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Joint Pain: Structure vs Function

This is not medical advice. If you’ve recently had an accident, go see a doctor.

“He who treats the site of pain is often lost” - Dr. Karel Lewit

A client comes to me with shoulder pain and it looks like this:

  • Mobility: He can barely get his arms overhead.

  • Strength: His rotator cuff muscles are terribly weak.

  • Movement: His shoulders shrug on push-ups and rows.

This client has localized pain in his shoulder (structure) that might be caused by poor mobility, strength, and movement pattern compensations (function).

The question is, how do we begin improving?


Structural Joint Pain

First, if you have a structural lesion, rest is probably required to aid the healing process. Too much action too early could do more damage than good.

For example, with shoulder pain, you must be able to lift your arm to the horizon before beginning the rehabilitation process. Structural limitations often determine when we’re able to begin exercising again.

The localized view of the injury (structure) is where most medical doctors finish their study. They diagnose you with a disease or syndrome and offer you drugs or surgery.

However, if a client’s shoulder pain is caused by poor thoracic mobility, no amount of drugs or surgery is going to fix that!

Functional Joint Pain

Joint imbalance → Joint Damage → Pain & Inflammation → Compensation & Disfunction

Functional rehabilitation takes a global approach to chronic pain by evaluating the body’s mobility, strength, and movement patterns.

In 1979 Dr. Vladimir Janda defined his crossed syndromes for muscle imbalance, and it’s these imbalances that create tissue damage, pain, and altered movement patterns.

If your doctor offers you drugs for your pain before first evaluating your mobility, strength, and movement, you don’t have a doctor, you have a drug dealer.

Physical Therapists are Better

Doctors receive zero education in resistance training. Physical therapists are very often far better than doctors for treating chronic pain because they understand muscle function and the global perspective to chronic pain.

If you’re dealing with chronic pain, find a really great physical therapist and they’ll help you discover and address the CAUSE of your pain (function)!

How do you know if your physical therapist is good?

If they offer you PASSIVE treatments like ice, massage, ultrasound, and electrotherapy, find a new physical therapist.

Passive treatments are far less effective and make you dependent on someone or something else.

However, if they offer you ACTIVE solutions to your pain i.e. exercises, that’s a great physical therapist and you’ll be on your way to pain-free living in no time!

If you’d like to work with me to overcome your chronic pain, go here.

Hope this helps! - Tom


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