A Pain in the Arse!!

October 14, 2019

A problem by any other name would still hurt the same, or would it?

Humans have always told stories to convey information between each other. They are a way of translating meaning and understanding between people and keeps us connected to each other.

Health care is no different, especially when describing pain.

Pain is an experience, only the person feeling it knows what it is like.

They often have to describe it to other people, so those people can help them with it.

To do this is not easy. 

Even before it is communicated to another person, the nervous system of the person experiencing that pain has noticed something in a certain body part, conveyed that signal to their spinal cord. That signal has been referred to the brain, all the centres of the brain have interpreted it based on all current information, or possible future events, and a response has been enacted based on that information.

What that means to that person, and what it feels like though, is still another level on top of this.

Everyone has a nervous system, and it works basically as described above. But pain is an individual experience, so even between signalling in a nervous system and a person feeling pain, that person is already trying to work out what it means.

For meaning, we have stories.

“It feels like……”

“When I bend it shoots, grabs…..”

“Everything is locked up….”

All of these are metaphors.


In an attempt to make sense of these experiences, and somehow organise them to make treating them easier, health and medicine then subgroups these.

If there is a disease, injury or condition, like rheumatoid arthritis or a Weber B fracture of the ankle, this is immensely helpful for managing those conditions.

It gets tricky when we are describing pain.

Let me list a few examples




Shin splints

ITB friction syndrome

Osteitis pubis

What do these actually involve? All they have in common between people that feel them is pain in a certain area.

For example Sciatica – a real pain in the arse (hahahahaha best physio joke ever)

That has been used to describe so many different pains and symptoms to me over the years that I don’t even know what it is any more. 

So much so that when someone tells me they have sciatica, apart from getting my awesome physio joke in there somewhere, the only thing I do is ask “what does that mean to you”.


So, if you’re walking around with a “thing”, that has a name, and that name describes pain, there are some points I want you to think about.

  1. No one else has your Thing – even if it has the same name, no one has ever had the same problem that you have now, because they aren’t you. This is important because..
  2. Your Thing can change – often when we have a name for it it takes on an extra dimension and becomes something we have to deal with forever. If this is rheumatoid arthritis, then yes, ongoing management of that will be needed. If that is “RSI”, then thinking that can’t get better doesn’t make any sense.
  3. Dr Google doesn’t know anything about your Thing. Given the wide range of experiences put under an umbrella term like “shin splints”, when you use a search engine to find information, you will find just as large a range. I could find you 2 pages that give you directly opposing advice for most of these things.
  4. People love to tell you about their Thing, and it is almost always bad. How many times have you heard “I had sciatica last year and it was easy, moved a bit and it settled down really fast”? Zero times, that’s how many.

    What about “I had sciatica last year and it was the WORST THING EVER AND IT STILL HURTS AND I’VE NEVER BEEN THE SAME”

    More often, I bet.

  5. Treatment plans need to be based on your Thing, not on someone else’s idea of what it is. There is no one treatment for RSI, or sciatica, because they are all different. But, all of them can be treated.



The thing with stories is the more we hear them, the more we believe them. Sometimes this is good, sometimes less good. If you keep hearing that ITB friction syndrome will always affect your running and there’s nothing you can do about it, then your knee hurts, you’re going to believe you’re in for the same fate.


So, if you have pain that you would like to understand, or change, as it is stopping you from doing something, then do something about it. 

This involves talking to someone who can look at you and tell you what your Thing involves. Sometimes with pain, it doesn’t have a name, and it has many causes. It is ok to just call it “your back pain”.

The lack of certainty that comes with a lack of a specific name doesn’t mean we don’t know how to help, or that it can’t be helped. 


Feel good that you don’t have to call it by the same name as everyone else. Unique problems can have unique solutions. It’s no coincidence that that list of things with vague names have a tendency to linger on for longer than they need to. What a pain in the arse!!!!! (ha, never gets old)

Leave that alone. Sort your issue out and get back to whatever it is you’d rather be doing.