With a fresh injury, the first question may be fairly straightforward: what got hurt?
With chronic pain, I usually have to ask a much bigger question: what has the body done since it got hurt?
Maybe you stopped rotating through one side. Maybe your hip tightened because you were protecting your back. Maybe one shoulder began doing the work of the other. Maybe the nervous system became increasingly sensitive to a movement that originally was painful for a very good reason.
By the time I see some chronic-pain patients, the original event is only one chapter of the story.
That is why I am interested in the timeline. What happened first? What changed next? What treatments helped, even temporarily? What made things worse? What activities disappeared from your life? What has become “normal” that was not normal before the problem began?
Those questions help me understand the adaptations.
This is also why repeating the same treatment that helped during the acute stage may not be enough months later. The body in front of us today may be dealing with a different combination of restrictions, sensitivities and compensations than it was dealing with at the beginning.
Chronic pain deserves patience, but it also deserves curiosity. We should be looking for meaningful changes in motion, function, tolerance and confidence—not simply counting visits.
If you have been dealing with the same problem for months or years, a fresh evaluation should look at the whole history, not just the painful spot.
–Marc Bonacci, DC, PMMTP
