, Gloucester, MA

November 15, 2012

On the Mend: Five worst challenges to your pain threshold

On the Mend
Joe DiVincenzo

---- — As a physical therapist, my job is to help people in pain.

The entirety of each of my work days is dedicated to eliminating one of the most unpleasant parts of life.

Every half hour, I meet someone new who has come to see me because they have pain. If you take into account the occasional holiday and day off, a full time therapist may see more than fifteen hundred office visits per year. That’s a lot of pain.

A health care provider in an orthopedic setting becomes well versed in a variety of types of pain over the course of a few years. And as any practitioner can tell you, patients and the stories of how they got injured ensure that no two clinic days are alike.

Yet with all the variability of a full-time caseload, there are certain diagnoses and disorders that make every therapist think to themselves, “Boy, am I glad I’m not going through that.”

Pain – whether emotional or physical – may be one of the most subjective and debatable topics you could ever discuss. But there are ways to measure pain that make it more tangible and quantifiable, because lets face it – humans love to compare experiences.

Patients ask me all the time, “What’s the most painful injury you’ve ever seen?” Ironically enough, it’s not anything unusual or exotic, and rarely is it the result of a heroic act.

So, after several years in an outpatient orthopedic practice, here’s one physical therapist’s list of the top five things he least wants to have happen to him.

5. Rupture your Achilles tendon and you’ll see more stars than there are in the night sky. After hearing the pop of the tendon, you can expect extremely high levels of pain for several hours to days. Shortly after that, the free nerve endings in the remaining portion of the tendon die off, leaving only mild soreness and the inability to walk – a mere shadow of the horrific pain a few days earlier.

4. A sudden tear of the ACL is enough to bring the toughest individual to his knees. Immediately after the searing nine out of ten pain, blood will rush into the knee and create a pooling effect. Coupled with the ‘ACL deficient hobble’ that is akin to all tears, you’ll have a long, nine month rehab ahead of you. While ACL tears have certainly earned a spot in the top five, none of them are as bad as number three.

3. A pinched nerve in the neck can render your entire arm completely useless. Most pinched nerves cause pain not only in the arm and neck, but in the shoulder blade as well. It may feel as if there’s a ‘golf-ball sized knot’ in your upper back for the duration of the day. When it’s not intense, it typically throbs to the point of nauseum and can take months to go away on its own – if it is so inclined.

2. Still a far cry from number one, a traumatic rotator cuff tear easily captures the number two spot on this list. It’s an immediate, nine out of ten pain that will likely drive you to the hospital. The sharpness of the pain can persist for months anytime you use your arm or hand, and the aching during the day and at night when you sleep can last indefinitely. Difficult to fix appropriately and difficult to rehabilitate, cuff tears are not for the weak.

1. Traumatically herniate a lumbar disc and it’s game over for you. Most women describe it as the worst pain imaginable – even more so than delivering a baby or passing kidney stones.

Understated, it may sound something like ‘completely incapacitating’ or ‘crippling.’ Most people are unable to work, to walk around or even go to the bathroom without assistance – and we haven’t even mentioned pain rushing down the leg, making it feel like it’s going to explode.

And here’s one more fun fact — most Americans acquire a lumbar disc herniation before the age of 55. Tick-tock.

Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes “On the Mend” weekly. Questions may be submitted by email to