It might not be just about fixing parts

There was a great segment on Good Morning America about back surgery this week, for those that didn't see it, here is the link - Back Pain Relief.  This patient is one of unfortunate millions in the world that suffer with chronic persistent pain.  I have the fortunate opportunity to be at course this weekend Explain Pain, presented by Adriaan Louw, a PT right here from Iowa (that's kinda cool, at least to someone that lives in Iowa).  It is based on the book Explain Pain by David Butler and Lorimer Moseley.  I have mentioned this book previously in a post Back Pain - Now What.  If you treat patients that have pain, or are a person in pain, I highly recommend this book.  It will help explain the biology behind pain, and if you really like this stuff (as I do) then this course is one to look at attending as well.

I will get into some of the mechanics of pain in future posts...but for now I want to pose some questions and thoughts.  As a Physical Therapist I was taught that there are very specific mechanical problems that are the cause to all injuries that we treat.  Don't get me wrong there is, but there is more to it than that as I have learned since graduating over 15 years ago.  We as human beings are an amazingly complex system (and we understand a lot of it, but by far not all of it).  Sorry to burst anyone's bubble that their doctor or physical therapist or whatever healthcare provider you see does not have all the answers.  If they say they do, my advice - RUN!!!!  Let's take a simple look at the body: There are just over 200 bones in the body.  Each of these bones come together to form joints, about 250-350 total depending on how you classify them. They are held together by multiple ligaments at each joint area.  The joints are moved and also held together by muscles. We have around 500-600 of them in our body, again depending on how you classify them.  These muscles are controlled by our nervous system.  It is just a little more complex, we have about 100 billion neurons (give or take one or two) in our brain controlling these muscles, along with all the other systems in our body.  Each of these neurons makes around 5,000 connections with other neurons to communicate all that we do.  Each connection is controlled by a multitude of neurotransmitters and other substances.  I apologize to the anatomist and neuro-scientist for this simple explanation, but I think that you get my point - it is pretty complex.  This amazing system allows us to function in our continually changing world we live in, hopefully in perfect harmony.  I like the analogy of a symphony, that our body plays a beautiful tune when everything is just right - it just happens to have more instruments than particles in the universe.  How cool is that!!!

So, when someone tries to tell you that they can fix your pain with just a fixing one thing as this women in the clip thought was lead to believe, be careful.  Again hear me closely, I am not saying that it may not help with your pain and fix a mechanical fault, but it could very well be due to more than one instrument not playing the right tune.  And the instrument you fixed may not necessarily be the right instrument.  But do not despair either and think if surgery or a drug or therapy can't fix me who can?  Realize your body heals itself every day and you usually don't have to do anything.  Have you ever got a paper cut on your finger?  Is it still there?  Did you have to put any thought into how to fix it?  Your body did it all on it's own, pretty cool!  Yes we might improve the environment a little with a band-aid and some triple antibiotic on it.  So does that mean I never need surgery or need to go to a doctor or physical therapist to help me recover from an injury?  No, not exactly, sometimes we need to help improve that environment for the healing to happen so something wrong does not happen and not allow the body do what it was designed to do.  But just something to think about...fixing something mechanically may not be the end to your pain.

We often compare our bodies to machines.  I do this often when educating patients to understand mechanical deficits that may be contributing factors to their pain.  (Realize I said "contributing" not "causing").   But as humans our bodies are far more complex than any machine.  Does anybody have a car or any other machine that repairs itself?  How about that has logic, reasoning and emotions?  Our body is far more complex, so fixing a broke part by replacing it, taking it out, strengthening it, stretching it, or giving it a drug may not be all it needs.

So what's everyone's thoughts?  Can we or should we be able to "fix" everything by working on the mechanical parts?  It may be a different way of thinking for some of you, but I think we need to make changes to truly help so many people in pain.