A few days ago, a member of my CrossFit gym came up to me after class and told me his shoulder was bugging him. He asked if I could show him a quick stretch to take care of it.
Let me tell you, I wish I could have shown him one thing that would take care of the pain. I really do. It would make my job as a PT a whole lot simpler. One stretch, one exercise, a little bit of dry needling or a manipulation.
But sadly, pain is far more complicated than that.
I told him what has become my standard answer at this point: "I'd love to help you, but I can't do it without knowing what's going on."
I explained that essentially, I'd be guessing at what was causing his pain, and to try and prescribe him a treatment without having all of the data would be doing him a disservice.
It certainly wasn't the answer he was hoping for. But it reinforces a point that I try to hammer home with current and prospective patients about their pain:
It's never one thing.
The Fantasy of the Single Fix
It would be wonderful if there was a single thing we could do for our pain—or even if there was a singular cause that required only a small number of interventions.
As I lay out in The I3 Model of Pain article, musculoskeletal pain is often the result of compounding insults (small amounts of irritation that, individually, don't cause issues) caused by incomplete mechanics (stiffness, weakness, poor load tolerance, reduced tissue capacity, etc.), resulting in injury.
Death by a thousand paper cuts.
A single exercise or mobility drill might address one piece of the puzzle, but it fails to see the human element of someone's pain experience.
What Really Contributes to Pain
Pain is a complex and multifactorial sensation we feel as humans. Numerous systems within our body interact to create the pain experience you feel.
To illustrate, let's walk through a "simple" patellar tendinopathy (aka runner's knee or jumper's knee). Here are just a few things that might contribute to the pain you're feeling:
- Excessive training volume without adequate recovery
- Ramping up your training volume too quickly without sufficient adaptation time
- Poor load tolerance
- Low tissue capacity
- Weakness in your quads
- Stiffness in your quads
- Stiffness in your hamstrings
- Stiffness in your ankles
- Weakness in your glutes
- Eating too many pro-inflammatory foods
- Sleeping less than 6 hours per night
- Sitting for more than 8 hours per day
- Previous history of pain in your knee
The list goes on.
There are SO MANY factors that need to be considered. I hope you're starting to see now how a single exercise or mobility drill only addresses a small number of these factors.
Why We Fixate on Finding "The Thing"
Whether it's finding the thing to fix our thing, or finding the thing that's causing our thing, as humans, we want to know there is SOMETHING wrong and SOMETHING we can do.
We take this reductionist approach largely because that's how the modern medical system evolved.
Doctors are trained to be diagnosticians—finding the thing that's causing your illness and delivering the cure. This system developed when waterborne and bacterial illnesses like cholera were the primary things doctors treated. There were clearly defined symptoms, and a specific drug or treatment protocol to rid our body of the disease.
The Medical Mismatch
Our current medical landscape looks much different.
In our developed world with luxuries like water treatment facilities, proper sanitation and hygiene, and carefully determined best practices to minimize the spread of disease, we have largely eliminated the types of illnesses doctors were trained to identify and treat.
Instead, our medical system largely deals with:
- Lifestyle-driven chronic diseases (heart disease, diabetes, Alzheimer's, etc)
- Musculoskeletal pain
Low back pain is the single leading cause of disability in the US and costs our medical system more than all of the other chronic diseases combined.
94% of all back pain is classified as "nonspecific"—meaning there is no singular cause.
Despite this, we still employ a reductionist approach to diagnosis and treatment. As I discussed in my article Fighting the Image, our primary "diagnostic" protocols, which prioritize x-rays and MRI's, are wildly unsuccessful and often leads to poorer outcomes and mismanaged patients. Doctors are looking for something wrong on the image that can explain their pain. They're looking for "the thing".
The Problem: We're Looking in the Wrong Place
We live in a medical mismatch where our doctors are trained to find "the thing" when it truly doesn't exist in isolation for musculoskeletal conditions.
Understanding musculoskeletal pain is fundamentally different from treatment of conventional disease. We need a different approach for infections than we do for back pain.
You can't see a lifetime of poor eating, lack of sleep, and sedentary behaviors on an X-ray.
You can't see improper technique, decreased tissue capacity, or poor load tolerance with an MRI.
But you CAN see arthritis. You CAN see a bulging disc. You CAN see a torn rotator cuff tendon.
So that's THE THING that gets the blame.
I've Been There (Looking for "The Thing")
I get it. I spent 5 years dealing with my own back pain. I thought that I needed to have an MRI to make sense of it. I figured that until someone actually went in there to see what was going on, I'd never get to the bottom of it.
I was looking for validation.
That's what finding THE THING really provides us: Validation that our pain is real, it's not all in your head, and that something can be done to fix it.
But depending on how "severe" THE THING is, this sense of validation can quickly give way to a victim mentality and sense of powerlessness.
- "My knee is bone on bone so I don't run anymore."
- "My labrum is torn so I don't throw a ball anymore."
- "I've got a bad back...a bad hip...a bad ankle."
We pass the buck and release ownership of our issues to the "bad [insert body part here]."
It's easier to blame the "arthritis" or "degenerative disc disease" your surgeon found on an MRI than it is to take ownership of your lifestyle, movement habits, and training volume.
Because if we don't get better, it's not our fault. We fall back on "the thing" that's wrong with us.
Here's the Good News
When we stop fixating on THE thing, we can focus on the things we actually CAN change.
We can't change what shows up on your MRI.
But we can:
- Improve how you move
- Build your tissue capacity
- Optimize your training load
- Address your sleep, nutrition, and stress
- Change your relationship with pain
These are the things within your power. And honestly? These are the things that actually move the needle.
Your body is amazingly adaptable. But adaptation takes time and requires looking at the whole human—not just the painful shoulder, knee, or back.
This is what we call Performance Physical Therapy—addressing ALL the factors that contribute to your pain, not just treating symptoms.
Back to That Gym Member
So when that gym member asked me for "one stretch" to fix his shoulder, I wasn't being difficult. I was being honest.
His shoulder pain isn't about finding THE thing. It's about understanding ALL the things:
- How he's training
- How he's recovering
- How he's moving
- His tissue capacity and load tolerance
- His beliefs and expectations
At Pack Performance PT in Rocky Hill, we don't guess. We assess.
We look at the whole human, not just the painful shoulder.
Because your pain isn't one thing. Your solution won't be either.
How We Actually Fix Pain at Pack PT
Our approach is comprehensive because pain is complex:
STEP 1: UNDERSTAND
- Thorough movement assessment
- Training history and load management analysis
- Lifestyle factors (sleep, nutrition, stress)
- Previous injury history
- What makes it better, what makes it worse
STEP 2: RESTORE
- Address ALL contributing factors (not just symptoms)
- Fix incomplete mechanics
- Build tissue capacity
- Optimize training load
- Improve recovery strategies
STEP 3: REBUILD
- Progressive loading protocols
- Build resilience and capacity beyond baseline
- Return to performance (not just pain-free)
- Long-term injury prevention strategies
This is why our evaluations are 60 minutes, not 15. This is why we don't just hand you a sheet of exercises and send you on your way.
Because your pain took months or years to develop. It deserves more than a guess.
Stop Looking for the One Thing
If you're tired of:
- Chasing quick fixes that don't work
- Blaming "the thing" on your MRI
- Getting temporary relief that never lasts
- Feeling powerless over your pain
It's time for a different approach.
At Pack Performance PT in Rocky Hill, Connecticut, we help active adults and athletes understand the REAL causes of their pain—and create comprehensive plans that actually work long-term.
Ready to stop guessing and start understanding your pain?
Schedule Your Free 15 Minute Phone Consult to see if we're the right fit to help with your pain.
During your 60-minute assessment, we'll:
- Identify the primary factors contributing to your pain
- Create a personalized plan based on YOUR body
- Show you what's actually within your control
- Give you a clear path forward to address the lifestyle and training factors as you progress
Questions? Text us at 860-266-6287 or email dr.matt@packperformancept.com.
You deserve more than one stretch. You deserve answers.
—Dr. Matt
Pack Performance Physical Therapy
Rocky Hill, CT
Matthew Szymanski
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