Normal vs. Unusual

This past week, I was struck by how often I was asked the following question by patients in the clinic:

"Is that normal?"

Most typically they are asking this regarding pain that they are experiencing.  It's a very logical question, whereby patients are seeking assurance or direction about their condition.  I've probably been asked this question hundreds of times over my 13 years practicing physical therapy.  Recently, I've been answering with the following response:

"No, it's not normal, but it's also not unusual."

What do I mean by that?  It may seem that I'm splitting hairs, but I believe there is a distinction between "normal" and "unusual".

I recently came across a simple definition that I think eloquently sums up physical therapy:  The restoration of painless, thoughtless movement.  By this simple description, pain is not "normal".  Most (not all) of the patients whom I see present with unilateral (one sided) complaints of pain and dysfunction.  That makes for a very simple testing approach.  If you can move one side freely without pain but not the other, then this is not normal.  Pain is a subjective symptom that is trying to get our attention for some reason, which may be directly related to tissue damage, or perhaps something even more complex.  It's not "normal" to be in pain.

But is it unusual?  When people ask me if their pain is normal, it's typically not during the first visit.  Rather, it's usually after a period of rehabilitation has gone by, and pain or swelling pops back up.  Unfortunately, progress in rehabilitation is not always linear.  You may go two steps forward, and occasionally one step back.  Or you may find that you have plateaued to some degree.  The reasons for this could be many, but a common one is that as folks progress, they become more active and/or perhaps less mindful, leading to slight set-backs.  It is those times when I'll explain to someone that what they are feeling is not normal, but it's also not unusual.

I find that most people are tough.  Sure, nobody wants to cope with the unpleasantness of a pain.  But in general, they are adept at coping and soldiering on.  What I do find that people are really seeking (along with pain relief) is assurances that they are taking the correct measures to allow for optimal healing and avoiding making matters worse.  It might not seem like much, but when you consider that one can experience pain for reasons far more complex than tissue damage, addressing the psychological component of pain is tremendously valuable.

***One final note on pain.  As I've written in the past, pain that wakes you an night, is unremitting, and does not respond to positional changes is a red flag.  This is certainly NOT NORMAL and requires a trip to your doctor to rule out anything systemic.