The Worst Pain Is Unexplained Pain — Rethinking Diagnosis in Physical Therapy

Описание: The worst pain is unexplained pain. In this episode of the Hands-On, Hands-Off Podcast, physical therapists Amy McDevitt and Paul Minkin explore why pain without a clear diagnosis is often the most distressing—and how physical therapists can communicate pain more effectively when imaging, MRI findings, and pathoanatomy don’t provide clear answers.

This conversation dives deep into pain science, musculoskeletal pain, low back pain, and the limitations of medical imaging in explaining symptoms. We discuss how overreliance on MRI results can increase fear, catastrophizing, and confusion for patients—and how language, context, and functional diagnosis can dramatically change outcomes.

Learn how to reframe pain using the ICF model, why pain does not equal tissue damage, and how PTs can shift from chasing a pain generator to treating the whole person. The episode includes a real-time patient role-play, practical communication strategies, and insights on direct access physical therapy, lifestyle factors (sleep, stress, activity), and the future of PT education.

This episode is essential listening for physical therapists, manual therapists, rehab professionals, and students looking to improve patient communication, reduce fear, and deliver truly person-centered care.


00:00 The Worst Pain Is Unexplained Pain
02:00 When Imaging Doesn’t Explain Symptoms
03:10 Why Conflicting Diagnoses Harm Patients
05:45 Why Diagnosis Still Matters to Patients
07:05 Treat the Person, Not the Pathology
09:30 How to Talk About Imaging Without Fear
13:00 Live Role-Play: Reframing MRI Findings
17:00 Pain Is a Dimmer Switch (Not a Damage Meter)
21:00 Why Early PT Access Changes Everything
26:00 How PT Education Must Change