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But what happens when we are treating our patients and they don’t get better? They are paying you good money for you to fix them and they are not getting anywhere. It’s a problem that every therapist will have faced at some time in their career, the patient that you just don’t know what to do with.
You’ve done every orthopaedic test you can find in the literature. You’ve looked at them posturally, you’ve tested flexibility and you’ve tested strength.
Modern research into pain science is proving that an individual’s structure has a poor association with the level of pain they are experiencing.
It’s not like we even needed research to prove this as we’ve all had patients that exhibit this anecdotally.
Why is it that there are those with perfectly healthy spines that suffer crippling back pain?
In reverse why is it that there are those who have spinal degeneration that shouldn’t allow them to operate at all, yet carry on without any restriction (Kalichman et al., 2010)?
How do a third of asymptomatic individuals over the ages of forty have partial or full thickness tears of their rotator cuff yet maintain full shoulder function pain free (Sher et al., 1995)?
Not only is pain poorly associated with structure, it would seem that many traditional orthopaedic tests are also poorly associated with the structure that they are supposed to be testing and have little sensitivity to identifying pain (Simpson et al., 2006).
Sometimes we don’t need to know exactly which tissue is causing our patients presenting complaint as pain can have a multitude of contributing factors.As long as we have a working diagnosis and we’re treating something allowing our patient to make a positive progression then we are doing our job right?