In pain? Please assess, don’t guess!
If you follow me on IG, you may have seen my new series: If _____ hurts, try _____.
And if you don't follow me on IG, what even are you doing? Hit the link here to take you to my account!
My intention for this IG series is two-fold: to encourage people to get assessed by a skilled practitioner when they are experiencing pain AND to recognize that most of our firefighting population will wait months to YEARS before doing so. I'm hoping to provide them with some temporary pain relief in the interim.
“No man has the right to be an amateur in the matter of physical training. It is a shame for a man to grow old without seeing the beauty and strength of which his body is capable.”
Before we go too far, let's rap about the term *injury* for a second. Injury implies damage to the tissue caused by either an acute insult or a long-term overuse situation. A soccer player can injure their ACL by being involved in a collision, and a runner can injure their bones (stress fractures) by increasing mileage too fast too soon. Both of these injuries cause pain and the pain is primarily due to damage to the tissues.
That said, there are many examples of experiencing pain long after the tissue has healed and even in the absence of tissue damage (an injury) in the first place! Did you know that amputees often feel pain in the absent limb for months or even YEARS after the limb is no longer there? And likewise, many of those nagging shoulder aches, low back pains, and knee stabs are not tissue damage, but a simple request from the victim. Quite often in a painful situation, it's the victim screaming while the culprit remains silent. It's your hip that's the likely culprit for your low back or knee pain. And as Dr. Perry Nichelston says, "Pain is a request for change."
I know the firefighting population pretty well. As a nearly 20-year veteran of the fire service, I've seen firsthand the suffering that goes on far too often and far too long. Firefighters are fearful of finding out there is something "damaged" or "broken" so they simply suffer...not in silence because that's not our style. They suffer LOUDLY.
But the majority of the time, we're suffering needlessly, and that's sad.
What should you do?
In the absence of a traumatic injury, always assume the BEST, not the WORST. Instead of: "Oh no! I probably have a torn rotator cuff", think "I might have a strength or mobility issue in an area unrelated to where I'm having the pain. And because I'm not an expert in assessing pain, maybe I should seek out an expert!" {And then seek out said expert!}
In some states, you don't need a 'referral from a doctor to see a Physical Therapist. It's called direct access care and it's awesome. There are a few rules depending on the state. In my state, the therapist can only see you for a set number of visits and it the case is something complicated or that might require imaging, they have to send you out for a doctor's referral.
Speaking of imaging, a note on that. Not every pain requires imaging. In fact, in the absence of a traumatic injury, there usually isn't a reason for it. Of course, this is on a case-by-case basis, but keep in mind that just because the expert sees *something* on the imaging, that's potentially not even your source of pain. I'm usually not a fan of citing older studies, but this one is a classic. 98 asymptomatic individuals were given an MRI and 64% of those individuals were identified as having an operable pathology. But they weren't in pain! (Jensen et al., 1994)
Now imagine if one of those patients with a pathology presented at a physician's office and got an MRI because they WERE in pain. That physician then might likely point at the image and say "Well! There it is. That's why you're in pain." And that patient just got an operation for a pathology that might not even be the root of the problem.
Someone I know has severe degeneration in their hips (identified accidentally via imaging on the low back for a traumatic injury). The physician casually stated "Well, I guess we'll see you in a few years for bilateral hip replacements!" This person does not suffer from hip pain almost a decade later. Be careful with imaging.
Other potential sources of a pain evaluation include Occupational Therapists, Athletic Trainers or Chiropractors who practice atypically.
Things to think about:
3 times per week for 12 weeks and twice a week for the rest of your life are business plans, not care plans. Move on to the next professional if that's their suggestion.
Truly talented practitioners are eager to see you LESS rather than MORE. They want you to be working on your own progress independently. Once per week while you're in acute pain and then 'as needed' until you're back to normal is a solid plan.
'Mill' type centers where the practitioner is seeing you and 3 other people at the same time aren't optimal for your care. If possible, seeking out a cash-based practitioner will likely save you money in the long run. Those practitioners' care isn't determined by insurance codes; it's determined by what the patient actually needs. Usually, you're better far faster.
Final thoughts:
If you're in pain, assess, don't guess. If you're in the Chicago-land area, John Campione and other practitioners at The Movement Guild have been my go-to therapists. You can check out their website HERE.
AZ is out for now, but one small ask. If you found this information interesting or helpful, please share it with a firefighter you know!
Jensen, M. C., Brant-Zawadzki, M. N., Obuchowski, N., Modic, M. T., Malkasian, D., & Ross, J. S. (1994). Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine, 331(2), 69-73.
