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What's in your cup?

There is a great analogy on pain developed by Adrian Lowe. I want to explain it to you because a common question I get, "My X hurts, what's wrong with it?" People have a common misconception that when something hurts, there must be something wrong, must be some kind of damage. For example, my knees hurt when I run so I must have bad knees. Or I can't lift anything because I have a "bad back". Sometimes people get more specific such as I tore my rotator cuff and that's why my shoulder hurts. Or the opposite is true. My shoulder hurts, it must be my rotator cuff. My knee hurts, must be my meniscus or I am bone on bone. My back hurts so I must have a herniated disc. The issue with this line of thinking is that pain is so much more complex than that. So many people have these same issues: arthritis, torn rotator cuffs, disc issues but they don't have pain! So what gives?


If you are willing, I want to do a hands-on example. Get a coffee cup and a measuring cup (1/4 cup). If you are not willing, use your imagination.


Place your coffee cup in front of you. Get your 1/4 cup and water.


If you feel stress or anxiety about anything (work, kids, corona, money, etc)- place some water in your cup.

If you are not happy with your job and dissatisfied at work- place water in your cup.

If you feel depressed- place water in your cup.

If you do not have a good social support system (or maybe currently don't have access to that support system)- place some water in your cup.

If you have not worked out 4-6 days in the last week or had increased physical activity for 30 minutes the last 4-6 days- place water in your cup.

If your nutrition is less than on par (you eat out several times a week, you don't eat enough vegetables, too much sugar, etc)- place some water in your cup.

If you did not sleep at least 7 hours a night and go to bed and wake up consistently at the same time for all 7 days of the week- place some water in your cup.

Is your cup full yet?

If you have any joint or tissue damage (known tear, known arthritis, etc)- put water in the cup.

If you have fear of movement (afraid to bend over, afraid to twist, afraid to reach overhead)- place some more water in that cup.

If you have limited tissue tolerance (or a lower pain threshold)- add water.

If you believe "your back can go out", "discs slip", "things get out of alignment regularly", "pain equals damage", "your doctor told you it's the worse he has seen", "your doctor told you that you should be hurting or you imaging was awful", "your doctor said you needed surgery"- add water to you cup.



Now is your cup full yet? If not, great! Is it almost full? Now let's say we do too much of a certain lift or miss a lift just the wrong way or decide to go run a mile or 2 when we've been sitting on the couch for 2 months. That adds water to your cup. Did it overflow if it wasn't already?



We live lift too much on the edge, living at our max capacity. We then do a simple task- sometime something as simple as reaching in the backseat to get your purse or picking up your suitcase then BAM! Pain! Was it really that one specific activity? Not likely. It was that your cup was already too full and you tried to add a little more water. Your body's warning system went off (pain).


Now of course, you can do things to calm your pain and the aggravated tissue, but you should also address other things in your cup to help bring your pain level down.


You, your physical therapist (that should be me) and your doctor should be able to change your pain without giving you a single exercise or medication. Just by helping you change what is in your cup we can help reduce your pain. On the flip side, we can make your cup bigger! We do that through improving your strength and aerobic capacity (of course in a progressive manner to not exacerbate your pain).



There are some of you who keep chalking up your various aches and pains to "getting older". I've got news for you. That is only a very small amount of water in your cup. Stop using that as an excuse. Stop looking to age as something to blame because your knee hurts after this workout or shoulder hurts here. Look to reduce what is in your cup and see what happens! You MIGHT just feel young again!


If you don't know where or how to start, PT can help with that. Physical therapy does not just have to be a little massage, some stretches and a few things with a theraband. If fact, it SHOULD be so much more than that. If your PT, isn't talking to you about the things in your cup and isn't eventually putting you under a load more than a colored band, find a new PT.


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