In my practice, I often ask the question, “Was there an incident that started your pain?  Or did it just creep up on you?”  The answer is very often, “Well, it could be (insert activity here), but I’ve been doing that for years, so I don’t think that’s it.”  But, perhaps, that’s exactly it.

Tissues have a certain amount of force they can withstand before they become injured/dysfunctional/irritated.  This is called tissue tolerance.  The end result of too much force is usually pain.  You see, pain is often the last symptom to appear, not the first.  So, prior to your experience of pain, damage has been done behind-the-scenes for awhile.  If you are body-aware, you may have already noticed this in yourself; perhaps your first perception of a symptom was tightness or decreased strength or lack of range of motion.  But the pain didn’t follow until later.

This process gives us some valuable insights into treatment.  At least, that’s how I see it, and that’s how I treat it.

First, pre-pain symptoms (the above-mentioned tightness, strength, and range of motion) should be watched for and can be used as warning signs to prevent further injury.  Maybe these pre-injury symptoms can be used as healthy reminders to improve your mobility, add in some recovery time, or focus on your nutrition.  Maybe they cause you to re-check your workplace ergonomics or your sleeping positions or your form in the gym.  Maybe they are a signal that your body needs some hands-on treatment.  Listen to those signals, and heed their warnings.

It is much easier to prevent an injury than it is to fix an injury.

Second, just because the pain has disappeared, doesn’t mean that the affected tissues are back to their normal pre-injury state.  This helps to guide my decisions for a patient’s return to activity and give appropriate movement guidelines.  So when I tell you to stop box jumps for the time being, or to raise your computer screen, there’s a method to my madness and science in my reasoning.

The bottom line is this: if you’ve been dead-lifting with a rounded spine for months, or you’ve been sitting at a desk job for years, or you’ve been hunched on your couch with your iPad and “it’s never bothered you before,” doesn’t mean that it won’t bother you now.

Straw.  Camel’s back.  Remember?