One of the difficult aspects of applying current research for treating various pathologies is that not everyone experiences an injury the same. Not only do we have to incorporate injury-based research, but we also should consider aspects of pain science research. Each component of the pillars of evidence-based practice should be incorporated in patient management.
Have you ever wondered why two patients with the exact same diagnosis can present completely differently? While one might retort that the severity of pathology (amount of arthritis or tendon degeneration), imaging studies regarding pain science have found that often presenting with a worse experience can easily present with minimal pathoanatomical findings. Pathology does not equal injury and hurt does not equal harm.
When an individual experiences pain, there are many different factors that go into it. Pain is actually that, an experience. Have you ever noticed how a baby looks to their parents to see how to react when hurt? Or how an individual might describe their pain differently based on the setting? Past experiences (their own or family members), social expectations, individual expectations, fear and much more can influence a patient's injury experience. Because of that, we cannot address every patient with "achilles tendinopathy" the same. We must incorporate their individual expectations, beliefs, and stressors into consideration when managing their care. While it can be upsetting that we aren't able to treat based on pathology alone or even regularly apply pathology-based research to our care, we are fortunate to understand WHY not all people experience an injury the same way. By further developing our understanding of pain science, we will hopefully be better able to treat our patients in the most efficient and successful way.
-Dr. Chris Fox, PT, DPT, OCS