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Why Does Pain Keep Coming Back? With Linda Gomercic
Advantage Healthcare & Physiotherapy | Movement and Pain
Host: Calum Fraser | Guest: Linda Gomercic, Senior Physiotherapist (Advanced Practice, Complex Pain)
[0:00] Calum: Why does one movement hurt but another similar movement doesn't?
[0:05] Linda: Our bodies use multiple muscles and joints that work together to perform even simple tasks. Changing how we move can change the demands placed on different tissues. Small differences in position, speed or movement can influence discomfort. Pain is also affected by factors such as fatigue, previous activity and sensitivity. A painful movement doesn't automatically mean we're damaging something.
[0:31] Calum: If someone has knee pain or shoulder pain, is it possible that something else in the body is contributing?
[0:38] Linda: The painful area is important, but it isn't always the only region worth considering. Different parts of the body contribute to the same activity. For example, reaching overhead involves the shoulder, the shoulder blade and the upper back. Walking and climbing stairs involve coordinated movement patterns through the feet, ankles, knees, hips and trunk. Sometimes changing movement in another region can influence symptoms. However, that doesn't necessarily mean that we've found the underlying cause.
[1:11] Calum: Can you explain how a problem with movement in one area might affect what happens somewhere else?
[1:17] Linda: Ultimately, our bodies work as a connected system rather than isolated joints. If movement is limited or uncomfortable in one region, we may actually change how we move in order to perform the task. For example, someone with limited upper back mobility might use a different strategy when reaching overhead. The strategy isn't necessarily wrong, but it may alter the demands on the surrounding joints and tissues. This is why examining the activity is often very useful. Importantly, not every movement difference needs correcting.
[1:59] Calum: Some people have treatment for their back or shoulder pain and feel better for a while, but the pain eventually returns. Why might that happen?
[2:08] Linda: There are several reasons why symptoms can return. Sometimes treatment provides temporary relief without addressing the demands of the person's everyday activities. A person might feel better after treatment, but then return to an activity that their body really wasn't ready for. Strength, endurance, movement options and activity levels can all be relevant. Pain can also be influenced by sleep, stress and other health factors. Recurring symptoms don't automatically mean something important was missed or that treatment failed.
[2:42] Calum: If someone experiences discomfort when bending, reaching or lifting, what could they try themselves?
[2:49] Linda: I would start by identifying which part of the activity is uncomfortable. Try changing one thing at a time rather than completely avoiding the activity. For example, if reaching overhead is uncomfortable, try reaching slightly forward instead of directly out to the side. If bending is uncomfortable, try reducing the depth, changing your foot position or even using a support. These changes may help make the activity manageable while symptoms settle. There isn't one adjustment that works for everyone. Avoid forcing movements that produce severe, new or substantially worsening symptoms.
[3:28] Calum: We hear a lot about correct posture, lifting techniques and movement patterns. Is there actually one right way to move?
[3:36] Linda: No, there usually isn't one perfect movement pattern for everybody. People have different strengths, flexibility, physical demands and movement preferences. Our bodies are generally capable of adapting to different positions. Sometimes modifying the movement is helpful because it makes an activity more comfortable or manageable. But that doesn't mean the original movement was necessarily wrong. The long-term goal is usually to have more movement options, not fewer.
[4:05] Calum: What would you suggest to someone who's had recurring pain for months or years, and feels like nothing is providing lasting improvement?
[4:15] Linda: First, recognise that recurring pain doesn't necessarily mean there's ongoing tissue damage. Consider the broader picture rather than concentrating only on the painful area. Look at patterns. Which activities consistently aggravate symptoms? Which activities are manageable? Consider whether activity levels have changed, particularly periods of prolonged rest followed by doing too much. Gradually rebuilding strength and activity tolerance can be helpful. Avoid constantly searching for the one perfect posture, exercise or movement correction. Persistent or changing symptoms may require a broader assessment to understand contributing factors.
[4:58] Calum: For someone watching who's dealing with recurring discomfort, what's one thing you'd encourage them to think about differently?
[5:06] Linda: Don't assume the location of pain tells you everything about the problem. Think about the activity you're struggling with rather than concentrating only on the painful body part. Consider whether small changes in how you perform the activity make it more comfortable. Look for patterns in your symptoms rather than judging progress by one painful day. Maintain manageable activity where possible and gradually build your capacity. Seek professional assessment for persistent worsening symptoms, significant weakness or major changes in function.