Have you ever visited your physio for one injury, only to find yourself saying, “Oh, and I’ve also got this, this and this”?
It’s something I see regularly in the clinic. Someone books an appointment for their shoulder, but they’re also managing an irritated Achilles tendon, recurring headaches and a knee that keeps flaring up.
While these problems might be unrelated, multiple or recurring injuries make me curious about what else is happening. At By Design, we use three separate or recurring musculoskeletal presentations as an internal clinical flag to look beyond the individual injury and investigate someone’s broader health, recovery capacity and understanding of their own body.
The first thing I want to understand is why these problems haven’t settled. Did the previous injury fully recover? Was rehabilitation completed? Did they understand what was aggravating their symptoms, or have they repeatedly pushed through warning signs without recognising them?
Sometimes the issue is inadequate rehabilitation, poor load management or limited awareness of what their body can currently tolerate.
Other times, people describe widespread or difficult-to-localise pain, unpredictable flare-ups or symptoms that seem disproportionate to the activity they’ve completed. These patterns can prompt us to consider changes in pain sensitivity and nervous system processing. Persistent pain can involve increased sensitivity within the nervous system, but multiple painful areas alone don’t establish central sensitisation or systemic inflammation.
This is where I start asking questions that might initially seem unrelated to the injury.
“How’s your sleep?” is usually one of my first. Sometimes the response tells me there’s plenty more to explore. Someone might struggle to fall asleep, wake frequently or have no consistent bedtime routine.
I’ll also ask about nutrition, hydration and alcohol consumption, but I’m not looking to conduct a complete nutritional assessment. I’m trying to understand whether there are obvious factors that might be influencing their general health, energy and recovery. Sleep in particular has a well-established two-way relationship with pain, and other lifestyle factors can influence how people experience pain and respond to physical demands. They’re worth considering alongside the physical assessment.
Then we explore stress, connections, training and exercise, and mindset. Are they constantly rushing, clenching their jaw or carrying tension through their shoulders? Do they have strategies for managing stressful periods? Do they enjoy their work, feel supported by the people around them and have time to recover? Are they exercising consistently, doing too much without adequate recovery, or avoiding movement because they’re worried about making things worse?
I also want to understand how they interpret their symptoms. Do they recognise patterns and feel confident making adjustments, or does every flare-up feel unpredictable and outside their control?
These conversations help us understand the person’s circumstances, not just their diagnosis. We also consider relevant medical conditions, including inflammatory disorders and persistent pain conditions, which may warrant further assessment or coordinated care.
But identifying six areas that could be improved doesn’t mean giving someone six new things to work on. In fact, I think that’s where we can lose people.
Someone has come to physiotherapy because they’re in pain, and our first responsibility is to assess that problem and develop a manageable rehabilitation plan. We might begin by adjusting aggravating activities, improving movement tolerance, building strength or introducing simple symptom-management strategies.
Sometimes I’ll encourage someone to focus on their breathing while completing an exercise or spend two minutes concentrating on how their muscles are working - really connecting mind to muscle. It’s a small opportunity to develop body awareness without introducing another complicated task. Other strategies, including medication through your GP or additional healthcare support, may be appropriate depending on the presentation.
As their confidence and capacity develop, we can gradually introduce conversations about broader health. Maybe it’s keeping a water bottle on their desk, establishing a more consistent bedtime or adding a short walk to their lunch break.
These aren’t solutions to every injury, and they don’t replace appropriate medical or allied health care. They’re simply manageable opportunities to improve health behaviours over time.
The goal isn’t to change someone’s entire lifestyle in one appointment. It’s to help them understand their body, recognise what influences their symptoms and gradually build the skills to manage their health with more confidence.
Sometimes three injuries are three separate injuries. But sometimes they’re a reason to ask better questions.
If you’re managing multiple injuries or recurring flare-ups, book an assessment with the By Design Physiotherapy team.
We look beyond the individual injury to understand your movement, recovery capacity and broader health.
To learn more about how we consider broader health in rehabilitation, read The Six Factors of Health.
This is general information only. If you’re managing pain or an injury, speak with your physio about what’s right for you.
About this article
Written by Marissa Seeley, Physiotherapist, By Design Physiotherapy & Strength
Published 31 October 2026
Framework note: The three-presentation flag is an internal By Design clinical screening prompt, not a validated diagnostic threshold for inflammation or central sensitisation. The Six Factors of Health is a By Design educational framework used to guide broader health conversations and clinical reasoning.
References:
Finan PH, Goodin BR, Smith MT. The association of sleep and pain: an update and a path forward. J Pain. 2013;14(12):1539–1552.
Kosek E, et al. Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain. 2021;162(11):2629–2634.
Lin I, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79–86.
