Why I Don't Like the Phrase "Root Cause" as a Physical Therapist
- Dr. Kelsey Changsing, PT, DPT
- 2 days ago
- 4 min read
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In theory, finding the “root cause” of a problem instead of only treating the symptoms is a great idea.
In physical therapy, for example, using ibuprofen and ice to manage knee pain may help with the symptom of pain, but it doesn’t necessarily address the underlying problem causing the knee pain in the first place.
The problem is that when most people hear the phrase “root cause,” they expect a simple and singular answer. And once they find the one thing that caused their pain, they can fix it and their pain will go away.
But our bodies are complex, and there is rarely one singular “root cause” of pain or injury.
A "Root Cause" Can be Multiple Underlying Factors
In practice, what we call a “root cause” may actually be several underlying factors contributing to a problem at the same time.
Take knee pain, for example. When most people start having knee pain, they usually blame it on one thing, such as an injury or simply getting older.
But maybe you were also dealing with extra stress at work and sleeping poorly around the same time that you increased your running mileage or started using heavier squat percentages during training. Rather than there being one specific injury or tear responsible for your knee pain, several factors may have affected how well your body was able to tolerate your normal training.
In this case, looking for only one factor oversimplifies what is actually happening.
Sometimes We Don't Know the "Root Cause"
There are also situations where we simply don’t know exactly why someone is experiencing pain.
Nonspecific low back pain is a good example.
This is usually diagnosed if there hasn’t been a specific injury and imaging findings don’t show anything that can clearly explain your back pain. You additionally may not have changed anything about your normal routine to explain your back pain.
But that doesn’t mean there’s nothing we can do.
Even if we can’t identify a specific “root cause” to change, we can still address the things you’re having difficulty doing because of your back pain.
People have been able to return to doing deadlifts, running, and generally living their life after experiencing back pain, even without having a perfect explanation for why the pain started.
Knowing Why Something Happened Doesn’t Always Tell Us How to Treat It
Sometimes we actually have a pretty good idea of why a problem happened, but knowing the cause still doesn’t tell us everything we need to do to move forward.
Apophysitis is a good example. You may be familiar with Osgood-Schlatter disease, which is a type of apophysitis that affects the knee.
It commonly affects youth athletes going through a growth spurt who are participating in a high volume of activities such as running and jumping.
So in this case, we have a pretty good idea of what contributed to the problem.
But we can’t go back in time and prevent that period of overuse from happening. And simply reducing the athlete’s training load doesn’t address everything they need to eventually return to their sport.
We also need to maintain their strength and potentially improve their flexibility while allowing the painful area to calm down, so they have less catching-up to do once they’re fully cleared to return to play. And once they are, we need to gradually rebuild their tolerance to the demands of their sport.
Knowing why the problem happened is helpful. But it’s only one piece of figuring out what to do next.
The Problem With Searching for THE Root Cause
My biggest issue with the phrase “root cause” is that it can cause people to endlessly search for THE ONE THING that will solve their problem.
Understanding how or why your pain or injury happened can absolutely be helpful. It can guide treatment and potentially help prevent the same problem from recurring in the future.
But spending too much time focusing on why something happened can take away from actually treating the problem.
At some point, we have to shift from looking backward to asking what we can do now to help you move forward.
A Better Way to Think About the “Root Cause” of Pain
When I think about finding the “root cause” in physical therapy, I’m less interested in finding one perfect explanation.
Instead, I’m interested in asking:
What factors are contributing to this problem right now?
Which of those factors can we actually change?
What do we need to work on to get you back to what you want to do?
Sometimes we’ll have a clear explanation for why your pain started. Sometimes there will be several contributing factors. And sometimes we won’t know exactly why it started at all.
But we don’t necessarily need a perfect explanation before we can start working toward a solution.
Because at the end of the day, the goal is to get you back to doing what you love without compromise.
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