"What you pay attention to grows"​
-Geneen Roth

There's nothing more seductive than "curing" a patient's pain.

When I first started working, I just wanted my patients to like me.
And if you fix a patient's symptoms in one visit, they will happily sing your praises.

But as time went on, I realized symptom responses vary drastically, and sometimes the pursuit of pain resolution does a long-term disservice to patients.

It's all between your ears

Pain is weird, and I'm not going to pretend I understand it.

Around 2010, pain science education became increasingly popular in practice.

Books by Gifford, Butler, and Moseley taught therapists about central sensitization, delta fibers, and the emotional nature of pain. I got a heavy dose of this in PT school from my spine professor, Adriaan Louw.

To summarize in one sentence:
Pain is an experience, not an isolated mechanical problem.

Clinicians needed to stop using words like 'tear,' 'degeneration,' or anything else that implied a patient's anatomical structure led to their symptoms. Runners often need these concepts to avoid freaking out about a mild meniscal tear or other normal degenerative changes, and understand that pain ≠ damage.

When I started my business and had significantly more time with patients, my narrow aperture, focused on eliminating pain, widened to the unique ecosystems sitting across from me.

Spending more time with people gave me a better understanding of how complex each case is. At the same time, I began to notice how varied pain responses were from patient to patient.

Having symptom resolution as our main priority felt like planning your financial future around winning the lottery.

Let's give it a guess

I understand patient's schedule with me get rid of their pain.
If I have a cranky tendon or joint, I want that pain gone!

I want to ensure that I do everything I can to alleviate my patient's burden, while recognizing that pain resolution cannot be our sole focus. Chasing pain relief at the expense of preserving mental and physical capacity can lead to larger long-term issues.

I can give a fairly good estimate of when people will feel better.
Even if I'm not confident in their time frame, I can outline my expectations for clinical and performance benchmarks to strive towards.

The best example of this is working with runners with proximal hamstring tendinopathy (PHT).

PHT is notoriously painful and takes forever to resolve completely. When I consult a new patient with PHT, I'm honest with them that we can generally get to running quickly, but a complete resolution of symptoms with fast running on inclines and prolonged sitting can take 12-18 months.

Patients who solely focus on symptom reduction can easily fall down the slippery slope of absolute rest, leading to lost tissue capacity, worsening aerobic fitness, and worsening mental health.

In reality, complete symptom resolution of PHT is often random, with patients noting that "one day it just went away". The only way to get there is to keep them lifting, keep them running, while giving them guardrails to maintain stable symptoms.