treatment that focuses on establishing and training “neutral” joint positions and proper balance of the muscles surrounding the joint could help to prevent pain from recurring. If however pain is coming from an issue that cannot be resolved with conservative methods alone, getting a referral to the proper healthcare professional should be considered for further diagnostic testing and treatment.
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