ASTR Institute Explains Why Chronic Pain May Persist After Physical Therapy, Injections, or Surgery

Root cause chronic pain treatment for patients still in pain after physical therapy, injections, medication, or surgery.

CLERMONT, FL, UNITED STATES, June 30, 2026 /EINPresswire.com/ -- ASTR Institute, founded by Dr. Joseph Jacobs, Doctor of Physical Therapy, Advanced Clinical Nutritionist, inventor, author, functional medicine practitioner, and cancer survivor, is sharing why chronic pain may persist even after standard treatments such as physical therapy, injections, medication, chiropractic care, massage, or surgery.

The goal of this educational release is to help patients understand that pain lasting for months or years may involve more than one irritated joint, tight muscle, damaged disc, inflamed tendon, or pinched nerve. While standard treatments may help many patients, ASTR Institute emphasizes that complex chronic pain often requires a deeper root cause evaluation.

Chronic pain is a major health issue in the United States. The Centers for Disease Control and Prevention reported that in 2021, an estimated 20.9 percent of U.S. adults, or about 51.6 million people, experienced chronic pain. The same report estimated that 6.9 percent of adults, or about 17.1 million people, experienced high impact chronic pain, meaning pain that substantially restricted daily activities.

These numbers show why many patients continue searching for answers after trying multiple treatments. For some people, pain improves after basic care. For others, symptoms persist because the original problem was only one part of a larger pain pattern involving scar tissue, fascial restrictions, trigger points, inflammation, posture, ergonomics, stress physiology, nutrition, sleep, and movement habits.

“Many chronic pain patients are told they did everything right,” said Dr. Joseph Jacobs, DPT, ACN, founder of ASTR Institute. “They went to physical therapy, tried injections, took medication, received massage, changed activities, or even had surgery. But if the deeper contributors to pain are not identified, the symptoms may continue or return.”

- Why Chronic Pain May Continue After Standard Care

Many traditional treatments focus on reducing symptoms, improving general strength, decreasing inflammation, or correcting one suspected pain generator. These approaches may be valuable. Physical therapy may improve mobility and strength. Injections may reduce inflammation temporarily. Medication may help manage pain. Surgery may repair structural damage when medically necessary.

However, chronic pain may persist when the treatment does not address all of the underlying contributors.

A patient may strengthen the muscles but still have fascial restrictions. Another patient may reduce inflammation with an injection but still have scar tissue limiting normal movement. Another may complete surgery but continue to experience pain from adhesions, nerve irritation, altered movement patterns, or protective guarding. Another may do exercises correctly but continue to overload the same tissues because posture, ergonomics, sleep, stress, and daily habits have not changed.

ASTR Institute teaches that chronic pain is often multifactorial. This means several factors may be feeding the pain at the same time.

“Pain is not always caused by one thing,” Dr. Jacobs said. “A patient may have scar tissue, fascial restriction, trigger points, inflammation, poor posture, stress related muscle tension, and compensation patterns all interacting together. A root cause approach asks why the pain is still there, not just where the pain is located.”

- A Root Cause View of Chronic Pain

ASTR Institute uses a root cause framework that looks beyond symptom location. The goal is to identify what is keeping the pain cycle active.

Scar tissue may develop after injuries, surgeries, inflammation, repetitive strain, or trauma. When scar tissue becomes restricted, it may limit normal tissue mobility and contribute to stiffness, pain, and movement dysfunction.

Fascial restrictions may create abnormal pulling patterns throughout the body. Fascia is connective tissue that surrounds muscles, nerves, blood vessels, and organs. When fascia becomes restricted, the patient may feel pain in one location even though the tension pattern involves a larger region.

Trigger points may refer pain to nearby or distant areas. For example, a patient may feel pain in the head, shoulder, back, hip, knee, or foot, while some of the contributing soft tissue restrictions are located elsewhere.

Inflammation may increase tissue sensitivity and make pain feel stronger. Nutrition, sleep, stress, chronic disease, toxin exposure, and overall health may all influence inflammatory load.

Postural and ergonomic stress may keep injured or irritated tissues under constant strain. Prolonged sitting, computer use, phone use, poor sleeping positions, repetitive work demands, and altered walking patterns may all contribute to pain persistence.

Stress and nervous system dysregulation may increase muscle guarding, clenching, pain sensitivity, fatigue, and fear of movement. This does not mean the pain is imaginary. It means the body’s protective systems may become more sensitive when pain has continued for a long time.

Movement compensation may also keep symptoms active. When one area hurts, the body often shifts load to another area. Over time, these compensations may create new pain patterns or prevent the original region from healing fully.

- Why Physical Therapy May Not Fully Resolve Chronic Pain

Physical therapy can be helpful for many conditions. It may improve strength, flexibility, balance, coordination, joint mobility, and function. However, some patients complete physical therapy and still experience pain.

ASTR Institute explains that this may happen when exercise is introduced before restricted tissue is released, when the patient is strengthening around unresolved scar tissue or fascial restrictions, or when the treatment plan does not fully address inflammation, posture, ergonomics, stress, nutrition, or behavior patterns.

Some patients are told to stretch or strengthen the painful area, but stretching a restricted or irritated tissue does not always resolve the source of the problem. Others are given exercises that improve general function but do not address deeper soft tissue adhesions or myofascial restrictions.

Physical therapy may also fail when the treatment is too general. Chronic pain patients often need individualized evaluation. Two patients may both have shoulder pain, but one may have scar tissue, another may have neck restrictions, another may have inflammation, and another may have stress related guarding or poor ergonomics.

“The problem is not that physical therapy is bad,” Dr. Jacobs said. “The problem is that chronic pain sometimes requires a more specific root cause approach. Strengthening alone may not be enough if restricted tissues, inflammation, posture, stress, or behavior patterns are still driving the pain.”

- Why Injections May Only Help Temporarily

Injections are often used to reduce inflammation, calm symptoms, or provide temporary relief. For some patients, they may be helpful. However, injections do not always address the mechanical, behavioral, nutritional, or soft tissue contributors to chronic pain.

A patient may feel better for a few weeks or months after an injection, but the pain may return if the same restricted tissues, movement patterns, posture, or inflammatory triggers remain.

ASTR Institute explains that this is especially important for patients who have had repeated injections but still cannot return to normal function. The injection may reduce one part of the pain cycle, but it may not remove scar tissue, release fascial restrictions, restore healthy movement, correct daily habits, or address whole body inflammation.

Research and clinical guidelines also show that chronic pain care often requires a broad approach. The CDC’s 2022 guideline for prescribing opioids for pain encourages clinicians to consider noninvasive and nonpharmacologic therapies when appropriate, recognizing that pain care should be individualized and should include more than medication alone.

- Why Surgery May Not Always End Chronic Pain

Surgery may be medically necessary for certain injuries, structural problems, or disease processes. However, surgery does not guarantee that chronic pain will resolve.

Chronic postsurgical pain is a recognized problem. Research has reported that chronic postsurgical pain may affect 10 percent to 50 percent of adults after major surgery, depending on the procedure and population studied. Other recent research has described chronic postsurgical pain as affecting approximately 10 percent to 40 percent of patients.

This matters because many patients assume that if imaging shows a structural problem, surgery will automatically eliminate pain. Sometimes it does. But in other cases, the patient may continue to have pain because of nerve irritation, scar tissue, adhesions, altered mechanics, inflammation, tissue sensitivity, or protective guarding.

ASTR Institute emphasizes that persistent pain after surgery does not always mean the surgery failed. It may mean that the body still needs help restoring tissue mobility, reducing compensations, improving movement, decreasing inflammation, and retraining daily habits.

“When pain continues after surgery, the patient deserves a deeper evaluation,” Dr. Jacobs said. “The answer is not always more medication or another procedure. Sometimes the body needs a root cause approach that addresses scar tissue, fascia, movement, inflammation, posture, and nervous system protection.”

- ASTR Institute’s Four Day Intensive Program

ASTR Institute offers a Four Day Intensive Program for complex chronic pain cases, including patients who have not improved with physical therapy, injections, medication, chiropractic care, massage, or surgery. The program is designed for patients seeking a concentrated root cause treatment experience.

During the intensive, patients receive focused care over four consecutive days. The goal is to identify and address underlying contributors to pain, including soft tissue restrictions, fascial limitations, scar tissue, trigger points, inflammation, posture, ergonomics, behavior patterns, and other relevant factors.

For patients who travel to Florida for care, the intensive format may be helpful because it allows for multiple treatment sessions in a short period rather than spreading visits over several weeks or months. ASTR Institute states that many patients seeking this type of care have already tried several standard treatments before requesting a case review.

ASTR Institute encourages potential patients to request a case review so the team can better understand their condition, history, previous treatments, symptoms, and goals before recommending the next step.

- Home Treatment and Provider Training

In addition to in clinic treatment, ASTR Institute offers home treatment tools and step by step online programs designed to help patients address pain related soft tissue restrictions at home. These programs may be useful for patients who are not able to travel or who need guided support after in clinic treatment.

ASTR Institute’s home treatment model includes patented instruments developed by Dr. Jacobs. These tools are designed to help patients work on soft tissue restrictions, scar tissue, fascial tightness, and myofascial pain patterns using guided protocols. The goal is to provide structured instruction rather than leaving patients to guess which exercises or tools to use.

ASTR Institute also offers provider training for healthcare professionals who want to learn the ASTR treatment model. Provider education includes the ASTR model, patented tools, scar tissue and fascial restriction release, myofascial pain, treatment protocols, and root cause thinking.

Dr. Jacobs believes provider education is essential because chronic pain patients often receive fragmented care. A patient may see one provider for medication, another for imaging, another for exercises, another for injections, and another for surgery. While each provider may help in a specific way, patients may still struggle when no one is evaluating the full pain pattern.

- Patient Education Through Books, Videos, and Online Resources

Dr. Jacobs has authored multiple health books focused on chronic pain, inflammation, nutrition, migraines, back pain, anxiety, depression, diabetes, high blood pressure, and natural healing. His educational work is designed to help patients understand the root causes of chronic symptoms and take a more informed role in their care.

ASTR Institute also provides treatment videos, success stories, product education, home treatment options, and provider training resources through its website. These resources are intended to help patients and providers better understand the ASTR model and the importance of addressing pain at its source.

- About ASTR Institute

ASTR Institute is a chronic pain and natural healing institute founded by Dr. Joseph Jacobs, DPT, ACN. Dr. Jacobs is a Doctor of Physical Therapy, Advanced Clinical Nutritionist, inventor of patented medical devices, author, functional medicine practitioner, educator, and cancer survivor. After experiencing chronic migraines, fatigue, and pain, Dr. Jacobs developed the ASTR treatment model to address pain at its source using a biopsychosocial approach.

ASTR stands for Advanced Soft Tissue Release. The ASTR model focuses on identifying and treating root contributors to pain, including scar tissue, fascial restrictions, trigger points, inflammation, posture, ergonomics, nutrition, stress, behavior patterns, and movement dysfunction. ASTR Institute offers the Four Day Intensive Program, home treatment programs, patented treatment tools, provider training, books, supplements, lab panels, and educational resources for patients and healthcare providers.

For more information about chronic pain, the Four Day Intensive Program, home treatment options, provider training, or Dr. Jacobs’ books, visit:

References

- Centers for Disease Control and Prevention. Chronic Pain Among Adults, United States, 2019 to 2021. Morbidity and Mortality Weekly Report. 2023.
- Centers for Disease Control and Prevention. CDC Clinical Practice Guideline for Prescribing Opioids for Pain, United States, 2022. Morbidity and Mortality Weekly Report. 2022.
- Rabbitts JA, et al. Prevalence and predictors of chronic postsurgical pain in children and adults.
- Park R, et al. Prevalence of postoperative pain after hospital discharge. Pain Reports. 2023.
- Rosenberger DC, et al. Chronic post surgical pain, update on incidence, risk factors, and preventive treatment options. BJA Education. 2022.

Dr. Joseph Jacobs, DPT
ASTR Institute
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Four Day Intensive for Chronic Pain | When Traditional Care Has Failed

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