Get to the root cause of the problem – why where you feel pain is not enough.

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Failed treatment?

One of the most frustrating things about rehabbing an injury or pain presentation is when things don’t progress as expected. You’re putting the work in but nothing is getting better. There can be a number of reasons for this, but a common one is assuming a diagnosis based off where the pain is felt.

For example: if you Google pain at the side of your hip that feels worse when you lie on your side or walk up stairs you’ll probably come up with a diagnosis of hip bursitis or maybe gluteal tendinopathy. And that certainly could be the case. But the problem is that the human body is a little more complex.

Referred pain

Pain at the side of your hip can come from local structures (like the bursa) but it can also come from the hip joint, the lower back, SIJ or even the mid back. We call this referred pain and it makes up a large chunk of pain presentations in the body.

Referred pain is a phenomenon where the “source” of the pain is different to where the pain is felt (eg. lower back source – side of hip pain).

Getting the diagnosis correct is crucial because a good outcome means targeting the right area. There’s no point changing a light bulb if the fuse is blown!

Steps to gaining an accurate diagnosis:

  • It starts with a detailed conversation around how the pain started and what makes it feel better or worse.
  • We then take some baselines (things that are either hard to do, weak, painful or restricted).
  • Each potential source is then tested (in the above hip case: we’d examine the hip, low back, mid back and potentially the SIJ).
  • Arrive at a diagnosis based on changes: If movement at a certain area changes to the baselines then that’s the source and treatment should focus on that area.
  • Treatment involves exercise or other interventions directed at the source of the pain.

Taking time to establish an accurate diagnosis reduces the “failed” treatments and sets realistic expectations around recovery times. We commonly find going slow at the start and avoiding jumping to conclusions pays off in the long run.

Winston Hills | Physiotherapy | Clinical Pilates

Tim Cathers

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