Root Causes Don’t Exist
There’s no such thing as a root cause to your injuries.
Whether you have a one sided achy joint that likes to flare up on you from time to time, an acute overuse injury, or experience chronic constant pain- likely you want answers. This is why you reach out to medical practitioners in the first place.
The Internet is an absolute ZOO with watered down oversimplified information on pain. If you type in “how to fix back pain” on youtube, every video will be different. Pain and rehab can be confusing to navigate since there is no consistency in reasoning.
Ultimately, pain is individual and has to be treated as such. We can aim to draw parallels from case studies and common impairment findings, but it is never that simple.
Unfortunately rehab providers want to be right above the actual needs of the client so they can stand out against the competition. Having some fancy answer that no other Physio or Chiro has thought about. They hold the key to ancient info that’s never been discovered or published in textbooks before. Just take my money now!! Fix me magic man!!!
Let me explain what I mean by root causes
A root cause is the fundamental reason or underlying issue behind a problem or event. It's the core factor that, if addressed, would prevent the problem from recurring.
Say you go to a Physical Therapist to be treated for wrist pain as an over zealous practitioner of handstands. The PT may infer that the root cause is stemming from lack of scapular elevation strength causing more pressure through the fingers and over reliance of wrist muscles.
But how can we explain being pain free with exercises that rely on greater end range wrist extension like planches?
On the other side, therapists are also quick to blame the injured joint directly. For instance, if you have knee pain- build more resilient knees. Or if you have flexion related back pain, progressively load those tissues with Jefferson curls. However what if that further exacerbates their compensations and makes things worse?
The reality is, sometimes X marks the spot and the painful region needs to simply build capacity progressively.
And sometimes improving how the neighboring joints move and share load can offload the painful area.
Even sometimes rest and doing nothing fixes the issue.
Most of the time you need a combo of all these in a systematic and staged approach
I feel bad for the patient nowadays in a watered down healthcare system. If you go to 3 different therapists, you'll probably hear 3 different root causes.
Somebody with the exact same objective findings can have two different pain presentations
If you show 3 different radiologist's an MRI you may also get 3 different interpretations of that image
The point is- even after an individualized assessment, we really still can’t claim this is a single root cause to specific pain related diagnosis.
We can’t catch pain with a fishing pole, we need a fishing net! Gather as much useful subjective and objective information as possible related to the injury and address all of it. Leave no stones un turned!
^This was the real game changer for myself as I was working through my hip injuries.
I was told my hips were in pain for so many different reasons each by different therapists I saw. For example- because my foot didn’t pronate, my hip capsule was stiff, I had tight hip flexors, it’s because of the labral tear (no hope, sorry), my breathing mechanics were off, I had a weak gluteus medius, my pelvis was twisted, and my internal rotation was non existent.
Could you imagine how confused I was at the time!?
10 different therapists, and 10 different answers. Who do I trust at this point?
This I why I became a Physical Therapist originally- because of my own frustrations with the health care system.
Id encourage clinicians to stop trying to find one root cause to pain. Put the patient first and take past injury history, objective impairments, previous experiences with physio, and demands of their performance based tasks all into account.
And from a patient perspective, don't look for someone to find a root cause. Take responsibility for your injuries and accept your current situation. No rehab plan will work if you dont. Most importantly find a rehab provider that advocates for you over trying to sound smarter than you.
Overtime your bullshit detector will progressively overload just like your muscles and joints will :)
What is your experience with pain? Feel free to email back, I’d love to hear your stories.
If you have some on going injuries and would like guidance, feel free to book a free discovery call HERE