He was laying on the side of the road body gripped in severe pain. He struggled to breathe. When John went out for his nightly bike ride, the last thing that was on his mind was a trip to the hospital in an ambulance. While much of the night is still a blur in his memory, the pain still persists.

The night started as a 25-mile ride with his bicycle club. As he entered the final mile, John peddled furiously in a friendly competition with fellow cyclists. One moment he was racing, the next moment he was flying over the handlebars and onto the ground. His front wheel hit a 6-inch trough before he even noticed it. The bike suddenly stopped, but John’s body kept moving and crashing onto the pavement. Landing on his right side, he crushed his ribs and shoulder blade. John laid there in crippling pain.

He couldn’t breathe or move very well and was not able to stand up, and his friends felt powerless to help. The next thing he remembers is riding to the hospital in the back of an ambulance as medics attended to his wounds. This story gives us a sense of how fast a fun evening can turn into a traumatic event. A car wreck, a sports injury or many other traumas can suddenly cripple us with pain. Pain is a sensation that can have profound effects on people.   The complaint of pain is the most common reason that drives people to seek medical attention.   When healthcare professionals treat pain, they have to determine the cause of the pain.

Pain has two origins it can be derived from the musculoskeletal or the nervous system.   Pain that arises from the musculoskeletal system is considered nociceptive and can be further described as somatic or visceral.  Somatic pain is from the musculoskeletal system skin, bones, muscle, connective tissue, and joints. Visceral pain arises from the organs of the body.  Many times somatic pain is associated with inflammation, which can be the primary stimulus of the nerve that transmits the “pain” signal to the brain.

Neuropathic pain arises from damage and association with the nervous system: examples include RSD, Fibromyalgia, Shingles, post-stroke pain.  This type of pain can be caused by trauma, but it can develop and linger for a prolonged time period after an injury has occurred.  This type of pain is hard for patients to describe and is very difficult to control and resolve.  Many healthcare professionals are not familiar with the best neuropathic treatments because neuropathic pain is hard to definitively diagnose.

Physical Therapists treat the symptom of pain on a daily basis.  Almost every patient has the common complaint that some body part hurts too much to allow them to function at a normal level.  The pain can limit ability to move, think clearly, sleep and live a normal life.  The treatments for pain are extensive and can include medications, modalities, behavior modifications, exercise, and a number of alternative type procedures.

Pain is perceived differently in everyone.  The pain “signal” is transported throughout the body on very small nerve fibers.  The key to treating pain is to be able to decrease the neural conduction on those small fibers. Physical Therapists use manual techniques, hot and cold packs, exercises, electrical stimulation and other modalities to treat the “cause” of the pain.  The most common cause of pain in the out-patient, orthopaedic Physical Therapy setting is inflammation.  The inflammatory process is a chemical process that irritates the small nerve fibers and the pain signal is transmitted from the site to the brain.  The transmission of the signal is slow compared to the speed of neural transmission for movement.  The Physical Therapists pain treatment will decrease the speed of the pain signal and hopefully stop it all together. In most instances, the use of ice is more effective in reducing the intensity pain compared to heat.

No one likes pain, but it is the bodies’ way to protect itself.  The pain signal forces people to change their ways.  If the pain is bad enough, the person will seek medical attention to control it.  Not all pain is bad but all pain lets a person know that there is some kind of injury or “process” occurring in their system that is not “normal.”  The pain signal must be respected and dealt with to assure that someone can live a healthy life.