“Why Does This Hurt?”: Understanding the Body Beyond the Diagnosis

When I started my physiotherapy training it was, as it should be, focused on learning anatomy, physiology, and pathology, and I spent a lot of my time memorising muscle attachments and nerve pathways.

This knowledge is essential. As healthcare professionals, we need to be able to assess a specific area, identify what structure is overloaded, injured, or inflamed, come up with a working diagnosis, and know when to refer on.

But in time, I found that when I focused most of my efforts on the diagnosis and the problem area, I struggled to offer a long-term solution. Something felt “off,” like I was missing something.

I’ve always been drawn to the why. Why does my left hip hurt and not my right? Why does one person have neck pain, while another struggles with their lower back? And why is it not shifting, or why does it keep coming back?

Of course, genetics play a role. Someone born with hip dysplasia is more likely to develop hip issues later in life. A person with hypermobility may be prone to dislocations. Sometimes, surgery is needed.

But often we fixate on the structural diagnosis - an injury, disc issue, or nerve problem - and underrate the role of other factors. These are often what help us get to the why, and through that, the solution becomes clearer.

So my next question is: what can we influence? Consider the following:

• Do you have old injuries that didn’t completely resolve, or that caused you to move or hold yourself differently, creating patterns of tension?

• Which parts of your body have been underworking, placing excess strain on a nearby structure? (For example, if the glutes and hamstrings aren’t working efficiently, the calves may end up doing far more than their fair share.)

• Are you breathing in a way that supports and regulates your nervous system, allowing your body to heal as it’s naturally able to? Or are you breathing in a way that feeds into stress and tension?

• What do you believe about your body? (e.g. “I’m just getting old,” “I’m just falling apart,” “My mum needed a hip replacement, so I probably will too.”) How might this shape your experience and your focus?

• Where is your attention, and what are your goals?

Since my initial training, two key modalities have shifted my understanding of the body:

• Be Activated: a muscle activation technique rooted in the body-mind connection, with surprisingly good and often fast results. This blew my mind.

• Go-To Therapist Mentorship: where I learned a step-by-step approach to retraining movement patterns and building resilience, always with the individual’s goals in mind.

Over time, I’ve found it far more effective, and more fulfilling, to go beyond the symptoms (without ignoring them) and explore the patterns and compensatons held in the body, recognising that body and mind are inseparable. This approach empowers the patient as they understand their body better and have the tools and understanding to make long term changes.

So I’d love you to think about this… what might be influencing your pain that isn’t on the X-ray?