Unless you have been living under a rock (or more realistically, you simply don’t follow many personal trainers on social media), you’ve probably noticed a recent (but not new) trend of personal trainers (yes, not physios) seeking to address the “root cause” of pain experienced by their clients. Interestingly, this isn’t just for acute pain (short term), but more often than not the goal is to address chronic pain (long term). This is clearly a very admirable desire, as I am sure we would all LOVE to have the skill set to be able to identify the root cause or single origin of our clients’ pain.

You see, when it comes to chronic pain in particular, it is rarely a “root cause” that you are looking for, but rather a set of factors arranged in a hierarchy in accordance with their relative contribution. That relative contribution is likely dynamic and may very well have changed since the initial onset of pain. To seek a single root cause is to ignore/show unawareness of the neuroscience of pain. I wish we could, I undoubtedly have a biomechanical bias and life would be easier if pain was simple and we really could just look at the body as a system that sets the alarm bells off in response to solely physical variables. But, it’s not. Ironically, you can actually appear far more intelligent as the guy who claims to be able to fix everything via the specific root cause, even though many of the most competent physiotherapists in the field would probably never claim such a thing. 

So, let me give you a real life case study of one of our clients. Before we get stuck in, this is not supposed to be a proclamation of my competence by any means, as there are plenty of cases where these results happen “by accident” (which is what makes pain fascinating).

 I will use his words to introduce his case, rather than my own:

“7 months then of 2 physios, a massage therapist, a rheumatology consultant, and specific isolation strengthening exercises to strengthen what seemed to be a bilateral triceps and patella tendinopathy. But still the result was frustration and extremely slow progress. I’m not going to sugar coat it, things got bad. Started pushing away friends and family, little to no energy, no motivation, and even for a short space of time depression. That might sound like an over exaggeration, but imagine a situation where you do something almost every day of the week for a couple of years that has enhanced your life and confidence so much (I was overweight before Uni), that you think improves your health, appearance and “likability”, and all of a sudden for months you can’t do any of it and it seems like you’re probably never going to be able to again.”

Now, the key feature of his case is that the potential “root cause” and the “solution” are two totally different things. You see, based on his training history, it is likely that his training practices may have played a role in the pain he experienced. However, what followed was a period of detraining and entry into the territory of feeling like he was fragile, isolation from friends/family, low energy/motivation and a spell of depression. The “root cause” is pretty much irrelevant at this point, as the set of contributing factors to his pain is now totally different to those of when he first experienced pain. Without considering mood, social health, attitudes and beliefs, past experiences etc., you may be missing the forest for the trees. 

And to use his own words again: 

“Fast forward a few weeks, pain was down, energy, motivation, digestion and mood were up. I’d started to be less hyper-focused and cautious of certain movements causing pain, and actually began pushing myself more in the gym. Another 8 weeks down the line, confidence back up and strength on the rise each week. Now don’t get me wrong, it wasn’t always a linear progression each week, couple of little bumps in the road, but its all a learning curve and I had the support of Gary each week to tackle any issues I had head on and ensure I was heading in the right direction to promote my health first and foremost, along with my fitness goals.”

We did not adopt a very specific exercise approach to correct weaknesses or address dysfunction, we adopted an appropriate, progressive programme with little to nothing that was overly fancy or different to what you would see on any other programme. However, psychological empowerment was a big part of the process, which was provided both directly (i.e. communication) and indirectly (i.e. by him seeing that he was in fact capable of making progress and getting past his pain). 

To conclude, I am not saying there is anything wrong with seeking to find the most important issues to address. Obviously, that is the goal, but just note that it is generally multifactorial, with each factor having its own relative contribution that may very well be very different to those factors that were present at the time of pain onset. Again, it is admirable to want to find the one specific cause of your clients' problems, but sometimes, we simply need to recognise that things can be complex and having some humility as to what you can/can't do will ultimately make you a better practitioner.

If you have any additional thoughts, feel free to respond to this email and let us know!