“My shoulder hurts, so there must be something wrong with my shoulder.”
It sounds perfectly logical.
And sometimes there is.
But pain is considerably more complicated than a simple alarm telling us exactly where something is damaged.
For therapists working with people in pain, understanding that matters.
Not because we’re there to diagnose what’s causing somebody’s symptoms — we’re not.
But because the language we use and the explanations we give can influence how a client thinks about their body.
Pain is real
Let’s start with something important.
If somebody says they’re in pain, their pain is real.
That remains true even if a scan hasn’t identified a clear structural cause.
It remains true if symptoms change with stress.
It remains true if they’ve had pain for years.
And it remains true if two healthcare professionals have given them different explanations for it.
Pain is a personal experience.
Our job isn’t to decide whether somebody “should” hurt as much as they say they do.
Pain and damage aren’t always the same thing
If you cut your finger, pain makes perfect sense.
There is tissue damage and your nervous system is doing a very useful job of encouraging you to protect it.
But pain doesn’t always correlate neatly with the amount of tissue damage present.
People can have changes visible on scans and experience little or no pain.
Other people can experience significant pain without imaging providing a simple explanation for it.
Persistent pain can become particularly complex.
The nervous system, previous experiences, sleep, stress, movement, general health, beliefs, environment and many other factors can influence how pain is experienced.
That doesn’t mean the pain is “in someone’s head”.
It means pain involves far more than one body part.
The body isn’t a machine with broken pieces
Therapists sometimes use very mechanical language.
“Your pelvis is out.”
“This muscle is completely knotted.”
“Your spine is misaligned.”
“This is all coming from your posture.”
Statements like these can sound authoritative.
But they can also leave clients believing their body is fragile, damaged or somehow incorrectly assembled.
Human bodies aren’t perfectly symmetrical machines.
They adapt.
They move.
They change.
And there is rarely one perfect posture or position that everyone must maintain.
As therapists, we need to be careful about presenting our observations as medical diagnoses or definitive explanations for pain.
Stress can influence pain — without causing imaginary symptoms
Most of us have experienced the physical effects of stress.
Jaw clenched.
Shoulders creeping upwards.
Sleep disrupted.
Headache appearing at exactly the wrong moment.
Our psychological and physical experiences aren’t separate systems.
Stress can influence muscle tension, sleep, behaviour, activity levels and how strongly we experience symptoms.
But saying that stress can influence pain is very different from saying:
“Your pain is caused by your emotions.”
We don’t know that.
And assigning particular emotions to specific body areas — for example claiming hip pain means someone is “afraid to move forward in life” — may sound meaningful, but it isn’t an evidence-based diagnosis.
We can explore.
We shouldn’t invent explanations.
Ask rather than interpret
Instead of telling somebody what their pain means, ask questions.
“When do you notice it most?”
“Is there anything that seems to aggravate it?”
“Is there anything that makes it feel better?”
“How is it affecting what you normally do?”
“How are you sleeping?”
“Has anything changed recently?”
Those questions allow the client to tell you about their experience.
You may discover that their shoulder is worse after eight hours at a laptop.
Or that their symptoms flare when they haven’t slept.
Or that they’ve stopped exercising because they’re frightened movement will make things worse.
That’s useful information.
And you didn’t need to tell them their trapezius is storing unresolved resentment to get it.
Where does massage fit?
Massage can be a valuable part of someone’s approach to managing discomfort.
People may find it relaxing.
It may temporarily reduce muscular tension or soreness.
They may find movement feels easier afterwards.
It may help them feel more comfortable and confident in their body.
And sometimes simply having an hour where they can relax and receive supportive touch is valuable in itself.
We don’t need to claim that we’ve “fixed” the underlying cause for the treatment to have value.
Avoid promising to fix people
Clients understandably want answers.
“Can you get rid of this?”
“Can you fix my back?”
“How many treatments will I need?”
It’s tempting to give a confident answer.
But pain doesn’t always follow a predictable timetable.
A more professional approach is to explain what your treatment may reasonably help with, monitor the client’s response and adapt accordingly.
If symptoms are new, unexplained, severe, worsening or otherwise concerning, appropriate medical assessment may be needed.
Knowing when something is outside our role is part of being a good therapist.
Movement isn’t automatically the enemy
Someone in pain may understandably become protective of the painful area.
Sometimes that protection is appropriate, particularly following an acute injury.
But persistent fear of movement can itself become limiting.
Therapists should be careful about language that makes clients frightened of their bodies.
Words such as “damaged”, “worn out”, “out of alignment” or “your back is a mess” can stay with somebody for years.
We can encourage people to listen to their bodies without suggesting they’re made of glass.
Look at the whole person
Modern approaches to pain increasingly recognise biological, psychological and social influences.
That’s sometimes called a biopsychosocial approach.
It doesn’t mean every pain experience is caused equally by all three.
It simply acknowledges that humans are complicated.
Bodies matter.
Health conditions matter.
Injury matters.
But so can sleep, stress, work, movement, beliefs, environment and what’s happening in someone’s life.
For therapists, the takeaway isn’t that we need to become pain specialists or psychologists.
It’s much simpler.
Stay curious.
Listen.
Ask questions.
Work within your scope.
Don’t diagnose what you aren’t qualified to diagnose.
And resist the temptation to give every painful body part a neat explanation.
Because when it comes to pain, the most accurate answer is sometimes:
It’s complicated.
