Cause Versus Symptom – Which Are You Treating?

This is a very commonly heard situation for several of my clients coming in for physical therapy. They say, “I hurt and am trying to treat that spot, but nothing is improving.” A common misconception is to treat the pain where it is felt. The pain that is felt is the symptom but is not always the cause. Sure, pain in one location can be caused due to a local issue, such as a broken bone or local trauma leading to local inflammation. For the most part, with less severe, less traumatic injuries, such as chronic back pain, there is a much larger causal relationship between the irritated tissues causing the pain sensation and discomfort which leads to pain in one location but the cause is not necessarily in the same location.

What Causes Pain? 

Pain is caused when healthy tissue is improperly loaded or overloaded, unhealthy tissue is loaded with a normal amount of stress but cannot appropriately control it, or unhealthy tissue is loaded in an unhealthy manner due to being overloaded. Unhealthy or unfit tissue means that the usual stress a tissue should be able to withstand is overpowered, fatigued and potentially painful. When this occurs over a long period of time, a chronic condition can arise. Tension builds up locally and can create the symptoms felt. The important caveat to understand from this progression of dysfunction is that the tension is the CAUSE of the pain and the pain is the SYMPTOM.. Differentiating the difference between these two concepts is very important for successful rehabilitation. 

Common causes of pain includes muscles that are tight, weak, underactive, or overactive. Tight muscles are simply muscles that are shortened over an extended period of time. When a muscle gets tight, it can create tension on either of its attachment sites and causes pain and discomfort. Tight muscles can frequently be seen in areas of weakness. This is an adaptation the body has made to assist the weakened structures (muscles, tendons, ligaments, etc). As a result, muscles assist the weakened areas by becoming tight and shortened in order to ‘strengthen’ and reinforce the weakened area. As a result, the muscles begin performing a job that it is not necessarily appropriate to perform. As more is required of the muscle, more tension is created and the higher the discomfort or pain level that is felt.

Weak tissues are more commonly injured due to their susceptibility and lack of appropriate resistance to external forces. Weak tissues are commonly weak due to overuse, such as with repetitive activity (ex the rotator cuff in a pitcher), elongated and stretched which increases the susceptibility for damage, or both. Think of weak tissues as similar to how an old, overused rubber band functions. The pliability of it decreases, its elasticity decreases – the ability to return to its original length – and its strength is decreased and can be easily lead to a tear. 

Overactive muscles can be similarly related to being tight for the same reason, as the muscle can work harder in an area of weakness to assist with strengthening the weakened area. Underactive muscles can occur when a muscle is neglected, not properly engaged in motion or simply unknown how to activate. You may have heard of the mind-body connection, as the mind is the conductor for activation of the body and the muscles of the body are the machine being operated by the mind. In simple terms, you need to know how to activate the muscle and know what that ‘feels’ like in order for the muscle to properly function. A commonly seen population that is in need to learn the mind-body connection is in the pubescent population. During this time, their physical appearance changes and several growth spurts occurs. In this time, an adolescent can grow up to 50% of their total growth in their lifetime (and in a very short period of time…)! This rapid change in stature can make for those awkward movements that teens will demonstrate. It is almost as if the body is growing at a faster rate than the rate the mind can learn how to ‘feel’ and control the newly acquired stature. 

The bottom line is understanding what the cause of pain is. Is it resultant due to a tight muscle group? Is it resultant due to a weakened muscle group? Or is it due to underactive or overactive muscles? Understanding this is very important to appropriately treating the pain. 

Why Does Knowing the Difference Matter? 

 Knowing the difference between the CAUSE and the SYMPTOM is a very important concept to understand. Let me pose this analogy for you. If you had a leaky roof, you could do one of two things: (1) Place a towel or bucket under the drip to absorb any water seeping through the ceiling or (2) FIX the roof! With option #1, it is effective only temporarily, as once the absorptive capacity of the towel is reached or the bucket begins to overflow, then once again water starts getting everywhere. The towel or bucket provide temporary relief to the leaky roof. In option #2, this is the initial CAUSE of the problem. If you fix the roof, then you fix the problem. Do you see the difference here? Placing the towel or bucket under the drip due to the leaky roof is a temporary fix that requires frequent maintenance and will only give you temporary relief. But when you fix the roof, less effort is now needed to control the leak, as the problem is fixed and there is no more leak!

Similar to working with pain, find the cause and treat it. We can work on a tender or painful spot all day long for weeks, but if no improvement is occurring, are we really working on the right spot? Of course not! You need to change the treatment approach by treating the cause. Now comparing that to a real-world situation, someone who has chronic low back pain, may not even necessarily have a problem with their back. The problem or cause may result from tissue tension that has built up over time in another part of the body, such as the hip, which can result in pain felt up the back (in the back). For example, in the golf swing a common cause of back pain is due to limited hip mobility. As a result of having tight hips, a lack of rotation is produced from them. With a lack of rotation is produced, the rotation is required to be produced from the next structure up the chain – the back. As a result, the back can have excess stress placed on it due to the extra force it is producing locally to create extra rotation in the swing – to make up for the lack of rotation produced from the hips (THE CAUSE). In this case, a lack of mobility is the cause and the resultant symptom is low back pain. The appropriate treatment is to improve the hip mobility to help reduce stress placed on the back and improve the overall function of the swing.

Improve hip mobility = less stress on the back = less pain = improved swing performance

This can be easier said than done, as finding the cause can be difficult at times. 

If you feel you need help finding the cause for your pain or have any questions about this article, please reach out by emailing me at [email protected].

Interested in assessing your own mobility levels? Check out our Home Mobility Assessment at https://online.par4success.com/start !