Why We Don't Chase the Pain Site: A Rehab-First Approach

By Dr. Michael Minenna D.C., B.Sc., SFMA, FMS

When something hurts, the instinct is to do something to the sore spot — press it, ice it, crack it, rub it. That instinct isn't wrong, exactly, but it's incomplete. If treatment stops at the painful area, the relief tends to be temporary, because the reason the area got irritated is still there. A rehab-first approach asks a different question: not just "how do we calm this down?" but "how do we make sure it can handle life again?"

Pain relief versus problem solving

Passive treatments — the things done to you while you lie there — can genuinely help in the short term. They can reduce pain and make movement feel easier. The catch is that, on their own, they don't change the underlying capacity of the tissue or the way you move. The best available evidence on managing most musculoskeletal pain points firmly toward active care — exercise, education, and load management — as the foundation, with passive treatments playing a supporting role rather than the lead.^1,2

Put simply: a treatment that makes you feel better for an afternoon is useful. A plan that makes your body more capable so the problem stops recurring is the actual goal. Rehab-first means leading with the second.

Building capacity is the through-line

Most non-traumatic pain is, at its root, a mismatch between demand and capacity — the body was asked to do more than it was currently prepared for. The durable solution is to raise capacity so the same demands no longer overwhelm the tissue. That's what progressive loading does, and it's why exercise is the backbone of nearly everything we prescribe.^2,3

This is where our guiding principle lives: there are no bad exercises, only too much too soon.³ We don't tell people to avoid movements or fear their backs. We meet the tissue where it is and build it up, deliberately, until the activities you want to do are well within reach.

Finding the real driver

Chasing the pain site also misses that the source is frequently elsewhere. A sore knee driven by a stiff hip, a cranky shoulder driven by a locked mid-back — treat only the symptom and you've left the cause untouched. Looking at the whole kinetic chain, rather than the painful link alone, is what lets us address the actual problem.⁴ A good assessment maps how you move, not just where it hurts.

What this looks like for you

A rehab-first visit still includes hands-on care when it helps — we're not against making you feel better. But it won't stop there. You'll leave understanding what's going on, with a plan that loads the right tissues in the right doses and a clear sense of how you'll progress. The hands-on work opens the door; the rehab is what keeps it open.

It asks a bit more of you than passively receiving treatment, and that's the point. People who actively build their own capacity get more durable results and a sense of control over their own bodies. At Boreal Spine & Sport, that's the outcome we're after — not just a quieter symptom today, but a more capable you that doesn't keep ending up back on the table.

References

1. Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86.
2. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence. PLoS One. 2017;12(6):e0178621.
3. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.
4. Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. J Man Manip Ther. 2013;21(2):90-102.