You have been fine doing the same recreational and day-to-day activities without injury or pain. After doing nothing special or different you have pain, and this pain has now been going on for weeks without resolving on its own. You did not injure yourself, so why do you suddenly have pain when you were fine before?

The amazing ability that our bodies have to adapt will only get us so far. The compensations your body has been making in the background have finally caught up to you. An example of this is back pain. Many of us have had it at one time, and it seems to follow this  random presentation. In my line of work I see some pretty ugly MRIs and X-rays of the spine. These bony abnormalities of collapsed discs, pars fractures, scoliosis, and anterolisthesis or retrolisthesis do not occur overnight. In most patients, these images have been present for years but went unnoticed because there was no pain, and thus no reason for imaging.

Why, then, do they have pain now? Isn’t it because of the obvious abnormalities in the spine? If these have been progressing over time without pain, why do they hurt now? The answer is that your body has been doing an amazing job of compensating. Muscle strength, avoidance behaviors, and altered movement patterns got you this far, and suddenly, one day it is not enough anymore. In most cases with back pain, it is because the muscles that are doing most of the supporting get weak and tired.

The first thing people jump to is, “I must have some horrible problem that is causing my pain.” This is the case for most of us; nobody is perfect, and we are all compensating in some way.Tree root Most of the time, what people and some doctors don’t realize is that you have been fine because, for a while, your body has learned to deal with the abnormality. Ask yourself:  why can’t it do so now?

In physical therapy, we give the body what it needs to get back to the “status quo.” We give it the strength and pain relief to overcome its current limitations and return to the pain-free life it had before. I prefer to attempt this method (physical therapy) before going in and changing structure (surgery) without knowing how your body will adapt, or even if it will change the pain.

There are those cases that need surgery; the level of needed activity level plays a role. However, conservative treatment should always be attempted before surgical intervention. Going into surgery stronger (versus weaker) because of therapy is always a benefit for the patient as well as the outcome of the surgery.

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