On average, people wait about five years before asking anyone about a musculoskeletal problem. Five years of working around it, adjusting how they lift, quietly dropping the activities that provoke it.

If that’s roughly your situation, you’re in ordinary company, and you haven’t ruined anything by waiting.

Duration matters less than you’d expect

Some of the largest changes I’ve seen have been in people who’d had something for decades. Not because I did anything remarkable, but because nobody had looked at the whole pattern — only ever at the spot that hurt.

A patient came to me with low back pain she’d had since her early twenties, and she was in her fifties when I met her. She is genuinely, impressively active; the amount she does while carrying that much pain still surprises me.

Most of what we do together is soft tissue release, active resistance stretching, massage work, and decompression, because her job keeps her seated and the spine needs the space back. At a recent visit I adjusted perhaps three things. She arrived at a 5 out of 10 and left at a 2.

The more useful finding was that her pelvis sits tilted forward, and the movements that hurt her stop hurting when it’s neutral. So the work now is training it to stay where it belongs, which takes the load off the low back that’s been absorbing it for thirty years.

Why long-standing pain gets missed

The longer something has been going on, the more compensation has built up around it, and compensation is what disguises the original problem. By the time you arrive, the spot that hurts most is frequently not the spot that started it — which is exactly why treating the loudest area gives you a few good days and then nothing.

Unpicking that takes a proper examination rather than a guess.

Two things I say a lot

The first is about balance. I won’t tell you to give up the things that bring you joy and keep you sane, because that’s rarely a plan anyone follows. What I’ll do instead is find where we can pull back so you’re not repeatedly setting yourself off, while you keep doing what matters to you.

The second is counterintuitive. On the days you feel good, that’s often when to ease off — because when you feel good and immediately do something that hurts you, your nervous system draws the conclusion that feeling good is unreliable. Giving your body a run of days where nothing goes wrong is part of the treatment.

Where to start

Tell me how long it’s been and what you’ve stopped doing because of it. That second answer is usually the one that tells me what we’re aiming at.