5 Reasons Your Pain Isn’t Improving Despite Trying Everything

Pain and injury are complex things and at times can be long - lasting or come and go. Today I explore a few of the reasons people are unable to overcome an injury or are forced to stop doing certain things they enjoy despite seemingly trying everything.

TOO MANY “PASSIVE” TREATMENTS

Unfortunately with most musculoskeletal (muscle, bone, joint, tendon, ligament) conditions, there is no quick fix.

A passive treatment refers to a type of treatment that is administered by a health professional (or on occasions friends, family etc).

Many people believe in the idea that things like spinal adjustments, massaging out “knots”, an injection or even a surgery will solve all their problems.

In many cases, these treatments can assist, but with most musculoskeletal conditions an active management plan will be required to make a full recovery.

NOT ENOUGH “ACTIVE” TREATMENTS

An active treatment refers to a type of treatment that the patient/client performs themselves

This is mainly in the form of exercise but could include psychological management strategies.

In even the most severe and acute injuries, some form of exercise will be suitable.

When you don’t do anything, your bodies tissues become weaker, more sensitive and less tolerant to load.

You need to find the right level for you but then make sure you progress it.

DOING TOO MUCH OR TOO LITTLE

After an injury or with long-standing pain, you will almost certainly lose your ability and capacity to perform certain tasks - whether it be exercise, sport, leisure, work or day-to-day activities.

Rest will allow pain to settle or avoid situations in which pain will arise but it will not help you get back to being able to perform these tasks.

Rest for too long, you become weaker, more sensitive and your overall health deteriorates. Push things too hard and you have flare ups leading to increased sensitivity, fear of making things worse and a negative experience with exercise.

You need to find the right level and then progress it.

NOT GIVING IT ENOUGH TIME

Studies show that musculoskeletal conditions with take 8 -12 weeks to improve. This does not mean you lay on the couch for 3 months and then your problems are solved.

People will often say they’ve “tried physio” but this might have only involved a couple of sessions involving some massage and basic exercise. You will not need to go to the physio for ever but it is important to follow up to make sure you are progressing, doing things correctly and at the right level.

Slow progress is better than no progress and if you can avoid having ongoing issues, surgery or medications it will be well worth your investment.

INCORRECT DIAGNOSIS

This can work two ways - not picking something up that is causing a problem OR picking something up that isn’t a problem.

Many medical or inflammatory conditions can masquerade as musculoskeletal problems - these could be auto-immune conditions affecting the musculoskeletal system or it could be other medical problems that create pain or referred pain.

Non- musculoskeletal conditions often will not fit a certain pattern and it is often the case that it can be detected with appropriate questioning and assessment followed by specific tests or imaging.

On many occasions, images can pick up abnormalities that may not be causing any pain. Disc bulges, cartilage and tendon tears are often normal findings in the pain free population. People will often live in fear due to the fact that they have a disc bulge but the evidence suggests that people who have never had back pain (and probably never will) may also have a disc bulge!

CHRONIC PAIN CHANGES AT THE BRAIN

When you’ve had pain for a even a few weeks, you get used to it and you develop increase awareness of your affected body part. As mentioned earlier, soft tissue injury will almost always settle down or heal within 2-3 months. Pain can remain due to changes in the central nervous system.

Immediately after an injury or painful episode, pain is an important protective mechanism. It is a message from the injured tissue to your brain to be careful. This is okay to begin with but if you continue to think you are in danger, the pain will continue long after tissue healing has occurred.

If we go back to the earlier point about doing too little or too much, if you protect it too much it becomes overly sensitive and if you go too hard if increases sensitivity. If correct pacing and pain management strategies are implemented, it is possible to build your activity levels and get back to pain free living. It just takes time, patience and good advice and guidance!