Have you been going to different practitioners trying to find the answers to your sore knee, hip, back, or shoulder? Are you getting enough sleep at night? Are you feeling stressed, managing your nutrition?

Have you blamed a muscle or body part for your patients’ sore knee, back, or shoulder?

We as practitioners need to stop trying to find an easy solution to pain. This is something all of us are guilty of, at one point or another. A patient is presented to us with a problem that has been affecting them for weeks, months, years – it’s only natural that we want to make them feel better as quickly as possible. As a consequence, promises of quick fixes have led many people to bounce between practitioners trying to find that one solution to their pain. 

On the flip side, patients need to take responsibility for their own education and understanding of their pain. 

At uni, we are taught that the body is made up of levers. There are uses for this model but when it comes to chronic pain, structuralism is not always the answer. 

There may be movements that feel like they cause an immediate reaction (back pain when bending over to pick up your keys or tying your shoes). However, contrary to social media/family/friends/next door neighbours, the answer is not going to be a single area that “didn’t activate” or “is overused”. This has led many to believe if you’re hurting in this spot, you need to work on that area to make it feel better. This unfortunately, has led to many of the problems practitioners and patients alike face when addressing pain. 

If pain is not structural, where does it come from?

This is difficult to answer as there really isn’t an answer.

Introducing… The Biopsychosocial Model!

The biopsychosocial model asks us to consider the biological as well as the psychological and social aspects of your, or your patient’s, lifestyle.

We can consider biological factors like inflammatory markers, nociceptor sensitivity, pathoanatomy, or neuropathology, however, this does not create a holistic image when we look at pain. Following a traumatic incident, there is upregulation of nociceptors and inflammatory markers near the trauma site that acts as a protective alert system to tissue damage in the area. The body is meant to heal itself and these inflammatory markers help to do that. This is what makes us more sensitive to movement. It is important that biological factors are taken into consideration when treating patients, however markers such as tissue damage are not the only explanation for what makes patients perceive pain. 

This is where the biopsychosocial model is utilised to allow us to better explain pain. The BPS model incorporates contributing factors that help explain why an individual may feel varying degrees of sensitivity day to day.  @hannahmoves has an incredibly effective tool for explaining how we utilize the BPS model with our patients as seen below

Poor nutrition, stress, anxiety, fear avoidance, poor sleep, training volume and past experiences will all contribute to how your patients feel day to day. It’s important that we address all of these factors when it comes to communicating with our patients, not just focusing on a single issue. Explaining pain science and incorporating motivational interviewing techniques with our patients is how we ensure long term results.

How do we relate this to a patient experience?

Take for example this scenario; a patient books in for a consultation with a history of non-specific lower back pain. They are a young professional used to training in the gym 4-5 days per week with preference to HIIT-style group classes. They have seen doctors for scans, chiropractors, physios, and osteopaths, and have yet to come across a consistent answer that will fix their problem.

The difficulty with this scenario we see all too often is that there is no real answer and trying to educate someone that after several weeks, months, or years of bouncing between professionals, is a challenging task. Scan reports can be useful in some instances for diagnosis but they can not explain a sensitivity experience. The holistic view of understanding pain science helps us understand our patients.

Being able to better understand the multi-faceted nature of pain, how and why it occurs, will help every allied health professional (and their patients) become better practitioners.

How do we become better at what we do?

Continue your educational journey and listen to your patients. There is always going to be something to learn but finding the right resources can be tough. Education is not just for practitioners but for anyone experiencing pain.