ONE of the more common questions I get in my line of work as a physiotherapist is “what is the problem?“. Of course, this is a very fair question indeed. You have pain which is creating emotional anguish and physical dysfunction. You’ve saught help by a professional who knows human anatomy and is an expert in injuries. So…. the next logical question ought to be “what the $%&# have I done?”.
To be honest, the answer is often a mix of layman terms and anatomical jargon as an attempt is made to explain in a few seconds what years of study is required know. Then at this point, I find it interesting as to what happens next. Magically, there seems to be a sigh of relief from the injured party. The mere explanation of WHAT is wrong, pronounced in some foreign latin dialect in a way that can only barely makes sense, is enough to instantly soothe the worries that have been causing so many sleepless nights.
But then I wonder how long that soothed feeling lasts?
Like some sort of immediate gratification, I guess. I imagine the client’s mind ticking over, thinking about how wonderful it is to be now fully aware of what the problem is but then just as quickly feeling reality set in as that realisation of knowing WHAT the problem is…. just isn’t enough.
The impressive pronunciation of “supraspinatus tendinopathy” with the diagram of where it is located on the body, followed up perhaps by confirmation on the ultrasound scan….. just isn’t enough. Because the most important question still remains – WHY IS IT CAUSING PAIN?
And this, ladies and gentleman, is the golden egg.
WHY is the question that must be answered to give true peace of mind. For the answer to WHY is the key to change. The answer to WHY enables us to do things differently. To make adjustments. To adapt. Knowing WHY something is going wrong enables us to take the fuel off the fire. To remove the agitation to the anatomical structure that is the WHAT.
In the experienced therapist’s mind, there should be no relief until the WHY question is answered.
It simply isn’t enough to aim to diagnose WHAT the problem is. Too many times we hear about people seeking treatment for their iliotibial band tightness, for example, but the answer for that they already know. Stretch it, roll it, massage it, needle it, cup it, loosen it etc etc. But they’ve done all that. And the problem is still there.
SO it proves that WHAT the problem is, wasn’t enough information. It was more important to know that the subtle foot pronation, coupled with the ageing running shoe, along with the weakness around the pelvis/hip muscles, was causing the iliotibial band tightness. So it was more important to correct the foot position, change shoes and initiate some strengthening of the gluteal muscles than it was to waste so much time at the point of pain.
The WHY question was the route to success. The WHY answer makes life easy for the therapist and the client. Next time you have an injury that creeps up on you, find out WHAT but don’t stop until you know WHY.