Why Your Physio Asks All Those Questions – History
After the pain has been investigated the physiotherapist will move on to getting an accurate history of the problem. The pain problem may come on quickly in a sudden injury or event, or slowly over a long period with a gradual worsening. A sudden event is likely to indicate a soft tissue injury to a muscle, joint, ligament or disc with the typical high levels of pain for the first period and then a gradual easing to a maintenance level. This will lead the physio to look for the likely damaged structure and examine the function of the anatomical area.
A slow onset of pain could reflect a number of things: one is that the person has been performing an aggravating activity many times over a long period of time and this is beginning to stress a structure by overuse; another aspect is that the person is maintaining a particular posture for significant periods of time leading to tissue stresses beginning to cause pain. Repeated performance of an aggravating activity can be addressed by changing the activity or managing the process in a different way. Postural correction can be useful to correct problems such as sitting at a desk, bending over too much or driving for long periods.
The typical history of a slowly changing problem is for there to be an onset at some point, either relatively sudden or slowly coming on, then for the pain to settle for a while. Then it recurs at some point and this cycle is repeated for an unpredictable period of time. If the problem continues one episode will occur where the pain will not resolve afterwards and the person then has a low level pain problem of a constant nature. Episodes may still occur on this base of chronic pain and the overall pain level can worsen with time.
The physiotherapist will want to know what the patient has done to try and correct the problem such as changing job, changing activities, taking up exercise, attending a manual therapist or avoiding aggravating activities. Injuries will present with acute pain settling to an ache which is aggravated by specific movements and postures, postural problems are clearly due to particular positions, disc problems may refer significant pain to the limbs and give anatomical deformities and nerve pains may be unpredictable and sometimes spontaneous.
The success and otherwise of the attempts to deal with the pain are also of interest to the physio as they may give clues to what approach might give further improvement.
Author: Jonathan Blood-Smyth