Where Did This Pain Come From?

By Dr. Bradley Cipriani, DPT, OCS, Cert TMM, HKC

When someone has a problem anywhere that I am trying to address, I do this under the assumption that some combination of the following two principles are happening:

1. The way this person moves is stressing their body in an abnormal or problematic way, and has over time resulted in some type of flexibility and strength imbalance. It is not until they get a little too weak, little to tight, little too out of balance that they now have pain from something that has quite possibly been building up for a long time.
   1. EXAMPLE: I assume when I have the thought in my mind ” Get up from this chair” and I get out of the chair…That is a success. I wanted to be out of the chair so I told my legs to get me out and they did. Even though I accomplished what I wanted it doesn’t mean that was the best most efficient way to do it. Maybe my knees collapsed inward increasing the pressure on one side of my knee, which caused excessive inward rotation at my hip, which led to increase strain on my lower back during this activity that I do a lot everyday of my life. Its like many short cuts in that it works fine for a while but ultimately becomes more of a problem in the long run (knee arthritis, back pain, etc)
   2. EXAMPLE: From what I understand about our kidneys, we only need one and even that one does not have to be fully functional for a person to live a completely normal life. I believe the value  is around 20% meaning you can live a relatively normal life with 80% of your kidney dead and not even know it. It’s not until you hit 81% that you are now sick and having kidney failure. The idea is that none of us are walking around at 100% health anywhere on our body and we don’t need to be, we just need to be above the threshold that becomes pain (if we get our glutes a little stronger and our hip flexor a little more strength into a stretch position maybe that takes us out of the pain zone)
2. Same as above but the reverse. This person has been in pain which has impacted the way they move, and they automatically begin to move in a way that causes less pain. This may work initially but over time this leads to dysfunctional patterns that stress other aspects of the body abnormally to work around a weak link.
   1. EXAMPLE: It hurts in my right knee when I get out of a chair, so I shift more weight onto the left knee when I stand up, and that doesn’t hurt so I do that now. My problem of right knee pain is solved until my left knee starts to hurt because i am putting a lot of pressure on it to ease the pain in my right knee. Now I get momentum by quickly rocking my head forward and straining at my back to get me up…which leads to back pain. The question becomes: Is there something we could do to improve the stability and function of that right knee so I can get of the chair using both legs like I should?

*Current research continues to show that MRIs and X-rays done on populations of people WITHOUT pain show significant arthritis, meniscal tears, disc herniations/bulges, stenosis, and other abnormal findings once thought to require immediate surgery. The health of our body is influenced by many factors including the structural integrity of our body revealed with imaging, but it is also greatly affected  by other factors including strength, flexibility, diet, body weight, cardiovascular health, circulation, and many others. Modification of any of these may very well make a formerly painful activity like getting out of a chair not painful (I stretched my quad…I strengthened my quad/hamstring/glutes…I lost 30 lbs….I push through my heels and squeeze my butt when I go to stand up which gets my glutes to assist in the motion…any of these or a combination may result in less or no knee pain) A good healthcare provider will direct your attention to the cause of the problem and attempt to address it through conservative means. The most important aspect is that you understand the root of the problem and the plan to address it makes sense to you.