Resistant Pain: A 3-Dimensional Moving Puzzle

The following is a copy of an article I recently wrote for BC Physio Magazine.

Supernova Remnant Cassiopeia A (NASA, Chandra, 1/6/09)

The following is a copy of an article I recently wrote for BC Physio Magazine:

After fourteen years of literally poking and prodding other people’s bodies all day, I have learned a few things about pain, anatomy and human nature.  I have done more than my share of market research in the hurting yourself category and have managed to work with or train under some of the world gurus in the pain and rehab space.  My name is Brent Stevenson.  I am the co-owner of Envision Physiotherapy in Vancouver and the author of the new book

Why Things Hurt: Life Lessons from and Injury Prone Physical Therapist.  It is a collection of stories and lessons, written in a humorous, conversational tone, that I have found to be the most meaningful and helpful for my clients as they navigate their journeys down the path of resistant pain problems.

I refer to pain as a 3-dimensional moving puzzle due to the entanglement of physical and emotional factors that contribute to the end perception of a person’s pain.  When I started my training as a physiotherapist I learned about anatomy and the different systems of the body, like the boney framework of the skeleton and all the muscles that attach to it.  I learned about the nervous system and the basic electrical wiring of the body followed by a superficial look at some of the organs that the skeleton was protecting.  I was then released into the healthcare world to try and help people with my new found knowledge, but quickly realized how superficial my understanding of the body and my ability to help people really was.  I knew about most of the pieces but didn’t really grasp how most of them integrated together as layers of systems within the body.  I helped people, but not the way I am able to today.

Today I am able to properly assess and treat the role of the container and the contents of the body; by ‘container’ I mean the skull, the ribcage, spine and pelvis and by ‘contents,’ I mean the organs, nerves and membranes that attach all through the inside of these cavities.  No I have not become a surgeon, but I have realized that most clinicians’ views of treating a person tend to pay a lot of attention to their outer shell and ignore all the guts that are pulling on the inside.  Muscles and joints tend to get all the credit when it comes to pain, but the deeper and broader my experience gets as a physiotherapist, the more I realize that organs, fascia, emotions and awareness are just as important, if not more.  My days of giving people stretching and strengthening exercises for their muscles are largely behind me because I have found a new approach that has proved to be profoundly more effective at dealing with pain and dysfunction.

My approach is to start with a strong emphasis on creating awareness and understanding in a people; they need to even superficially understand WHY they are feeling what they are feeling in order to calm the emotional contribution to the pain puzzle.  Pain is stressful for most people and typically the medical system’s focus on putting a name or ‘diagnosis’ on it actually makes it worse by shifting the people’s attention from WHY to WHAT.  The initial investment of time into client education usually pays dividends into calming stress and creating a commitment to help the person assertively help them self because they better understand the direction they need to go.  A simple biomechanics and anatomy lesson as it relates to a person’s posture can go a long way to helping one understand their body and their pain.

We all have fantastically bad ways of holding ourselves up against gravity all day as we stand, sit, walk and move, but most fail to realize what they are doing wrong or how much impact little habits can have.  Some people attempt to hold their whole bodies up with their backs, while others subconsciously clench their butts all day.  Some people unknowingly grip with their stomach and others bury all their anxiety and stress into their chest; we are what we do repeatedly, and it usually takes another objective person to point it out to you.  I am that person for my clients.  When people come to me with no idea how or why they started hurting, I typically start by pointing out a few things about their posture and then move on to trying to see what I can change on them.

The single most powerful tool I have found to change people’s function and pain quickly has been the use of IMS dry needling (intramuscular stimulation).  It is a technique that allows trained physiotherapists to assess and treat the interaction of a person’s muscular and nervous system at the same time.  Your body is full of sensory feedback loops that connect your body to your brain and spinal cord.  Irritations around your spine and/or your joints will typically creative a reactive tensing or bracing of muscles that can compress joints, restrict movement and eventually create pain.  The skilled manipulation of an acupuncture needle into groups of these reactive muscles can calm a reactive nervous system and help reset the tension levels in the spine and joints to a more appropriate level.  It is an extremely effective technique in the hands of someone who understands biomechanics and posture.

IMS can have profound and lasting effects, but sometimes it doesn’t.  Sometimes it lasts a week and then the problem comes back and sometimes it just hurts and doesn’t seem to help.  Although I find it to be the best tool, I found that I needed something to fill in the gaps for the people that it just wasn’t the game changer for.  Some people simply needed posture and movement advice, but a smaller percentage of people still had something that they needed physically done to them that IMS just wasn’t getting at.  In the past five years I have been effectively filling those gaps with osteopathic manual therapy in the form of visceral and neural manipulation.  I have now taken ten advanced courses on learning how to feel and treat the fascial restrictions around organs, nerves and membranes in the body with my hands.  It has allowed me to look at a person’s body as a whole and not just an outer shell.  It has answered a lot of frustrating questions for my clients that weren’t improving with more traditional therapies.  In a nut shell, in order for your body to move well and feel good on the outside, the stuff on the inside needs to be able to move too.  Injuries, stress, surgeries and infections can cause physical restrictions in the fascia around your organs and nerves and many times that is the root cause of your alignment or pain problems.  Visceral manipulation is a subtle technique, but one that holds a lot of answers for people with resistant pain problems.

Once persistent tension in the body has been addressed by means of awareness, IMS and/or visceral work, typically people need to learn how to develop a new strategy for how to hold themselves.  Our brains create motor programs as sequences of muscle activations so we don’t have to think about everything that we do, but sometimes that autopilot goes down a bad path and needs to be retrained.  Loosening tension on someone will only last so long if their movement strategies just start creating tension again as soon as they walk out the door.  Most resistant pain problems become resistant because they haven’t been treated as a 3-dimensional moving puzzle.  If you genuinely want to change your pain, be open to the idea that some of it is an emotional experience and some of it is a physical experience and you will likely need someone with a toolbox of techniques to help you and a motivating way of teaching you how to move differently.

If you have found this article interesting, you will find much more detail and a broader variety of topics in the articles and videos on  My new book summarizes what I believe everybody should understand about their bodies, but commonly don’t.  You will learn a lot and likely laugh along the way!

Please feel free to leave questions or comments below and I will do my best to answer as many as I can.

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