I find that a lot of people that we meet in the clinic day to day view pain as a pretty straight forward output. Something’s “broke”, so it needs to be “fixed” for the pain to stop. Unfortunately, as we had talked about in an earlier blog, it’s not that easy… Pain doesn’t nicely correlate to the amount of harm happening at a site, and can be influenced by a variety of other factors seemingly unrelated to what’s happening at the injured area. Lucky for us, we’re complex beings with an even more complex system of inputs, wiring, and outputs that we’re all still trying to better understand.
A research study I had come across the other day highlights just that. The research group conducted a study around atraumatic rotator cuff tears, looking at whether a person’s shoulder pain was influenced at all by the severity of their rotator cuff tear. They collected information over 4 years looking at people with atraumatic (not related to a single trauma) full-thickness rotator cuff tears. After crunching the numbers, they found that the rotator cuff tear severity shown on MRI was not associated with the level of pain these people experienced. They found instead that those people with a greater number of comorbidities (the presence of further disease or disability) and a lower base level of education experienced greater levels of shoulder pain.
These results confirm that pain can be caused and driven by a lot more than just harm to the site. These results also help provide hope that those with atraumatic full-thickness rotator cuff tears can improve their pain without changing what’s happening at the site! In fact, non-operative treatment (e.g. exercise) is recommended as the first line of treatment in the case of atraumatic full-thickness tears because it tends to improve pain similarly or better than surgery.
If you’re wondering if this is applicable to other findings on MRI throughout the body, you’d be right. Non-operative treatment is also recommended first for degenerative meniscal tears and hip and knee osteoarthritis. Again, with these conditions they’ve found improvements in pain and function with Physiotherapy intervention, even though there is no change in the structure on MRI or x-ray.
If you have questions about these and want to talk further with a Physiotherapist, don’t hesitate to contact us and book in today.