You have done the exercises. You rested when you were told to rest, and moved when you were told to move. Maybe you had a scan that showed something, or showed nothing at all, and neither answer changed how you feel.

And the pain is still there.

Most people conclude at this point that they are the problem. That they did not try hard enough, or that they are just getting older, or that this is simply how their body is now. In many cases, that is not what has happened. The treatment was not wrong. It was aimed at one layer of a problem that has more than one layer.

Written by a registered osteopath, this is a guide to the layers that do not get looked at. Internal organs referring pain into the shoulder or the back. Breathing mechanics dictating what the neck has to do twenty thousand times a day. Blood sugar affecting the environment in which your connective tissue is trying to repair. Inflammation lowering the threshold at which your nervous system decides something is worth telling you about.

Who this is for

• Pain that has lasted months or years and has not resolved despite good treatment
• Symptoms that move around the body, or return to the same place every few months
• A scan that showed something, and treatment aimed at it that changed nothing
• Being told repeatedly that everything looks normal while you continue to feel unwell
• Anyone about to book another appointment who wants to walk in with better information than last time

What is inside

• Why a standard appointment cannot assess a system of interacting parts, and what a thorough one looks at instead
• The four components of stress that almost never get measured
• A region by region breakdown of the lower back, neck, shoulder and hip, including what refers pain into each
• What to do instead of stretching
• Sleep, food and inflammation: the environment your tissue is actually trying to repair in
• Which blood markers are worth asking for, and how to read them together rather than one at a time
• Supplements, and why the honest answer is usually to test first
• Red flags: the specific warning signs that mean stop self managing and get assessed
• Self assessment tools to complete before your next appointment

This is not about pushing through, and it is not about your pain being in your head. It is a practical account of what a full investigation actually covers, so you can work out whether yours was one.

Jean C**k is a registered osteopath and functional medicine practitioner. This guide sets out the questions he asks, the patterns he looks for, and what he does when the obvious answer has already been tried and has not worked.

This guide is general information and education. It is not medical advice, and it is not a substitute for individual clinical assessment by a qualified practitioner who has examined you.