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Peelin' Those Onion Layers

As a physiotherapist, I peel metaphorical onions for a living. Layer by layer, I begin to understand the source of pain or disability and if I am successful, I discover the root cause. Sometimes the root cause is physical, sometimes psychological and in the case of chronic pain, it's most often a mix of both.

If someone comes in with knee pain for example, we must look above at the hip, and below at the ankle (there's two layers right there) and get a complete history in order to understand the mechanism of injury and treat properly. If this pain is "acute", meaning that it is directly related to soft tissue damage and/ typically lasts only a few weeks, this is baby onion... maybe a few layers and we are good to go.

What happens when the pain has been kicking around for years and is no longer accompanied by tissue damage? Everything has healed, but the pain is still present and possibly at higher intensities. Well... this would be considered a bigger onion and this is what makes my job interesting. To peel these particular layers, it will require more listening, more compassion, more empathy and may produce more tears during the process. Getting to this core isn't easy for anyone, but it is necessary if we want to make any sort of change.

Pain is always influenced by a unique set of inputs to the brain, and it is my job to help the person sitting in front of me uncover what "inputs" are influencing their personal pain experience. These biological, psychological and social inputs come in all different thicknesses. Past experience, mood, stress, drugs, alcohol, lifestyle, culture, diagnostic imaging, socio-eco status, stigmas, tissue damage, personality, pain catastrophizing etc. all have an impact on how someone experiences pain and these are the crucial layers to see. Once we can see and acknowledge these layers, with hard work we can strip them away one by one. The person living with pain can begin to simply move more and slowly get back to doing the things they love doing all because we chose to investigate.

How can we treat the pain without understanding the source? Simple- we can't.

This short post is meant to highlight the fact that people should never have to feel ashamed for experiencing pain they way they do even when the tissue damage has healed or the doctor says their scans are normal. As a matter of fact, tissue damage is just one input out of many that can cause pain. Just because some people's inputs are invisible and we haven't been curious enough to understand, doesn't give us the right to judge how someone should or shouldn't experience something.

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