Vail health column: With pain management, the solution is in the story
Would it make sense to wait for the engine to blow before adding oil? Of course not! We would acknowledge the warning signs: an illuminated check-engine light, the smell of burnt oil or a puddle under carriage. We know from these cues to look for the source — a worn gasket, a leaky valve, a missing cap. Treat the underlying issue, and disaster is averted.
Why don’t we follow this same logic when it comes to our health? The common approach to health care is equivalent to adding oil once the engines blown. The blown engine is pain. It is when the body has lost its ability to self-heal and self-regulate. Even though it’s the last player to show up for the dysfunctional party, we wait for pain.
Rather than looking for the source, we treat the pain. It hurts “here,” so we tape/brace/needle/cut “here.” Or we get films of “here” to confirm it is damaged. In the United States, we are statistically very good at proving there is damage but rather ineffective when it comes to resolving the pain. Research from the American Pain Society shows the annual cost of chronic pain in the United States is as high as $635 billion per year.
Here is the thing: Nothing happens for no reason. Pain has a story. It doesn’t come uninvited, and it sends plenty of messages that it’s coming. We just ignore them. The clicks, tension and tingling try to warn us. The problem isn’t that we are in pain but why. What if we focused more on the story, not the symptoms?
Take, for instance, a torn meniscus (cartilage in the knee) or a torn labrum (cartilage in the hip). After dealing with years of tweaks, pops and imbalances, we finally feel pain. We get an MRI to confirm the damage. After conservative therapy and then surgical repair (and maybe repeated bouts of each), we still have the pain. Maybe there is more to it than the broken bit.
The story: It all began with a sprained ankle 15 years ago. When the ankle rolled, one of the 26 bones in the foot got stuck. So the foot technically stayed in a rolled position. To make walking normal, the foot had to compensate by over-pronating (flattening arch toward the floor). Doing this means the knee has to rotate excessively. The foot isn’t moving enough, so the knee takes up the slack. Knees are much better at bending and straightening than they are at rotating. In time, the meniscus tears and the knee hurts.
And it continues. After the meniscus repair, the foot still doesn’t move enough. You brushed off that old sprain and so did everyone else. That old sprain left you with limited dorsiflexion (bending of the foot toward the shin). This shortens the end of your stride. To compensate, the hip will rotate forward to “clear” the leg on the back swing. As the hip stays forward, the glute muscle loses some of its leverage. It stops being very good at pushing you forward, so the hip flexor muscles have to work harder to pull you forward. In time, this imbalance pulls your hip off axis. A ball-and-socket joint works best with the ball centered in the socket. In time, the strained labrum tears, bone spurs develop and, of course, the hip hurts.
The story can and will continue. We’re pouring oil in but not finding the leak. It’s in the story. We have 206 bones and 639 muscles and our unique experiences with them all. There is no one size fits all with health care. Something got the ball rolling. The solution is in the story.
Julie Peterson, MPT, is the owner of Concierge Physical Therapy Colorado. She is a certified neurokinetic therapy specialist with a strong background in manual therapy. She can be reached at 970-306-3006 and firstname.lastname@example.org. For more information, visit http://www.conciergeptcolorado.com.
Heroes look like these guys: Bill “Sarge” Brown, Bob Parker, Pete Seibert, Sandy Treat, Dick Over, Hugh Evans and so many others from the 10th Mountain Division who helped win World War II and, while building the peace, also built the ski industry in the United States.