When it comes to musculoskeletal pain—whether it’s an aching shoulder, a stubborn back, or a nagging knee—most people start with the same question:
“What’s wrong?”
This is a natural and understandable instinct. Pain grabs our attention, and we want answers. In many cases, the “what’s wrong” mindset leads us to seek a diagnosis: a label that identifies the source of our discomfort. Maybe it’s a herniated disc. Maybe it’s rotator cuff tendinopathy. Maybe it’s hip impingement. These diagnoses carry the weight of something damaged—something broken that needs fixing.
But here’s the problem.
The “what’s wrong” approach often assumes there’s a single, static cause—one that a practitioner can pinpoint, and one that will lead to a clear treatment path. It reinforces the idea that pain is the result of something that has gone awry and needs to be externally repaired. It frames the patient as the passive recipient of care. And it encourages a search for the one magic fix—be it a pill, a shot, or even surgery.
Yet, for most people dealing with persistent musculoskeletal pain, that approach rarely provides the whole story.
There’s another question we could ask instead:
“With what?”
That may sound vague at first, but it’s a fundamental shift in perspective. “With what” turns our attention toward how we’re moving, loading, adapting, and using our bodies. It acknowledges that pain is not just a mechanical failure, but a signal—an invitation to change something in the way we move, breathe, stand, train, or recover.
Let’s break this down.
The Trap of the “What’s Wrong” Model
Pain, especially when it lingers or recurs, feels like a warning light. So it makes sense that people want to know what’s broken. This mindset is rooted in the structural model of medicine, which has historically been very successful in acute trauma cases. If you break a bone, you get an X-ray. It shows the break. The diagnosis matches the damage. You get a cast, and it heals.
But chronic or movement-related pain is rarely that simple.
Someone might get an MRI of their lower back and be told they have degenerative disc disease. That sounds scary—but countless people without any pain at all have similar imaging findings. A study published in The New England Journal of Medicine showed that many people have bulging discs or arthritis visible on scans but report no symptoms.
What’s more, the diagnosis itself can shape the experience of pain. When someone is told they have a “torn” structure or that their spine is “degenerating,” it often creates fear. That fear can reduce movement, increase guarding, and heighten sensitivity—ultimately reinforcing the pain.
In this model, the body is treated like a machine that breaks down. The job of the provider is to find the faulty part and fix it.
But humans aren’t machines. We are adaptable, ever-changing systems. And most pain isn’t a sign of damage—it’s a sign of load intolerance or movement inefficiency. That’s where the “with what” question becomes powerful.
The Wisdom of “With What”
Instead of asking, “What’s wrong with my shoulder?” we might ask:
With what movement does it hurt?
With what level of load, intensity, or duration do symptoms show up?
With what positioning do I feel relief—or increased discomfort?
With what breathing or bracing strategy am I unconsciously moving?
With what muscle groups am I compensating?
This approach accepts that pain is real, but views it as a signal, not a diagnosis. It shifts the focus from finding damage to identifying a pattern. It’s a question of capacity and context.
Take someone who has knee pain while squatting. The “what’s wrong” model might lead to imaging, a diagnosis like chondromalacia, and a prescription for rest and NSAIDs. But the “with what” model asks what kind of squat causes pain. Is it a deep squat? A narrow stance? With load or without? Can they tolerate a lunge or step-up?
Now we have information.
Maybe they lack ankle mobility, so their knee tracks forward too early. Maybe they shift weight toward one leg. Maybe they don’t engage their hips. Rather than blaming the knee, we explore with what movement strategy the pain is emerging—and more importantly, how it might be improved.
Pain becomes part of the feedback loop.
From Diagnosis to Dialogue
The beauty of the “with what” mindset is that it puts the person experiencing pain back in the driver’s seat. It invites experimentation. It encourages curiosity. And it makes the process of recovery more collaborative and exploratory—not just a passive wait for someone else to “fix it.”
This mindset shifts the focus from fear to skill. Instead of reacting to pain with panic or avoidance, it encourages observation and adaptation. You begin to see pain not as a sign of failure, but as a prompt to explore. You might modify the load you're using, change your movement strategy, vary your warm-up, adjust your recovery habits, or reflect on sleep and stress levels.
Pain isn’t ignored—but it isn’t catastrophized either. It becomes part of a thoughtful feedback system.
Ask:
With what habits did this pain develop?
With what changes does it improve?
With what inputs—be it strength training, breathing, walking, or recovery strategies—can I build resilience?
The answers may not be instant. But they lead to self-efficacy, not fear. And that shift—from diagnosis to dialogue, from passivity to participation—is where real progress begins.
The Practitioner’s Role
This shift doesn’t mean practitioners aren’t needed. Quite the opposite. A good physical therapist, trainer, or movement specialist is trained to ask these “with what” questions. They observe patterns, assess load tolerance, test capacities, and guide the process of movement re-education.
Rather than simply delivering a diagnosis, they become a coach in the discovery process.
This is why two people with the same diagnosis can have completely different outcomes. It’s not about what the MRI says. It’s about how each person moves, adapts, and responds.
Final Thoughts
The next time you’re in pain, consider reframing the conversation.
Instead of asking, “What’s wrong with me?” ask, “With what inputs, patterns, or demands did this pain emerge—and how might I change them?”
Pain is rarely just about damage. It’s about information. About load. About perception. And about adaptability.
When you stop seeking a fix and start seeking understanding, the path forward gets a lot clearer.
You are not broken. You are responding.
And that means you can respond differently.