There are decisions we make when we are young that end up shaping far more of our lives than we could have understood at the time. Choosing a profession is one of them. When I decided to become a physical therapist, I certainly had reasons for doing it, but I could not have appreciated what spending the next two decades in that profession would eventually give me.
The longer I do this work, the more grateful I am that I happened to choose a profession that requires me to continually study the human body. More specifically, I am grateful that my profession has forced me to spend so much time trying to understand pain.
I want to be careful with the word understand. The more time I spend working with people in pain, the more I appreciate how much there still is to understand. If anything, it has probably done the opposite. Pain is remarkably complex, highly individual, and influenced by far more than whatever tissue happens to hurt at a particular moment. Every year seems to reveal another layer of complexity.
But there is tremendous value in simply being forced to keep asking questions about it.
Every day, people walk through my door because something hurts. They want to know what happened, what it means, whether they damaged something, what they should avoid, and when they can get back to doing the things they enjoy. Trying to answer those questions responsibly has forced me to dive deeply into a subject that is still ridiculously misunderstood.
And increasingly, I appreciate what a privilege that has been.
The Privilege of Perspective
After spending enough time in any profession, certain ideas begin to feel obvious. You forget that they were once unfamiliar to you too. You have heard them, studied them, challenged them, watched them play out hundreds or thousands of times, and gradually they become part of the way you see the world.
That has happened to me with pain, injury, exercise, and adaptation.
When someone tells me that something hurts, I do not automatically hear, “Something is damaged.” When someone experiences pain while performing an activity, my first thought is not necessarily that the activity must be eliminated. When someone has arthritis on an X-ray or a disc problem on an MRI, I do not automatically assume that the image determines what that person will be capable of doing five or ten years from now.
Those ideas now seem relatively ordinary to me because I have spent decades surrounded by them. What I continue to realize, however, is that they are not ordinary at all to most people.
In fact, many of the principles that guide good rehabilitation and long-term health are surprisingly non-intuitive.
If something hurts, stop doing it. If something is damaged, protect it. If a joint is worn, use it less. If an activity caused pain once, avoid it in the future. If an image shows something abnormal, fix the abnormality. If it cannot be fixed, learn to live within the new limitations.
All of those ideas make intuitive sense.
Unfortunately, biology does not always behave intuitively.
Pain Is Not a Simple Warning Light
Pain certainly matters. It deserves attention, and sometimes it alerts us to something that requires immediate medical care. But pain is not simply a direct measurement of tissue damage. It is an experience produced by a living nervous system attempting to protect a living human being.
That distinction changes almost everything.
Pain can be influenced by injury, inflammation, previous experiences, expectations, sleep, stress, fear, context, physical capacity, and many other factors. Tissue health matters enormously, but it exists within a much larger biological system.
Understanding even that much can change the trajectory of someone's life.
One of the greatest safeguards against debilitating chronic pain may be developing a better understanding of what pain actually represents. When people believe that every painful sensation indicates ongoing damage, avoidance becomes logical. Movement decreases. Confidence decreases. Capacity decreases. Activities that once seemed normal begin to feel dangerous.
Eventually the person's world can become smaller.
The tragedy is that this process can occur while someone believes they are doing exactly what is necessary to protect themselves.
That is one reason education about pain is not some academic side note to rehabilitation. What we believe about our bodies influences what we are willing to do with them.
The Strange Messages We Receive About Health
Our healthcare system creates a particularly confusing contradiction around physical activity.
We are constantly told that we need to move more. Exercise reduces the risk of numerous chronic diseases. Strength matters. Cardiovascular fitness matters. Maintaining muscle matters. Balance matters. Physical activity supports independence and quality of life as we age.
The message is clear: movement is medicine.
Then something hurts.
Suddenly the messaging often changes.
Stop running. Don't squat. Don't lift anything heavy. Be careful with your back. Avoid that movement. Protect that knee. You have degeneration. You have arthritis. Your discs are worn. You are getting older. Maybe it is time to find something easier.
The same person who desperately needs physical activity for long-term health can quickly receive a collection of messages encouraging less and less of it.
This does not mean that every painful activity should simply be pushed through or that injuries should be ignored. There are times when protection, modification, rest, medical treatment, or surgery are entirely appropriate. The problem is not that caution exists. The problem is that caution too often becomes the destination rather than a temporary part of the process.
We tell people they need to be active, but we often do a poor job teaching them how to remain active when their bodies inevitably hurt.
That is an enormous gap in healthcare.
A Living Body Is Not a Machine
Part of the problem may come from the way we have learned to think about the body. We often describe it as though it were a machine. Something breaks, we diagnose the broken part, repair it, and return the machine to service.
That model is appealing because machines are understandable.
Human beings are much messier.
A machine generally deteriorates with use. A living biological system can become more capable because of use. Muscles strengthen when appropriately challenged. Bones adapt to loading. Tendons change their capacity. The cardiovascular system becomes more efficient. The nervous system learns. Movement becomes more coordinated. Skills improve through practice.
Stress is not simply something the body survives. Appropriate stress is one of the primary ways the body develops.
This is the basic principle behind training, rehabilitation, and adaptation, yet very few people are ever explicitly taught it.
Instead, people frequently learn about their bodies through diagnoses. They learn the names of damaged structures, degenerative findings, abnormalities on imaging, and things they should avoid. They may receive remarkably little education about how adaptable they still are.
That imbalance matters.
If people understand themselves primarily through what is wrong with them, they naturally begin organizing their lives around protection. If they understand themselves as adaptable organisms capable of responding to appropriate challenges, an entirely different set of possibilities emerges.
We Are Not Taught How to Be Patients
The more time I spend in healthcare, the more I realize how much knowledge we expect ordinary people to somehow possess without ever teaching it to them.
Most people are never taught how pain works. They are not taught the difference between pain and damage. They are not taught the basic principles of adaptation, progressive loading, training, recovery, or behavior change. They are rarely taught how to interpret medical imaging or how common supposedly “abnormal” findings can be in people who feel perfectly fine.
Then we expect them to make reasonable decisions when they are frightened and hurting.
We should not be surprised when they struggle.
Our healthcare system is generally much better at identifying disease than teaching people how to live inside a changing human body. It can diagnose, image, prescribe, inject, operate, and refer remarkably well. What it often struggles to provide is the patient education and ongoing support required to understand health over the course of a lifetime.
That is not necessarily an indictment of the people working within the system. Many excellent healthcare professionals simply do not have the time or structure necessary to provide that kind of education. But the limitation remains.
And when education is absent, people fill the gap with whatever explanations are available to them.
Gratitude Rather Than Superiority
I do not view any of this as an argument that physical therapists understand the body while everyone else does not. Physical therapy has its own blind spots, outdated ideas, incentives, traditions, and limitations. There are physical therapists who promote the same fear-based messages I am describing, just as there are physicians, trainers, coaches, nurses, chiropractors, psychologists, and other professionals who have remarkably sophisticated understandings of pain and health.
This is not us against them.
If anything, recognizing the gap between what has become familiar to me and what remains unfamiliar to many people has made me more patient.
It reminds me that ideas I now consider obvious took years for me to understand. I had the advantage of studying them professionally, attending courses, reading research, discussing cases with colleagues, and then testing those ideas against thousands of hours spent working with actual people.
Why should I expect someone to intuitively understand principles that took years of education, experience, and repeated exposure for me to appreciate?
The Unexpected Wealth of Understanding
There are professions that pay more than mine. There are professions that carry more prestige. Physical therapy is certainly not positioned at the top of the traditional medical hierarchy.
But careers give us things beyond income and status.
They shape what we pay attention to.
My profession has forced me to pay attention to movement, pain, strength, adaptation, aging, injury, recovery, behavior, and the extraordinary ability of human beings to change. It has repeatedly made me confront my own assumptions about the body and replace simple explanations with more complicated ones.
That knowledge inevitably influences how I live my own life.
When something hurts, I have a framework for thinking about it. When my body changes, I am less likely to immediately interpret that change as catastrophe. When I train, I understand that stress and recovery exist in relationship with one another. When an activity becomes difficult, I can think about modifying dosage rather than abandoning the activity entirely.
None of that makes me immune to injury, pain, fear, aging, or disease.
It simply gives me a better map.
Having witnessed the consequences of people navigating their health with frightening or incomplete maps of their bodies, I have come to appreciate just how valuable a better understanding can be.
A Profession I Would Choose Again
When I entered physical therapy, I could not have known that one of the greatest benefits of the profession would be the education it gave me about being human.
I did not know how much time I would eventually spend thinking about pain. I did not know how complicated pain would turn out to be, how dramatically our understanding of it would evolve, or how important that understanding could become in preventing a temporary problem from turning into a lifelong identity.
I certainly do not have all the answers now. My continued involvement in this profession has only made me more aware of how much there still is to learn.
But I am deeply grateful that my work requires me to keep learning it.
Every day I am reminded that the human body is not simply something that breaks down and needs to be protected. It is a living, learning, adapting system. It responds to what we do, what we believe, what we practice, and what we repeatedly ask of it. Understanding that does not guarantee perfect health, but it can profoundly change our relationship with our bodies when inevitable challenges arise.
There may always be professions with greater prestige and greater financial rewards. But I happened to choose one that keeps me close to questions about how human beings hurt, heal, adapt, learn, move, and remain capable throughout a lifetime.
Twenty years later, I understand the value of that far more than I did when I began.
And I wouldn't give it up for the world.
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