Why Is Our Rehab System Failing Us?
In 2025, we have more rehab professionals than ever—more physical therapists, chiropractors, orthopedic surgeons, massage therapists, and acupuncturists. We also have the most accommodating workforce in history, with jobs increasingly designed to reduce exposure to physically demanding or injurious tasks.
And yet…
Lower back pain is more prevalent than ever.
It remains the leading cause of disability worldwide.
We’re still clawing our way out of the opioid epidemic—a crisis that preyed on the widespread issue of chronic pain.
So, what went wrong?
Why is our rehab ecosystem so ineffective?
Here are my humble thoughts as someone who has lived too close to the opioid epidemic and witnessed firsthand the failures of our current system.
1. The Overemphasis on Biomechanics and Anatomy
One of the biggest issues is that pain is still being treated through an overly anatomical and biomechanical lens. This has led to patients being reduced to labels like “shoulder,” “lower back,” “disc bulge,” or “arthritic knee”—not seen as people, but as parts.
Here’s the problem:
Research consistently shows that anatomical findings and biomechanical “imperfections” only weakly correlate with pain. They do not explain the pain experience.
Pain is shaped just as much—if not more—by your beliefs, your emotions, and your relationship with your provider. So when we treat someone like a body part, we miss the person entirely. It’s illogical, and it’s unaligned with current evidence.
2. The Fragility Narrative
Building off that, many providers unintentionally view the human body as fragile and unable to adapt. The traditional biomechanical model promotes rigid “right” and “wrong” ways to move, framing anything outside those bounds as dangerous or damaging. But this has been widely disproven by the literature.
These so-called “wrong” ways of moving are often unavoidable in daily life. When clients are told that normal positions or movements are harmful, they begin to associate daily activity with damage—which increases pain and fear.
Instead, we should embrace a core truth:
The body is adaptable.
With the right entry point, appropriate progression, and thoughtful intensity, we can build capacity and resilience in nearly any movement or position.
3. The Rise of Cookie-Cutter Rehab
When you reduce someone to a diagnosis—and falsely believe there's a universal “right way” to move—you end up with generic, one-size-fits-all exercise programs.
But even if two people share the same diagnosis, they have different goals, histories, fears, and capacities. Rehab must be individualized. Otherwise, we risk starting clients at the wrong intensity, progressing them too slowly (or too quickly), and ultimately failing to help them return to the activities they love.
4. Our Broken Relationship with Pain
We’ve created an unrealistic, binary view of pain:
You’re either pain-free, or something is “wrong” and needs to be fixed—like a broken car.
But the truth is, no one lives a pain-free life.
Pain is not just a sign of damage—it’s a messenger, a signal that your body perceives a threat or has reached a limit. It’s unpleasant, yes, but it can also be a guidepost for growth.
To strive for a pain-free life often leads to a sedentary one. But when you try to engage in meaningful, physically active experiences—your body may not be prepared. The solution isn’t avoidance. It’s capacity building.
Pain can show us where we lack strength, resilience, or confidence—and by building those qualities, we can expand our sense of what is possible in daily life.
This doesn’t mean pain should be ignored or blindly pushed through.
But it can be navigated with intelligence, and with the help of a skilled provider.
A Way Forward
It’s my belief that these are the reasons we find ourselves in our current situation.
And while this might sound pessimistic about the present, I’m deeply optimistic about the future.
I believe we’re on the cusp of a shift. More and more people are ready to move beyond outdated narratives. Ready to embrace a view of the human body that highlights resilience, adaptability, and antifragility.
Change is coming—and it starts with how we think, how we talk, and how we move.
