Are We Creating Patient Dependency—or Empowering People to Resolve Their Own Pain?

What if the greatest success in physical therapy is teaching patients they don’t need us anymore?

By Dr. Kim Byrd-Rider, PT, DPT

Who Gets the Credit When Pain Disappears?

Recently, I overheard an occupational therapist complaining about neck pain to a physical therapist.

He offered dry needling. After all, he had successfully relieved her friend’s neck pain.

Problem solved, right?

Maybe. But I wondered:

If he relieves her pain, what has she learned about relieving it herself?

Here were two rehabilitation professionals, trained in human movement, discussing how one could fix the other.

The irony was hard to ignore.

Have we become so accustomed to having someone else fix our pain that we’ve forgotten how much we can do for ourselves?

The Revolving Door of Pain Relief

Your neck hurts. You get a massage. Wonderful!

Three weeks later, the pain returns.

Another massage. Maybe dry needling. Chiropractic manipulation. Acupuncture. Kinesiology tape. A TENS unit.

Your calendar fills up. Your wallet gets lighter. Your neck continues to have opinions.

These treatments can provide legitimate relief. But when the pain returns, what happens?

Another appointment?

Another practitioner?

Another temporary fix?

Somewhere along the way, a belief can take hold:

“When something hurts, someone else needs to fix me.”

The problem isn’t necessarily the treatment. It’s what happens when treatment replaces learning.

We can relieve someone’s pain without teaching them anything about their movement habits, nervous system, stress responses, or ability to manage future symptoms.

We may have successfully treated the pain while leaving the person dependent on the next treatment.

Why I Don’t Automatically Eliminate Pain First

Someone might ask, “Why not relieve the pain first and teach exercises afterward?”

Because pain can also provide valuable feedback.

When a movement reduces my patient’s pain, I pay attention. We explore it further.

When symptoms consistently worsen, I reassess.

I’m not inside my patient’s body. They are.

And I want them learning to recognize those responses themselves.

Pain isn’t a perfect compass, and severe pain sometimes requires immediate relief. But I don’t believe passive treatment should automatically come before teaching someone what they can do independently.

Years ago, a supervisor criticized my physical therapy documentation because I focused heavily on pain responses during exercise.

I asked her:

“If you ask patients what their goal is, isn’t it usually to get rid of their pain?”

Patients don’t typically come to therapy dreaming of ten additional degrees of shoulder flexion.

They want to sleep, work, walk, and enjoy their lives without pain.

And I want them discovering how their own actions can help them achieve those goals.

What Yoga Taught Me at Thirty

When I began studying traditional yoga at thirty, we practiced without mirrors.

Instead of looking outside ourselves to determine how our bodies should move, we learned to look inward.

Feel your shoulder. Recognize its position. Move it. Notice the difference.

We were developing proprioception and body awareness.

But we were also developing something else.

Trust in our own ability to understand and influence our bodies.

That lesson became foundational to my Physio-Zen philosophy.

I educate. I guide. I observe. I correct. I mentor.

But the patient does the work.

My approach may take longer than a passive treatment. The immediate pain relief may even be the same.

But the patient can leave with something additional: knowledge, confidence, movement skills, and the ability to manage symptoms independently.

That’s self-efficacy.

And those skills may help prevent future episodes of pain.

In fact, a 2024 study published in The Lancet found that an individualized walking and education program delayed recurrence of activity-limiting low back pain—a median of 208 days versus 112 days in the control group.

Imagine if we invested as much energy in teaching people how to maintain their bodies as we do in treating them after something hurts.

The Question We Should Have Been Asking

Remember the occupational therapist with neck pain?

At the beginning, I wondered who would get the credit if the physical therapist relieved her symptoms.

But perhaps that was the wrong question.

I think back to those yoga classes without mirrors.

At thirty, I thought I was learning how to position my body without looking at it.

Decades later, I realize I was learning something far more important.

How to stop looking outside myself for every answer.

And perhaps that’s the most valuable lesson we can offer our patients.

The needle may relieve the pain. The exercises may relieve the pain. Both can have a place in recovery.

But only the patient can develop the skills that become their own.

The greatest achievement in rehabilitation isn’t becoming the person everyone needs to fix them.

It’s becoming the person who teaches them how much they can do without you.

Supporting Research

• World Health Organization (2023). Guideline for Non-Surgical Management of Chronic Primary Low Back Pain.

• Núñez-Cortés et al. (2024). Pain neuroscience education and exercise for chronic spinal pain. PAIN. Study

• Pocovi et al. (2024). Walking and education for prevention of low back pain recurrence. The Lancet. Study

• Hernandez-Lucas et al. (2024). Exercise and education for back pain prevention. Journal of Back and Musculoskeletal Rehabilitation. Study

Passive treatments can be beneficial and do not inherently cause dependency. The evidence supports active self-management but does not establish that withholding pain relief improves outcomes.

My Physio-Zen WorldWhere Lifestyle Medicine Reaches Its Full Potential.

Created by Dr. Kim Byrd-Rider — Doctor of Physical Therapy • Scholar of the Wisdom Traditions.