Physical pain

Most of my patients consults me ​​for pain that appeared without any clear trigger. This spontaneous pain may have started very gradually over a period that is difficult to define, or it may have been observed for the first time suddenly during a walk. The fact that there was no accident makes it difficult to attribute the pain to a traumatic injury. In this case, we may speak of atraumatic pain or idiopathic pain (from the Greek idios [self] and pathos [suffering]).

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Many medical diagnoses fall under the category of idiopathic pain, and this is where it becomes useful to learn a little about the basics of medical terminology.

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There are diagnoses that simply describe the location of the pain in Layman terms. More commonly used in French, terms that end with -algia (from the Greek algos [pain]), -dynia (from the Greek edo [to devour, pain that devours us]), or -go (from the Latin igo [to transform]) essentially means the same.

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• Shoulder pain or brachialgia;

• Neck pain or cervicalgia;

• Knee pain or gonalgia;

• Low back pain or lumbago;

• Fibromyalgia (chronic pain in the entire body’s connective tissues and muscles);

• Allodynia (skin pain to light touch).

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To describe an area that may show signs of inflammation, the suffix -itis (from the Greek itis [inflammation]) may be used:​

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• Tendonitis (inflammation of the tendon);

• Epicondylitis (inflammation at the elbow’s epicondyle);

• Arthritis (inflammation of the joint);

• Capsulitis (inflammation of the shoulder’s capsule and ligaments);

• Periostitis (inflammation of the periosteum, the bone’s outer membrane);

• Plantar fasciitis (inflammation of the plantar fascia);

• Bursitis (inflammation of the bursa);

• Myositis (chronic inflammation of the muscles). 

 

If the area in question does not have inflammation, but there may still be microscopic changes, such as wear and tear, denatured cells, nerve growth where there should be none or mechanical entrapment, the suffixes -osis or -pathy may be used (from the Greek pathos [disease]):

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• Tendinosis or tendinopathy (disease of the tendon);

• Discopathy (disease of the intervertebral discs);

• Neuropathy (disease of the nerve);

• Radiculopathy (entrapment of the nerve at the spine level).

• Arthrosis (disease of the joint). In English, we mostly call it osteoarthritis. This may lead to confusion as the suffix -itis means inflammation, whereas in reality, osteoarthritis is not an inflammatory condition.

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The term syndrome may also be used:

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• Carpal tunnel syndrome (median nerve trapped in the carpal tunnel of the wrist);

• Thoracic outlet syndrome (nerves or arteries trapped between the neck and shoulder);

• Patellofemoral syndrome (kneecap not moving properly);

• Subacromial impingement syndrome (tendons and other structures trapped in the narrowing of the space between the shoulder bones);

• Rotator cuff syndrome (pain in the shoulder’s inner muscles);

• Iliotibial band syndrome (pain in the outer knee);

• Temporomandibular joint syndrome (painful or locked jaw);

• Myofascial pain syndrome (muscle pain from trigger point).​

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When a mass of cellular tissue is protruding from the cavity in which it is normally contained, through a weakened opening, it is called a hernia:

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• Disc hernia (the inner gelatin of the intervertebral disc popping out through a torn or weakened outer membrane);

• Inguinal hernia (a portion of the intestines popping out of a weakened opening in the abdominal muscles);

• Incisional hernia (a portion of a muscle or other tissue popping out of a badly healed surgical incision).​

 

Finally, the term dysfunction describes very generic situations:

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• Joint dysfunction (a stuck joint);

• Muscle dysfunction (a muscle that doesn’t function properly). ​​

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Of course, all the conditions mentioned above can result from an accident, but they mostly develop in more nebulous contexts, such as faulty biomechanics, fatigue, mechanical irritation, mechanical wear and tear, or physiological degeneration due to age, genetics, illness, a known complication of a medication, or lifestyle habits. Pain can take time, even years, to surface. Therefore, it is not always easy to reconstruct the exact chronology of how the pain came to be.

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Most of the conditions described above will not benefit from the healing process as understood in traumatic injuries, simply because they are not injuries, but rather abnormal biomechanical or physiological states. Even if these conditions resulted from irritation or slow mechanical wear, thus justifying the presence of injury and inflammation, the capacity for cellular regeneration is often poor or absent, either due to the very nature of the injured cells, which are typically tendons or cartilages, or due to faulty biomechanics or persistent mechanical irritation that prevents the injured area from healing.

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Thus, without correcting the abnormal biomechanical or physiological state, or adopting strategies to slow down or compensate for degeneration, the suffering person risks a stalemate with their pain and limitations for years or decades.

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In physiotherapy, a thorough examination will be conducted to understand the causes of pain and physical limitations. Depending on the nature of the problem, several treatment options may be considered, such as strengthening exercises, stretching exercises, therapeutic massage for muscles, manual therapy for joints, the Mulligan approach, the McKenzie method, electrotherapy, and taping.