Why this debate should matter to you - the therapist and the patient.
The search for structural faults that are causing pain is still going on.
And it'll continue to do so.
I think it has do do with basic human psychology - we have this need to put labels on everything we see. Our brains want easy explanations - all the time.
Our brains produce visual (and other) illusions because they are hardwired to resolve every computational problem they encounter.
They are not computers running Windows; they can't just crash - they have to continue functioning - even if that means finding patterns in meaningless noise (pareidolia, conspiracy theories, astrology).
So where do you - the patient come in?
Well - your expectations are shaped by this mechanism. You want answers when you consult a health care professional. And those answers better fit your view of the world - or else!
Structural faults like ruptured discs, degenerated vertebrae, pulled muscles are easy to put a finger on - just think of an MRI scan that shows a bulging disc. What's easier then to show you - the patient in pain - that picture and explaining that that bulge causes all your problems. And since an operation could clear that right up you could be pain free again in a week or so.
It's convenient, easy, convincing - and even fits the symptoms sometimes.
Now compare this to a more functional explanation - with or without the scan if you like.
The doctor would explain to you that yes - there is a bulge - but it could be an old one you've had for a year already (without symptoms) - and that the reason you are in pain now is that your brain "has decided" to produce a painful sensation because of some factor that could be biological, social, psychological or all three.
His advice is to keep active, distract yourself as much as possible and adjust your daily life accordingly and check back in one or two weeks if things don't get worse.
Which would you rather pick?
Exactly - option one is simple the better sounding one. Until you had the operation of course and the pain is still there.
That's not to say that all operations are for nothing. But even orthopedic surgeons have started to admit over the past few years that the outcomes weren't that great in cases where the main reason for an operation was pain as a symptom.
Long term studies show that the outcome over the long run is even the same compared to conservative care.
This goes for spinal surgery and other kinds too (think osteoarthritis of the knee).
Pain - like it or not - is in your brain!
It always is - and always will be. It's an emotion like anger, fear, love and all the others. And like all the others it's being put together according to the circumstances you find yourself in.
So if you change the context - you can change the pain - your pain.
Some methods and influencing factors I already have described in my Pain for Dummies Series.
Here are a few more:
- Kinesiotape: How does it work? It's all about low-level cutaneous neural system input - or "grooming" as it's known in primate circles. Have you ever seen chimpanzees grooming each other? That's what kinesiotape does. And if you can honestly say that you wouldn't like to be groomed for a few hours each day you are a liar!
- Feldenkrais: that guy was a genius. Simply brilliant! He recognized that the brain is plastic and likes to learn. That's what happens when you do those exercises - your body learns how to move more efficiently. It's all about feedback and re-programming better motor patterns. When I say Feldenkrais I also mean all the other offshoots his work created: Somatics (faster, shorter - equally cool), Alexander Technique, Rolfing, Yoga, ...
And of course - when you try new movements you have to concentrate a lot - distracting yourself - again.
- Meditation: training how to calm "the mind" - to get the same level of control over your "mental muscles" as over the ones you exercise in the gym.
- Feedback therapies: Mirror Box for CRPS, Phantom Limb Pain and the like. Tactile input for parts of your body you can't see - like our back. And auditory training for tinnitus.
- Redcord: we use this device in our clinic and I have to say it's phenomenal! There simply is no faster way to re-program motor patterns.
- Motor imagery: works. Close your eyes and work out at the same time. Mentally rehearse things that you have to do every day and try to make them more efficient.
- Neuromatrix training: read the blogs - mine, David's and Diane's.
- Educate yourself: the 20th century is over. The expansion of the Internet puts the worlds knowledge at your fingertips (otherwise you wouldn't be reading this!). The more you know about yourself the better off you are.
- Give back: there's nothing like sharing what you have learned or experienced with the rest of the world. By putting your thoughts into words you go over the experiences again - putting them into proper perspective. The only thing you can do wrong is not doing it.