There are multiple pain management options available today. Some, like spinal manipulation and acupuncture, are thousands of years old while others are new technology claiming to help with treating pain. How do you know what is the best for you?

Our advice? Leave it to the experts.Very often we get clients looking to book in with us with a very specific treatment in mind. “I only want IASTM” or “I only want dry needling”.

(Both of which are not evidence-based treatment.)

This doesn’t make sense to me at all. You don’t call up a dentist to book for a root canal or a tooth transplant before you had your toothache look at.

You also don’t ring up a orthopaedic surgeon’s office to book in for a remplissage procedure just because you have shoulder pain.

Why then are you looking to determine your course of pain treatment when you have no training in diagnosing or managing your condition?

Dr Google, Forums, Facebook groups can be good sources of information

I was checking in with one of my ex-clients (who stopped coming) today to see how he’s going.

He told me he’s about to start shockwave therapy. I wasn’t surprised.

20 minutes into the conversation, I found out that he hasn’t been for a consultation with the podiatrist who is offering the shockwave therapy before. This surprised me. I have two major concerns:

  • If the podiatrist hasn’t met or examined the patient before, how did the podiatrist determine if shockwave therapy is appropriate?
  • If he hasn’t met the podiatrist before, who recommended shockwave therapy?

Internet forums recommended shockwave therapy. According to the ex-client, he did his research into his condition and shockwave therapy repeatedly came up as a beneficial treatment option.

How would my ex-client, a non health care professional, be able to determine what the forum users were saying as true?

He also said he tried all sort of home exercises and they didn’t work. Of course they didn’t work. Instagram rehabilitation doesn’t work!

Your muscles are tight

Most of us would have heard of this before. Either from a physiotherapist, massage therapist, or even a chiropractor.

Do you know ‘tight muscle’ as we know it doesn’t actually exist?

Yes, you can have a cramp. Yes, there are conditions like cerebral palsy that comes with true muscular contracture and spasticity. Outside of those specific conditions, no. Muscular tightness is an urban myth.

Let’s talk for example frozen shoulder. The shoulder is “stuck” right? The limited in the patient’s range of motion is real right? Yes and yes. But that doesn’t actually come from a “tight muscle” as we know it. When patients with frozen shoulder are put under general anaesthesia, their range of motion improves by A LOT. We are not talking 10 or 20 degrees – it’s 44 to a 110 degrees difference!

What about my tight shoulders? Did I hear you ask? Same difference. When participants were asked to identify their typical tender spots in their muscle, the area they identified were actually the softest spots in their muscle! Furthermore, there was no increase in tissue hardness in participants who were more sensitive to pain.

What about trigger points?

They also don’t exist.

I am also starting to think clinicians who attribute their patients pain to myofascial pain syndrome, trigger points to be either plain lazy or incompetent. It’s easy to attribute your pain experience to something that doesn’t exist, no? You don’t have to even try to find out what’s wrong.

If they don’t exist, there is no reliable way to assess and measure them. You can never be wrong. How good is that? For the clinician. For you? It’s unfortunate.

Study 1: Two experienced clinicians were asked to identify the trigger points in the upper trapezius muscle. The agreement on both the location of the trigger points and the number of trigger points present were poor.

Study 2: Four chiropractors and four licensed psychiatric residents examined 20 muscles of 52 individuals for taut bands and local twitch responses … their findings were not reliable and no better than chance.

In short, if you were to get all the chiropractors or all the physiotherapists to examine you in the clinic on the same day, they’ll probably come out with different findings. For those that they got right? Random coincidence (i.e. no better than chance).

So, how are they going to treat your pain if their approach to pain is WRONG in the first place?

“But my friend, colleague, family swears by …”

Needling: Yes, there are some poorly designed studies to support the use of dry needling as a pain treatment option. However, no study demonstrated that needling therapy has an effect that is beyond placebo.

Needling refers to the treatment where sterile needles are inserted into myofascial trigger points. If

While manual techniques may seem effective, for both clinicians and patients alike, research doesn’t support their medium to long-term effectiveness of passive therapy treatments. As of now, the pain relief associated with these treatment are not established to be better than placebo effects.

Passive treatments include:

  • Laser and TENS: MAY be effective for short term pain relief
  • Ultrasound is no matter than placebo

Pain is complex and multifactorial

We need to embrace a different approach to managing and treating pain. We already know the old school biomedical/structural approach is outdated and doesn’t fit into the current understanding of pain. Furthermore, there are many different types of pain!

The latest research shows the best approach to managing musculoskeletal pain is rehabilitative exercise therapy. It sounds boring. It doesn’t seem like much. But it’s the only treatment that has withstand the rigour of scientific research.

We have blogged about IASTM (instrument assisted soft tissue mobilisation) and how it doesn’t work.

We have blogged about how chiropractic adjustments only provide short-term relief.

How to find the perfect pain solution?

We think a good doctor of chiropractic is someone who is able to provide all of these treatments (that everybody loves) but choose to not offer them. Because they don’t give you long term pain relief. This is the epitome of ethical and honest health care.

All chiropractors received chiropractic clinical training, but the best chiropractor is the one who puts it into daily practice. This is the chiropractor who will be able to help you find the perfect pain solution.

Rehabilitative exercise therapy is so promising that we see results even three years after. We blogged about this in Why We Choose Exercise.

Just because manual therapy doesn’t work for you doesn’t mean you have to jump straight into less conservative care such as nerve block, spinal cord stimulation. Maybe you think pain killers and muscle relaxants are the easier way out but research has also shown that medications, together with nonsteroidal anti inflammatory drugs NSAIDs, are even less effective than manual therapy.

If you have tried multiple treatments but still can’t seem to work your way out of chronic pain, stop trying more assisted soft tissue mobilization or physical therapy. They are not likely to work.

Ask yourself if you have given a rehabilitative exercise a fair shot. Again, this is NOT THE SAME as a self-directed home exercise program.