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

The worst pain is unexplained pain. In this episode of the Hands-On, Hands-Off Podcast, physical therapists Amy McDevitt and Paul Mintkin 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 over-reliance 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.