My blog posts are often inspired by the conversations that happen in the clinic. This is true this time as well… with a bit of a twist. Ironically, I recently had to deal with a particularly annoying back injury. Now it was my patients turn to ask me how I hurt my back. Interestingly, more than one patient admitted to a level of satisfaction knowing that I could hurt my back. This was a fine reminder that misery loves company. I find it funny that people think doctors don’t have to deal with the same things everyone else deals with. In fact, no one will escape the elephant in the room.

I know there may be an elephant stomping my way when a patient adamantly reports not knowing what they did to have pain. Now, of course, with a little digging we can often reveal a probable cause of pain, say due to a forgotten mishap. However, many times the patient is sincerely baffled by why they are hurting. Let's dig a little deeper into the sometimes not-so-obvious reasons pain can occur… including the elephant.

Injury

It would seem obvious that if we have a slip, fall or some other trauma, we would most likely be aware of it. The trick here is that not all injury is an obvious trauma. Much more common are repeating mini-traumas known as microtrauma. Microtraumas are small insults to a tissue that cause a little bit of damage at a time and will often go unnoticed until that damage gets bad enough to trigger a pain response “out of nowhere”. Take for example the common blister. We may not know our shoe is rubbing and irritating the side of our toe or heel until the damage reaches a point of pain.

Physical microtrauma do not have to result from active motion. Microtrauma may also result from prolonged compression, stretch or twisted position. Ever fall asleep in a chair or in an odd position on the couch and wake with a crick in your neck? Have you been a bit stiff after a long road trip or plane ride? Do you tend to stand on one foot more than the other? These microtraumas can lead to muscle and ligament damage, resulting in tissue malfunction and pain.

Microtrauma is exceptionally common, hard to detect and the primary reason why getting regular wellness checks with your chiropractor is such a great preventative measure.

Inflammation

Inflammation is often associated with pain and again may result from an obvious trauma or not so obvious microtrauma. When there is no evidence of any kind of trauma and inflammation is still present, what then? Ruling out any kind of trauma still leaves hundreds of possibilities. All of these possible causes of inflammation can be grouped into just two categories. Environmental causes and Biochemical causes, with the understanding there is some overlap in these groups as well.

For example, a sunburn or sudden dramatic changes in the weather would be examples of purely environmentally induced inflammation. An infection or hormone irregularity would be an example of a biochemical cause of inflammation.

What about an allergy? Environmental or biochemical? A substance is only an allergen if a person reacts to it. The allergen does not cause the inflammation. Rather, how the body responds to the allergen is what causes the inflammation. Even if the allergen comes from the environment, the allergy is a biochemical cause of inflammation.

Inflammation is not only associated with pain but also with most disease. A Functional Medicine practitioner can reveal the source of inflammation and guide the patient back to a healthier place.

Elephant

Whether pain results from injury, inflammation or some combination, ultimately our body is tasked to heal the injury. Over time our body will become less efficient at recovery from injury. Some people will begin to notice this even in their 20s while others may keep chugging along rarely dealing with pain, well into older age. The reasons for this disparity are complex and include factors such as lifestyle choices, genetics and a person's propensity for good or bad luck.

One way or another we are designed to wear out. Aging is a part of life and like it or not, that is the way it is. This will still hold true even if science figures out a way to prolong life for hundreds of years. When there is an elephant in the room, especially an old one, sometimes things just happen.