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I can still clearly remember a poster I saw as a child in a healthcare clinic.  It was a beautiful poster of an iceberg where you could see the exposed tip and the much greater mass underneath the water surface.  It read, “Your Symptom is the Tip of the Iceberg”.  At the time, the true meaning did not resonate with my young mind. Fast forward many years later and practicing as a new grad, the poster popped back into my thoughts clear as day. It made total sense. 

The pain that you are feeling is often just a small piece of the puzzle. Like the tip of an iceberg, pain is usually noticed first and subjectively the most obvious part of the problem.  But lurking beneath the surface lies the much larger part of the problem and unfortunately might have been hiding for an exceptionally long time.  The pain might have presented itself many years before as an insignificant tweak in your knee every time you run too much.  Currently you have started training for your first half marathon and the tweaky knee is full blown painful and inflamed. That’s the tip of the iceberg. 

The actual issue was badly sprained ankle 10 years ago that quickly resolved and currently is pain free but presents with stiffness and slight weakness since the injury.  There’s more.  That stiff and slightly weak ankle has been forcing you to alter your mechanics of a squat/kneeling/snowboarding/descending stairs etc. for many years and now your hips have learned to compensate.  There’s still more.  Then 3 years ago you hurt your back doing squats at the gym.  It resolves after a couple of months but remains tight with overuse.

Summary of finding:

1. 10 years ago, you badly sprain your ankle and presents with stiffness and weakness.
2. You soon develop a ‘tweaky’ knee with too much running because of the stiff and weak ankle.
3. 3 years ago, you hurt your back doing squats because of your hip dysfunction created by the stiff and weak ankle. Now your back gets tight often but does not really affect your lifestyle.
4. Currently you present with an acutely painful knee since started to train for a ½ marathon, tightness in your back/hip/ankle, a weak ankle, and mis-aligned pelvis at rest. 

That is the giant part of the iceberg that sits under water. 

The takeaway?  Your body is complex and has a great ability to compensate for minor issues whether it be tightness/weakness/minor tweaks etc.  These compensation mechanisms will often lay dormant for many years and surface as an inconspicuous pain.  Then the cascade begins, ultimately leading to the knee pain that brings you into our clinic and your physiotherapy homework focuses everywhere except your painful knee.  That’s because your ‘Pain is the Tip of the Iceberg’.

If you are need of assistance navigating your path to wellness, our PhysioWorks team is here to help.  We would be happy to help you unravel the complexity of your issues. 

Rob Iwasaki, BScPT, BScKin, Clinical STOTT Pilates, CAFCI, IMS