Pain and function: a physiotherapist’s view of the body
Pain and function always go hand in hand — one disrupts the other and vice versa. In this piece, I share my thoughts as a physiotherapist on why an X-ray doesn’t always tell the truth, and why the root of one shoulder’s pain may actually lie in the ribs or pelvis.
Why pain and function go hand in hand
Pain has been a subject of research for decades. People talk about trunk stability and psychosocial influences, and a huge number of studies have been done — yet no absolute truth has been found.
Doctors see pain as inflammation, to be treated with medication. Physiotherapists see weakness or movement patterns. Manual therapists and chiropractors talk about hypermobility and hypomobility. The psychological side can’t be set aside either — pain affects the mind, and the mind affects pain. For the average person, the picture of all this can stay quite blurry.
There are also big differences among the specialists themselves. In Estonia, physiotherapists with very different backgrounds are at work — from chair exercises for older adults to manual manipulations. One bad experience doesn’t mean physiotherapy doesn’t work. It means you haven’t yet found the right person.
How the body compensates — the shoulder joint as an example of pain and function
You often hear that the spine is a robust structure that can tolerate a lot of load. True — an X-ray, CT or MRI alone can’t tell you whether a person has back pain or not. But this robust structure is surrounded by highly sensitive sensors: ligaments, nerves, connective tissue and the joint capsule. All of them talk to the central nervous system.
When one area compensates for another, a joint ends up under more load than the surrounding muscles can stabilize. That is where dysfunction is born. For example, a lack of flexion in the shoulder joint starts to be compensated by shoulder elevation, i.e. hiking the shoulder up.
The shoulder joint itself is a floating joint — it attaches to the scapula, which glides over the ribs and articulates at the front with the clavicle. If the foundation is unstable, cracks appear in the house. The scapula rests on the ribs, the ribs on the spine, the spine in turn on the muscles and finally on the pelvis. Every link needs control.
The notorious rotator cuff isn’t the only player in shoulder stability. The triceps and the latissimus dorsi also play their part. When the shoulder goes too far into external rotation, the latissimus dorsi kicks in. When it goes too far into extension, the biceps steps in. During movement, the muscles around the bone are constantly coordinating — including muscles you wouldn’t normally think about.
Personal experience: when pain and function get tangled
About 7 years ago I had to leave my previous office job because of severe back pain. According to the radiological studies, this pain “shouldn’t have existed”. I went through the same runaround as many others, until I eventually qualified as a physiotherapist myself.
The consequences were constant neck pain and difficulty breathing. Pain in the middle of the chest locked up the neighboring ribs, which in turn affected the diaphragm. The body blocked one side of the abdominal and back muscles in order to restrict movement. A cascade like this isn’t common, but it isn’t exactly rare either. It eased during my studies and then showed up in a different form later, during intensive strength training — I got a strange shoulder injury, which, as a physiotherapist, I found very interesting to untangle.
Practical takeaways for dealing with pain and function
Overloaded muscles gradually start asking for help from more distant muscles — the neck, the spinal erectors, even the hip. That is why pain has to be looked at broadly, and the root cause isn’t always easy to find. That doesn’t mean working on it is pointless. On the contrary: a problematic joint or muscle can tell the nervous system to reduce maximal strength even in movements that at first glance don’t seem related to the pain.
A simple truth: take care of your old injuries. Foam roll. Go to the spa. Visit a masseur and a physiotherapist before pain comes looking for you.
FAQ — about pain and function
If the X-ray is clear, is the pain “all in your head”?
The sensation of pain always arises in the brain, but that doesn’t mean the cause is imaginary. The problem often lies in movement mechanics, which imaging doesn’t show.
Do painkillers solve the problem?
Medication can relieve the symptom, but if a dysfunctional movement pattern is behind it, the pain returns as soon as the medication wears off.
How do you find a good physiotherapist?
One bad experience doesn’t mean the profession doesn’t work. The level of specialists varies a lot — ask for recommendations, look at their experience, and find someone who looks at the body as a whole.
Author: Georg Laasik
Source: WHO – physical activity.
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