“Why does it still hurt?”

If you’ve been living with chronic pain for months, or perhaps even years, you’ve probably asked yourself the same question more than once, “Why does it still hurt?”

It’s a reasonable question, and unfortunately, one that doesn’t always have a simple answer. Many people have experienced treatments that focus on the area where the pain is felt. When the shoulder hurts, treatment naturally begins with the shoulder. When the low back is painful, attention is directed to the lower back. In many cases, this approach is appropriate and effective. However, for some people, pain persists despite treatment, returns repeatedly, or seems to shift over time.

Over the past several decades, research has transformed our understanding of chronic pain. We now know that persistent pain is not always explained by a single injured tissue or by what appears on an X-ray or MRI. Some people have significant structural changes with very little pain, while others experience persistent pain despite relatively minor findings on imaging (Brinjikji et al., 2015). Pain is a complex experience influenced by the nervous system and shaped by biological, psychological, and social factors unique to each individual (IASP, 2020).

This does not make the pain any less real. Rather, it reminds us that persistent pain is often multifactorial and deserves a thoughtful, comprehensive assessment. Because of this complexity, many healthcare professions now embrace a whole-person approach to understanding persistent pain. Manual Osteopathic Therapy is one perspective within this broader model of care.

One of the guiding principles of osteopathic practice is the relationship between structure and function. The body is viewed as an integrated system in which muscles, joints, fascia, nerves, circulation, and other tissues continuously influence one another. Rather than assuming that pain originates somewhere other than where it is felt, a Manual Osteopathic assessment explores how different parts of the body may be interacting and whether there are factors that could be contributing to a person’s symptoms (Nicholas & Mercer, 2022).

One of the remarkable characteristics of the human body is its ability to adapt. Following an injury, surgery, or a period of reduced activity, the body often develops temporary movement strategies that allow us to continue functioning while tissues recover. These adaptations are normal, protective, and often essential.

Sometimes, however, those adaptations remain long after healing has occurred. Over time, changes in movement patterns, muscle activity, breathing mechanics, or joint mobility may influence how forces are distributed throughout the body. For some individuals, these changes may become one of several contributors to ongoing discomfort or reduced function.

For example, someone experiencing persistent neck pain may also have reduced movement through the upper back and ribs, altered breathing mechanics, or longstanding postural adaptations. Likewise, ongoing low back pain may coexist with reduced hip mobility, previous ankle injuries, abdominal surgical scars, or repetitive occupational demands. These observations do not necessarily explain why a person has pain, nor do they imply a single “root cause.” Instead, they provide valuable information that helps build a more complete picture of how the body is functioning.

For this reason, a Manual Osteopathic assessment often extends beyond the area where symptoms are felt. The goal is not to search for one hidden answer but to identify potential contributing factors and better understand how the body has adapted over time.

Hands on assessment allows practitioners to evaluate movement quality, tissue mobility, joint motion, and areas of tension or restriction. These findings are considered alongside a person’s health history, lifestyle, daily activities, functional goals, and, when appropriate, information provided by other healthcare professionals. Together, this information helps guide an individualized treatment plan.

Treatment may include gentle manual techniques intended to improve mobility, reduce unnecessary mechanical strain, and support more comfortable movement. Education, breathing strategies, home exercises, and movement recommendations may also form part of care, helping individuals better understand their bodies and participate actively in their recovery.

Emerging research has also highlighted the important role of fascia, the body’s continuous connective tissue network. Fascia helps transmit force, supports movement, and contributes to proprioception—the body’s awareness of position and movement. While research continues to evolve, this growing understanding reinforces the importance of viewing the body as an interconnected system rather than a collection of separate parts (Schleip et al., 2012).

Importantly, Manual Osteopathic Therapy is one component of a comprehensive, person centered approach to persistent pain. Depending on an individual’s needs, care may also include medical assessment, physiotherapy, massage therapy, psychology, exercise therapy, medication, or other evidence-informed interventions. Each profession brings its own expertise, and collaborative care often provides the greatest opportunity to support long-term health and wellbeing.

Living with chronic pain can affect every aspect of life from sleep and work to relationships, recreation, and emotional wellbeing. While no single therapy can promise to resolve every person’s pain, taking the time to understand the many factors that may be be contributing to the experience can provide valuable insight and help guide individualized care.

Ultimately, a whole body assessment is not about finding one hidden cause of pain. It is about recognizing that every person’s story is unique. By considering movement, function, health history, lifestyle, and the body’s remarkable capacity to adapt, Manual Osteopathic Therapy offers one perspective within a collaborative approach to understanding and managing persistent pain.

Sometimes the most important question isn’t simply, “Where does it hurt?” It’s also, “What factors may be influencing why it continues?”

References

Brinjikji, W., Luetmer, P. H., Comstock, B., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816.

Butler, D. S., & Moseley, G. L. (2013). Explain Pain (2nd ed.). Noigroup Publications.

International Association for the Study of Pain. (2020). IASP terminology.

Nicholas, J., & Mercer, S. (2022). Osteopathy: Models for Diagnosis, Treatment and Practice (2nd ed.). Elsevier.

Schleip, R., Findley, T. W., Chaitow, L., & Huijing, P. A. (Eds.). (2012). Fascia: The Tensional Network of the Human Body. Elsevier.