As a physical therapist in private practice, I’ve had the opportunity to work with thousands of patients over the years. I’ve streamlined my intake process collect the data I need to efficiently move through the initial evaluation process and make an assessment of needs.  My intake form has changed over the years, based on my needs, as well as the demands of insurers, but the form always has offered the new patient an opportunity to tell their story.

The question that I ask is “How did your symptoms begin?”. This offers the patient an opportunity to move in any direction they choose, from dry, objective reporting to rather lengthy dissertations on how they believe their issues began. The relatively small space which I provide on the form appears to inhibit some, while others with continue their story on the back or add additional pages. Their story is important me as well as to themselves. But, over the years, I have taken note of some interesting things related to people’s stories. Excuse my reaching back to my mental health degree for this, but it seems that most of us have a need to have our pain make sense to us. The story we tell seems to make it all seem like a logical result of the preceding circumstances.

“My neck hurts because I sleep on my stomach”

“My right shoulder hurts because I am right handed and that is the arm I use for most things”

“My left shoulder hurts because I am right handed and I use the left arm to stabilize”

“My low back hurts because I have a family history of low back pain/arthritis/sway back/flat back”

“I have a twisted pelvis/one long leg which makes my back hurt”

“I have foot pain because my feet are flat/I have foot pain because my arches are too high” (OK, which is it?)

“My posture is bad”

“I must be sleeping wrong” (I love this one!)

“My back hurts because my core is weak” (I hate this one!)

“My neck hurts because I was told I have ‘Military Neck’ ” (I hate this one even more!)

The stories are each unique, but have a repeating theme. It seems we all wish to make sense of our pain, to feel like we know the cause, so that we don’t do it again. But how often to we really know the “why” of it all? I use a hypothetical example in treatment, one that we have all heard variants of over the years. I tell folks:

We’ve all heard stories of the person who bent down to pick up a pencil and their back “went out”, never to be the same again. It is doubtful that that episode took them from having no issue whatsoever to being fully incapacitated; it was a series of unfortunate events, most so inconsequential that they barely noticed them.

While this is a hypothetical example, I don’t feel it is far from the truth in many cases. While the cause of a pain may be obvious in the case of a direct injury, how do we account for the wild fluctuation in how different people respond to similar injuries?

Do we, as health professionals, allow these stories (often myths) to continue, as a means to justify our existence, to continue to perpetuate myths without regard to truth? While we may have no better insight into true causation, do you intercede, pointing out implausibilities of their “story”? We all have our favorite theories, as well as behaviors we both encourage/discourage. To some the “military neck” is crucial. Military neck is what some practitioners use to describe a neck with reduced degree of curvature/lordosis. Some say that this lack of curvature lessens the neck’s ability to act as a shock absorber and leads to pain/dysfunction. I see this and many other deviations from the norm as part of the grand Bell Curve that exists among us and is not necessarily an issue.

I used to believe, even recite, many of the above stories as reasons that pain existed in my patients, but no more. It was coming to understand the “normalcy” of postural asymmetry which made me look closer (See my blog post “1.6%). If only 1.6% of us have a perfectly aligned spine (not to mention everything else that may accompany that spinal curve in regards to postural asymmetry), and the remaining 98.4% of us (me included) do not necessarily have pain, what exactly do we think we are correcting and why? These are not exactly popular topics of conversation in the manual therapy/body work fields, as entire modality empires have been built around correcting faulty posture as a means to address pain and dysfunction. Changing postural deficits seems to create improvements, at times, but was it the change in posture that helped the pain or was it the manual interventions that were performed along the way that were helpful?

Ultimately, our story is our own and few friends are made by challenging someone’s core beliefs. I seldom come right out and discredit my patient’s stories. I do, however, try to look beyond their story and attempt to make sense of it from my own professional frame of reference.

What stories have you heard that you question?

For now,

Walt Fritz, PT

Foundations in Myofascial Release Seminars