On my Instagram account, I made a reel that talk about getting over one million views. I find the internet an amazing place as it opened my eyes to many misconceptions about physical therapy, how to advocate for yourself and the healthcare system, and how to manage pain. One comment was made on my reel and I wanted to discuss more about it as I found it as a medium to help you understand more about misconceptions surrounding MRIs, physical therapy, and pain.
The Comment
The comment was made by someone who said that they went to physical therapy five years ago for knee pain and underwent physical therapy treatment for eight months. However, they did not feel any changes or progress from the treatment. Later, they wanted to know what was going on so they decided to get an MRI. However, the commenter said they were afraid to get an MRI as they equated getting one to getting a surgery afterwards.
The Misconception Surrounding MRI
You have to understand that anytime you deal with a medical provider and they tell you when you do a certain treatment and you have to do another treatment, I will consider getting a new healthcare provider.
If you get an MRI, you do not have to have surgery. If someone is telling you that you have to have a surgery, find someone new who will actually listen to your values and what you want to get from your relationship with that healthcare provider. If surgery is just not something that you want in your life and is an important factor, your healthcare provider must work with you to do all the things that you can to avoid ending up getting surgery.
MRIs also do not necessarily tell you what is actually wrong. You can have an MRI and it could come back saying you are completely fine with no structural changes to any parts of your body. When this happens, you are left with the question, “Why do I have pain? Am I a crazy person?” However, you have to understand that pain is not correlated to what we see in imaging.
In one of my blogs in the past, I talked about a study that looked at rotator cuff tears and individuals from ages 30 to 80 years old in that study and it was found that around 40 percent of the sample population had rotator cuff tears. All of the people in the sample population did not have any pain or experienced symptoms that anything was wrong with their shoulder. Another study showed that when people have an MRI, their pain after they look at the MRI results, the pain actually increases. So in general, MRIs are great diagnostic tools, but when tackling pain and injury, it might not be the best thing to help move you forward out of an injury.
Going To Physical Therapy And Seeing No Change
Looking back at the comment made on my Instagram reel, the person said they have been going to physical therapy treatment for eight months and nothing was happening. If this happens, I advise going to a new physical therapist or seek another treatment.
In my practice, if I’ve been seeing someone for two months and I do not see changes in pain, I will send them back to their MD to get some kind of medication to help manage the pain, or inflammation, or nervous system issues that might be going on. I need them to go and get medication so they can get over the pain humps in order for us to do the exercises properly that are necessary to move forward.
I might also consult with another physical therapist and have them see that particular patient. They might see something that I do not see or connect with the patient in a different way that can help them move forward from their pain.
I really believe that if you haven’t seen any progress in two months, that is the time to change it up and find something different.
Pain And Time
The commenter likewise said that the knee pain had been going on for five years. When you have pain for that long of a time, the tissue damage from whatever happened during the initial injury is already healed at that point. For inflammation and for muscular changes to happen after an injury, it usually takes six to eight weeks. Unless it is surgery so that’s a different conversation. But if it is just a slight injury, you will generally feel better in about six to eight weeks.
If it does not heal in six to eight weeks, we will start to move to the territory of pain as a chronic issue. Generally, when we have pain that’s been lasting for a long time, it is not a tissue issue anymore as it is most likely a nervous system issue. Here, we want to look at things that might be causing your nervous system to be on higher alert and causing pain in the area that you had the initial injury.
Who Are You Without The Pain
When people experience pain for years, I like them to consider the question, “Who are you without the pain?” Sometimes, when we’ve had pain for a really long time, it becomes part of our story and it feels difficult to let go of it because you’ve been obsessed for it for so long.
So we have to look at this from not only a physical standpoint but also a mental standpoint of how we move past this pain and into a new chapter of our life. If my patient is honestly not ready to give up their story that they have around their pain, I probably won’t work with them not because I cannot help them, but because the person is just not really ready to move on from this injury.
Pain And Environmental Factors.
The other thing that we look into when the nervous system is on high alert is environmental factors. If you are not happy with your job, if you are not getting enough sleep, if you are not eating well, if your stress is really high – these can all impact your pain levels and make it worse. We look to change these things as well as changing your movement patterns so that pain can start to get a little bit better.
