"WHY ISN'T THE SAME THING WORKING THIS TIME?!"Nov 07, 2021
Ever had a pain start up that you recognized, because it’s in the exact same spot as before, but then you went to do the exercises/treatment that helped last time, and it didn’t work this time?? Or have you ever been describing what’s going on to a friend and they say “OMG, I had that EXACT thing! Do this! It was a game changer!” And then you do and it doesn’t work??
This can happen for a multitude of reasons. But the main one is this: Pain is far too complex to be a one-size-fits all approach.
One of the reasons is simply that pain in any one particular area of the body has several possible origins. And unless you target where it’s coming from, it’s not gonna go away. A very generalized example of this could be pain in the right sacral area (around that bony spot that’s between your low back and your glutes): It could be coming from the glutes directly, but it could also be referred from your lumbar spine. Or possibly coming from your pelvic floor. Or sometimes even from your mid back. There are other possibilities, too, but I think you get the point. You could roll out the glutes and do all the activation drills you wanted to, but unless you address that actual issue, you might get some short term relief, at best, but then it’ll come back. Another example is the shoulder. I had someone recently who came in with a very similar symptom presentation as previously and it was some of the same movements that bothered them. Pain with strict press and HSPU mostly, pointing to the top of the shoulder and some into the outside of the shoulder. The last time it had been tendinopathy of the supraspinatus (one of the rotator cuff muscles) and had cleared up pretty quickly with some dry needling and intentional strengthening drills. This time, when it flared up, they tried those same drills to no avail. They messaged me and I was able to get them in for an assessment and found that this time it was subscapularis, which while it is still within the rotator cuff family, actually has a very different function and needed to be addressed with vastly different exercises. Once we had that figured out and treated it, they were quickly able to progress back into all the things.
So by all means, if you’ve had something similar before and have some tools (in the form of exercises, etc) that worked, try them! But if you don’t see changes fairly quickly, pivot!! What’s that saying about continuing to try the same thing and expecting a different outcome? That applies here, too.
If this sounds like what you’re dealing with, jump on a discovery call with me. I offer 10 min free ones where I can give you quick advice, and only if it warrants PT and we’re a good fit will I suggest setting up an appointment. I can also help you find a provider in your area or even the right kind of provider if it isn’t PT! But don’t keep trying something that just isn’t working.
Now there are other reasons as to why it’s not working other than it’s actually a completely different cause - Though with all of those reasons, the best advice is gonna basically be the above paragraph - when in doubt, consult a healthcare practitioner that you know just wants to help you get better regardless of whether it’s them you see or not. Another possible reason is that it IS the same thing but you just kinda got lucky the last time. Meaning that you might have improved regardless of the treatment. This does happen. Our bodies are very resilient; often more so than we give them credit. So if it was something relatively minor (though the symptoms may not have felt that way), and you were healthy enough (including mental and emotional health), it might have just healed on it’s own with time. Now with that said, there are generally things you can do to speed up that process. I often see the above scenario happen in a case like a CrossFitter who’s having shoulder pain and gets an MRI that shows a rotator cuff tear (for the record I don’t recommend imaging 99% of the time. AND physician guidelines are also starting to say they shouldn’t be recommending imaging.) Now, whether or not that’s what’s causing their pain is something we honestly CANNOT say (research has proven this. Plenty of people have tears with full function and no pain.) But that sure as hell doesn’t seem to stop some providers from saying it. If you see the more “traditional” PT where you get maybe 20 min with them and they tell you to “hold off on lifting for awhile and in the meantime do these yellow/red theraband exercises…”. Now from a research and clinical experience standpoint, that should simply NOT work. Namely because tendon injuries do not respond well to rest, and a theraband exercise for someone who’s got some strength is simply not enough loading to cause any positive adaptations in the tissues. With that said, someone who’s young and healthy and sleeps well and otherwise active, etc, may get lucky and be able to slowly get back to all of the things regardless. Why? Because they still were able to get inflammation down enough to allow the tissues to calm down enough to function properly and slowly strengthen as they got back into lifting. Now, I’m not gonna dive into the science behind that too much because I don’t wanna make this blog super dense. I will make a quick note, though, that the “young” aspect of that is because of our body’s fluid content being higher at younger ages, and more mobility allowing better fluid movement, therefore more dilution of any inflammatory chemicals. But no one gets away with age as an excuse for not being able to the things you love doing. You can and will get back there if you want to. There are other ways to “flush out inflammation.”
It could also be that you’ve gotten stronger since the last time (or you’re stronger than the person giving you what they did) and therefore the exercises simply aren’t enough. My point is, another thing that might be going on is you need more LOADING than what you’re doing. Far too often, we rest or underdose loading when it comes to recovery. For example, if you can squat 200 lbs, sidelying clamshells simply ain’t gonna cut it if you’re trying to load up the glutes. Again, that where it’s really helpful to have someone in your corner (me or whoever) guiding you and progressing exercises based on YOU and meeting you where you currently are.
Now I do wanna make a quick note that I don’t completely hate “basic low level” exercises like yellow theraband ER. They have their place. They can be helpful for getting some muscle activation without ticking off the tissues and increasing pain. But they are really only appropriate in the acute phase (first few weeks) if at all. And even when they are, there are honestly better ones and by better, I mean more effective, efficient, and fun (though admittedly there is some bias there in that last bit). You HAVE to move on from those and continue to build strength in order to become more resilient and decrease the chance of flare ups!
So to summarize, the “old stuff” or suggested things aren’t working because:
It’s something completely different that just has a similar presentation and you’re missing the true underlying issue
You’re on the right track but not loading/challenging the tissues adequately
There are other non-physical factors on board that need to be addressed as well
Inflammation is on board still more than last time, which isn’t allowing the drills to do what they’re meant to
Again, these are very generalized, but hopefully this information helps! If this resonated, please share this on whatever platform you prefer! Questions? Drop them below in the comments!
And if you found yourself wanting to have someone help guide you in finding the underlying cause and/or appropriate loading, etc…
Oh, and one last bit…if you are having any “red flag” symptoms along with the pain this time, DM me or your PCP or some healthcare provider ASAP (may be nothing, but this is definitely a rather safe than sorry situation). The list of red flags are a little different in the case of headaches or abdominal pain, but this list covers the big generalized ones, particularly for low back pain:
unexplained/unintentional weight loss (over 10lb in 3 months)
unrelenting night pain that doesn’t change with position/activity
bowel and bladder changes
night sweats (new onset)
Because I have to make sure this is clear: Reminder that this blog is not intended to be individualized medical advice. Please consult a healthcare practitioner directly for individualized care