Since my first year out of physical therapy school I’ve been searching for the elusive “magic pill” that would miraculously fix back pain (really any body part) with little to no effort exerted by me OR the patient, leading to massive amounts of fame and fortune that would allow me to travel the world curing people’s physical ailments while living a life of luxury. I’ve spent years and countless hours and dollars traveling to various continuing education courses that preach that their philosophies and techniques are the holy grail of alleviating physical pain and that all the other techniques out there are essentially witchcraft.
Luckily my first physical therapy mentor who ended up being my 1st boss in the PT world (Bob Seton out of Destin, FL) taught me on day one of my last internship of PT school that one size does not fit all. He told me that in order to provide the best care possible, sometimes (most times) we need to use “tools” from different treatment philosophies. He was essentially saying that nobody’s treatment philosophy is the end all be all and that we must go in objectively to each unique condition and “reach into our toolbox” to pull out what is best for that particular patient at that particular time. This was one of the most valuable lessons I ever learned in my professional career that has helped me overcome obstacles when treating difficult and complex diagnoses and ultimately assisting my patients back to a pain free life. But even with that valuable lesson in the back of my mind...
I still couldn’t help but to keep thinking that there must be an easier way to “fix” physical pain.
It was also around the beginning of my professional career that I really started to question what is really causing the pain response and how it differs from acute (new) pain vs chronic (long lasting) pain. I looked into chiropractic medicine and admired how somebody can limp into a chiropractor’s office in excruciating pain and walk out pain free! But then I couldn’t decide if this treatment was a true fix or just a bandaid when I saw how many of those patients “required” regular weekly/monthly visits to maintain “proper alignment.” I questioned it because if regular adjustments are required to maintain proper alignment, how in the heck did anybody survive before 1895 when the profession was officially started?
I’m not calling BS on chiropractic medicine, I’m just giving you insight to my thought process.
Another “quick fix” that amazed me initially was injections, specifically cortisone injections.
Similar to the previous paragraph, you can be in excruciating pain walking into the doctor’s office and feel like you could dance your way back to the car after getting that magical drug shot directly into your painful area. Well, “sometimes it could take a few days for the injection to take effect” but in most cases patients will experience relief immediately. Once I learned more about what is actually happening at the physiological level, I realized that cortisone injections are very similar to WD-40. Growing up we really only needed 3 tools: duct tape, WD-40, and a hammer. If it couldn’t be fixed with those 3 tools then you had a real problem…
Take this analogy for example, this makes sense to 99% of the people I’ve told it to. When your wheel bearing on your car starts to go bad, one of the first signs is you can hear a noise (usually a squeaky noise). You could easily spray some WD-40 on that wheel bearing and the noise would go away instantly. Until the WD-40 wears off and the bearing starts to squeak again. You can repeat this process multiple times however the length of quiet time usually begins to decrease with each application. Ultimately what is going to happen is your wheel is going to fall off and pass you by because the bearing finally disintegrates.
That process is pretty much synonymous with what is happening inside your body, especially when getting injections in your knee. You keep injecting that WD-40 (cortisone) into your knee which does a great job of taking your pain away. BUT it does nothing to fix the reason why your pain is there in the first place. And NO the pain is not there because “it’s bone on bone”! I want to know why it’s bone on bone to begin with. I could easily write 2000 words on that last sentence alone, and probably will sooner than later…
I will however admit that there is one and only one diagnosis that I actually encourage my patients to get an injection to help accelerate their recovery… and that is for hip bursitis. When the hip bursa gets inflamed it can be extremely painful and very challenging to calm down. This happens because the hip bursa is “used” with every single step you take so it never truly has a chance to “rest.”
My take home message for considering a cortisone injection:
if you plan on getting a second injection then you better plan on having surgery. I don’t know if I can think of a single person that I know that has had more than one injection who did not inevitably end up having surgery.
So my search continued for the elusive quick fix magic pill and it led me to Functional Manual Therapy. Functional manual therapy focuses on restoring the body back to it’s efficient state. This is where I transitioned from revolving my treatments around pain relief to not giving a crap about your pain and focusing on what your body is telling me. Sounds pretty intense when I say it out loud like that, but it’s true!
I’ll never forget the first time I heard my last boss and mentor Aaron Robles out of Jacksonville, FL say “I don’t care about your pain. I care about your function.” I think I had only been working for him about a month at that time and I remember thinking “what an a**hole.” But over the next 6-12 months as I learned more and more about functional manual therapy, I started to see my patients getting results that were higher level and longer lasting than I had ever seen before. This led me to diving all in to better understand the why behind these exponentially better results.
Super duper long story short
Functional manual therapy focuses on the problem causing your pain. Nontraumatic pain is 99% of the time the result of a problem that is occurring somewhere else in the body. For example, nontraumatic knee pain is caused 99% of the time from a deficiency above and/or below the knee itself. In my experience, the number one cause of knee pain is glute weakness. So because the glutes are not doing their job, the knee gets “overworked and underpaid” and that is what ultimately causes the inflammatory response and eventually pain to occur.
By now you might be wondering
“I thought the title of this was the quick fix magic pill? You haven’t said anything so far about any of those options being quick and magical.” And you’re right, none of those 3 options (chiropractic, injections, functional manual therapy) are magic AND quick fixes. Could it be because the quick fix magic pill doesn’t exist? Well I guess it depends on your definition of “fixed.” If your definition of fixed is being out of pain, then yes that absolutely does exist in a variety of options. Quick pain relief can be found at your doctor’s office in the form of prescription pain pills, at your orthopedic’s office in the form of surgery, and even at your local drug store in the form of OTC pills, creams, braces, etc, etc.
BUT if your definition of fixed is fixing the reason your pain is there in the first place, then the answer is no. Remember, we are strictly talking about non traumatic pain or pain that just started out of nowhere. What I’ve found throughout my career is that non traumatic pain is usually YEARS in the making. Seriously! At my Naples office location, we typically see patients over the age of 60 that have ailments that they attribute to “just getting old.”
I’ve discovered that most of the conditions that I treat on a daily basis are the result of a small thing that started 20-30 years ago which started the process of asymmetry within the body. Referring back to functional manual therapy, in the efficient state every joint in your body has equal pulling on all sides of it which essentially takes the compressive forces off the joint itself. Equal pulling can only happen when you have equal strength. And seeing how the vast majority of Americans sit much more than they stand, it should be easy to see how sitting can lead to asymmetry.
Think about when you are standing, your muscles have to fight gravity and provide balance for 360 degrees. When you have muscles regularly activating in 360 degrees, symmetry is the result. But when you’re sitting, 95% of the muscles that are required to stand are now allowed to “rest” because you now have a chair keeping you from falling and providing your balance. And when do we as Americans start to sit longer than we stand??? Nowadays it’s usually back in grade school but I’ll settle for your first “real job.”
But it doesn’t all have to be doom and gloom!
Reason being because at Berman Physical Therapy we’ve helped thousands of people over the years get out of pain so they can stop taking pain pills, avoid injections, and avoid surgery all together! It just takes time. Sorry to be the bearer of bad news but there is no quick fix for non traumatic physical pain. It’s going to take time because it took a long time to get there.
In general, most of our patients get significant pain relief after about 6 weeks depending on how diligent they are with their homework. Then we’ll spend another 6 weeks MINIMUM working towards making sure the pain doesn’t come back. With that said, I’ve worked with plenty of people for months and even years towards fixing issues that have been going on for many many moons.
The most important thing we consider with our interventions is our objective outcomes. Meaning, I don’t care about your pain. I care about what your body is telling me. Like I said earlier, we’ve worked with thousands of people and not one time was this next saying not true...pain and function are inversely related. This means that as your function goes up your pain will go down. Increased function means you are physically stronger. It takes muscles time to build back up stronger than before your pain. It can be frustrating but if you trust the process, I can honestly say that I’ve never had a single person whose function returned back to normal not get the pain relief they were looking for.
Here’s how I guestimate your prognosis using our services.
If your pain is constant, meaning you don’t have any positions of relief, then I’m significantly less optimistic that we can help you with your symptoms. However, if your pain is NOT constant and it comes and goes, then I’m very optimistic that we can help you with your symptoms. It really is that simple, not easy but simple.
So if you’ve been living in pain for far too long, or if you’re relying on injections to keep you moving, or if you’ve been told that you need surgery; give me a call or text at 239-431-0232. I’ve gotten pretty good over the years of asking great questions over the phone that can give me realistic expectations regarding your outcome. So why wait? You’ve got nothing to lose other than a few minutes on the phone with me! Looking forward to hearing from you soon