When pain sufferers seek treatment, they know they are looking for pain relief.

However, what motivates them to seek pain relief isn’t always clear to themselves.

For most parts, most of us are happy to live with an occasional back pain knowing it will pass without intervention. We go on with life as per normal and expect it to go away by itself.

Even if your lower back pain doesn’t pass and becomes chronic, you may not immediately resort to treatment. You’d probably know of people who would live with their aches and pains with absolutely no interest in any form of therapy.

No matter how hard you try to encourage them.

Why?

What are values?

“Possible is more a matter of attitude,
A matter of decision, to choose
Among the impossible possibilities,
When one sound opportunity
Becomes a possible solution.”
Dejan Stojanovic

From a philosophy or ethics viewpoint, values are beliefs that guides or motivates decisions or actions.

To simply put it, they are what is important to you.

This is where most people get confused: values are not goals.

In that sense, wanting to be pain-free is not a value. It’s a goal – albeit not a SMART goal.

Values are what made you decide that being pain-free is important to you. More important than being in pain.

You may have been in pain for two weeks, two months, two years, or even twenty years?

At which point did being pain-free become more important to you?

What was it that made seeking help a priority for you?

If you had already sought treatment from a chiropractor or a physiotherapist and you looking here now, it is very likely that what was offered to you was not congruent with your value system.

Value #1: Is long-term results or short-term pain relief more important?

An ex-client with neck pain, shoulder pain, elbow pain, and numbness and tingling into the hand shared about his recovery experiences. He discussed why he decided to keep going with treatment despite a rocky/painful start. His symptoms were mostly gone by visit 6th/7th and he came to me for a total of eight visits.

I emphasised a lot that Square One Active Recovery is about long-term pain solutions.

By that I mean you more permanent relief and that when you experience the same back pain in the future, you would have an idea of how to successfully manage it.

It’s an empowerment approach.

It is hard change treatment process.

With that, it is also not uncommon for my clients to feel worse in the short-term.

That doesn’t mean there are no improvements in other areas of their lives.

It certainly doesn’t mean they are getting worse.

Perhaps they have more awareness of their bodily or physical sensations. Perhaps they are more confident/less afraid with day to day activities. Perhaps their attitude towards exercise and/or what it means to be pain-free has changed. Perhaps they are now stronger and more robust than they were before. Perhaps their range of motion has increased.

Perhaps you are looking at the wrong places when trying to find your recovery success.

Please don’t get me wrong. I am not trying to say you should change your reality or imagine positive changes that are not there.

I am inviting you to consider if it is possible that you are missing the forest for the trees.

There’s hard data to suggest that short-term symptom aggravation is okay, if not better, for you.

Painful exercises are good for you in the short term!

Research tells us that feeling better after a session (or at the initial stages of recovery) doesn’t predict recovery success. It means you can feel better or feel worse at the early stages and they are both okay.

Similarly, feeling better doesn’t mean that you are in fact getting better.

Other studies have also demonstrated that painful exercises can be SUPERIOR to pain-free ones in the short-term.

Yes, it is indeed not intuitive. However, that doesn’t make the data any less true.

The purpose of science is not to validate our own beliefs or biases.

Research, at its core tenants, is about the intellectual freedom to pursue the truth with the scientific method. No matter how unpopular it is.

This is what led me to give up chiropractic adjustments and other form of in-demand, fashionable hands-on therapy.

The truth of the matter is that long-term result is more important to me. As counter-intuitive and bad-for-business as that may be, clients who stick with the process have such good results that they encouraged me to raise my fees.

But this is not about me. This is about what is important to you.

Is short-term relief or long-term results more important to you?

If long-term results are important to you, how much are you willing to let go in the near future to achieve just that?

This is not fluff. From weight loss to better exercise habits, long-term behaviour change (i.e.  NOT immediate shiok/feel good pain treatments) is the key to successful pain treatment outcomes.

Value #2: Is being comfortable more important or is being effective more important?

Without a doubt, long-term recovery success is in the hard change. Period.

What about the quality of the treatment you are receiving? Everybody would like to have fast and good results but what does fast and good recovery look like?

Is the highest quality of care more important to you or is being comfortable more important to you?

Understanding what is education

To a huge extend, you pay for professional advice because they can see a bigger, more holistic picture of what you need to do to achieve success. Professionals are also trained to make sound decision during times of uncertainty. Sometimes I choose not to answer questions not because I can’t but because it will lead to better outcomes for you.

It is true that the best clinical guidelines for lower back pain and musculoskeletal conditions all point towards education as a core pillar of a successful treatment.

But what is education?

The Wharton School published an excellent commentary more than a decade ago that said education is in the learning, in the not teaching.

This is so profoundly beautiful for me.

I can be excellent at teaching you but that does not guarantee that you will be excellent at learning how to find freedom from pain.

(In fact, it’s not uncommon to hear people getting better than getting worse. It’s a recovery-injury-recovery cycle because neither who they are or their ecosystem has changed.)

The Wharton’s piece highlighted that the traditional approach to education focuses on teaching and it is based on the false assumption that being taught well equates to learning well.

If we are willing to accept that the expensive Montessori method of self-directed learning and collaborative play as plausibly superior to authoritative content-based methodology, why would you short-change the efficacy of a self-directed, collaborative recovery approach to your own pain?

As adults with access to social media and Google, we sometimes expect instant-information and instant-answers. We forget that even as grownups being taught doesn’t equate learning.

When clients ask me questions, they expect to be given straight answers.

Is this education though?

If a child were to ask you for help with a math problem, would you just give them the answer if your priority was to help them learn?

“I want a good recovery!”

I understand a good recovery is important to you. My question then becomes is the quality of your treatment more important or is feeling comfortable more important?

Are you able to accept not being given straight answers for the purpose of your own learning?

If comfort is more important to you, are you willing to forego good and fast results?

Value #3: Is an exercise prescription more important to you or is behaviour change more important to you?

Knowing is not doing. Knowing is certainly not half the battle won.

Of course I will never try to sway you with only one Wharton commentary.

Multi-award winning psychology professor Laurie Santos’s work in cognitive science specifically challenged knowing is not half the battle won. She calls it the G.I. Joe fallacy.

It’s fascinating, really, because even when patients know that $9 chiropractic treatments is too good to be true, it doesn’t stop them from going for it.

Despite our fixation with knowing and understanding, research doesn’t support that either is particularly helpful with long-term change.

We consistently underestimate what it takes to change behaviours

A huge part of my work is moving away from telling clients what to do. The end result is that they develop a sound decision-making process that they can apply to their own symptoms. It’s not about being given long-term results. It’s about finding true freedom from pain.

You can’t make an employee more diligent by telling them to work harder or how to work harder.

Sure, they can spend more hours at work but long working hours doesn’t increase work productivity.

(We may readily accept this as true today but think about the resistance we had towards such narratives a decade ago. Good science doesn’t change just because we are not ready for it.)

You also cannot get some one to quit smoking by teaching smokers the health risks that they are exposing themselves to.

A commentary published in Public Health, heavily emphasised that changing health behaviour is not common sense. They authors specifically called out the appeal to common sense as “deliberately anti-intellectual and anti-scientific”.

According to the authors, all the good lifestyle changes that you are thinking of have to come with with sustained motivation and support!

In their words, “Just getting on and doing it, guided by a government body, is not the answer.”

A lot of my clients would come to me thinking that exercise is the single best cure to their chronic pain. Most of these clients would also readily admit that discipline, time commitment, motivation are barriers to their recovery.

Why would you not address these barriers you yourself identified as you would address your perceived physical ‘deficits’?

I am not saying that you must work with me on the softer bits in recovery.

I am saying research shows that effective change is the best long-term pain solution for you.

Again, it comes down to what is important to you.

No single solution to a chronic problem

We used to think alcohol consumption is a single, independent behaviour problem. In that sense, we think we can find a single solution to the alcohol abuse problem.

It is not true, is it?

Alcohol use disorder among veterans, athletes, Aboriginals and Torres Strait Islanders, and university students stem from completely different circumstances and there is no real blanket solution that will be effective across all individuals within their contrasting environments.

Likewise, from chronic pain research, we do know that psychosocial and socioeconomic factors have a strong influence on a person’s unique pain experience.

Your pain experience is very real and quite often unique to you alone.

This is why a what-is-important-to-you process makes a difference in achieving the results you are after.

How to find your own values?

As for recovery-specific values, the best place to start is to think about why you are seeking pain relief now and not before.

• Is your pain affecting your work productivity?
• Is your pain changing who you are as a person? Perhaps your outlook or attitude towards life has changed because of your pain?
• Is your pain affecting your relationships?
• Is your pain distracting you from daily activities?
• Is your pain causing poor focus/attention?
• Is your pain disrupting your sleep?

I know asking you to think of what is important to you and to be able to articulate them is no simple task.

If you need help, here is a list of over 230 personal values.

As for recovery-related values, I have discussed the following in this blog,

Compassion vs stress
Task-relationship vs social relationship
Process-driven vs outcomes-only-focused
Hard change vs easy change (also adaptive vs technical change)
Premium fees vs cheap fees
Solution-focused vs problem-focused
Coaching vs therapy
Positive self-talk vs negative self-talk (exercise-based)
Exercise vs rest (load management)
Pain vs damage (knee arthritis)
Slipped disc vs pain
Feeling better vs not feeling better (at initial stages of recovery)
Evidence-based wellness vs sensational wellness (diet)

At this stage, I think it’s important to highlight that values are not dichotomic. It’s not a yes or no situation.

Rather, values are a continuum.

It’s about understanding what is important and how we can harness into that to give you the best recovery outcomes possible.

What is important to you is the most important of them all

When it comes to managing your aches and soreness or your recovery from chronic pain, you want to know what works best.

That’s totally fair and reasonable.

You are seeking treatment because you want the best physical version of yourself.

You are spending good money because you want the best treatment for yourself.

But what if the best approach to treatment, from a hard science perspective, starts with you?

To a huge extent, we already know what works best.

As normal human beings, we see our pain is an independent physical experience. Yet if we were to dig further into how our pain behaves in the context of our daily lives, we see the interactions between pain and family, pain and work, pain and personal well-being, pain and everything-that-is-important-to-you.

Your pain doesn’t exist in a silo and good results only come when we look at you with a non-fluffy, hard data whole-person approach.

If you would like to embark on a you-centered recovery experience, book in for an appointment with me via the form below and discover the difference the right care can make.

Your Recovery Journey Begins Now

Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, chiropractor Jesse Cai founded Square One Active Recovery to deliver recovery goals in just 4 to 7 visits.

Not getting results from your chiropractor, TCM doctor or physiotherapist? Book an appointment to discover the difference the right care can make.

*We do not offer short-term pain solutions such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.

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