The Neighbourhood Clinic was established to provide excellence in healthcare to our local community. Part of that role we see is sharing important clinical and scientific messages. Pain is a condition that is rife in our society and there is so much misinformation about what it is and how it works that we thought this series may help to be part of the solution.
Part 1 of this series was about the idea that pain is commensurate to the brain's perception of threat. So when you stub your toe, whilst nothing is broken the brain thinks it may be and so you holler and swear... until you don't and you look a bit sheepish.
Well this post is about a young man in his mid 20's that presented with pain in his foot that was spreading to his leg and low back. It had been there for 2 years on and off and had substantially affected his life.
Over that time he had seen a variety of podiatrists, physiotherapists and GPs. He had the full barrage of scans, MRIs x-rays and ultrasounds. All with no results. He had been told things ranging from flat feet, weak core, weak glutes. He had been given braces and orthotics.
As a musician, he had been told not to stand at gigs, nor stand when performing, nor use the pedals for his guitar. He had tried resting. He still didn't like walking more than 200m at a time. He would only wear one set of sandals that he really liked and no other shoes.
He had moved out of the house he loved so he could be closer to his workplace and therefore not have to walk so much.
What can be done in cases like these? Empathy followed by education and encouragement. Empathy in the sense that this young man's life had been flipped upside down. He was not doing any of the things he liked doing. And all he could do was think about his foot.
His situation had to be acknowledged and empathised with. Education in how the body works was next. Muscles and bones and joints are similar to your skin. When you cut your skin, it bleeds, scabs and heals. Your body does that too. But your brain can be become overprotective. Like a stubbed toe but more permanent.
This made sense to him as he had been trying to reconcile his scans that showed nothing wrong with the pain he was feeling. And he was encouraged to take ownership of his body and its sensations. If he felt pain he was to remind himself that it wasn't causing damage. He was also encouraged to do the things he loved, to play music, to go to gigs, to press the peddle as many times as he wanted!
So what happened? His foot and leg pain eased away over a few weeks. What?! Why? Pain is weird. It can be related to something that is broken or torn but it can also be because the brain is over protective.
The role of the pain practitioner (whether that be an Osteo or a GP or a Physio or someone else) is to figure out of the issue is physical or over-protective or somewhere in between.