Diagnosis by Technology vs. Diagnosis by Exam

Does it really matter which means are utilized to determine a patient’s diagnosis? When it comes to diagnosing musculoskeletal pain, I certainly think so. The art of performing a physical exam on a patient is missing in the realm of musculoskeletal medicine. I know this because, as an experienced physical therapist, we are the only physicians who rely on extensive physical examinations to diagnose and treat the majority of physical ailments. Other physicians, such as general practitioners or orthopedic doctors, utilize MRIs and x-rays to diagnose. So, why use physical examinations? There are plenty of reasons.

What Actually Is Your Problem?

Seems like a pretty simple question to answer, right? Wrong. All too often I see patients in my office who have a hard time answering this question. Why? Often they find themselves in my office after experiencing pain for several months and after seeing multiple other physicians before me. The first thing that I usually discover is that the patient has yet to have had a comprehensive physical examination. This is what the background of their treatment usually looks like –

  • First, they saw their family physician and verbalized their pain complaint
  • The family physician prescribed pain medication and referred the patient to a specialist, usually an orthopedic surgeon
  • The specialist also listened to the patient’s complaint, maybe even performed a brief exam, and then ordered an MRI or x-rays to determine a diagnosis

That’s when I come into play. The patient arrives at my office and tells me, “I have a bone spur,” or “I have a bulging disc,” etc. To which I reply, “Yes, that is what your MRI/x-ray says, but what actually is your problem.” {cue blank and confused stare} It is amazing to me how many patients, by the time they end up in my office, have lost sight of what their original complaint was due to being so fixated on this diagnosis that has been determined by a machine.

The Art of the Physical Examination

Once the patient realizes that I am actually interested in their original complaints, they are eager to explain things further, such as:

  • When did their pain start?
  • Is there a difference in the origin of their pain vs their pain now?
  • What movements make the pain worse vs which movements ease the pain?

The physical therapists at OSPTC are trained to make a diagnosis by physical examination. We don’t send you out for an MRI or x-ray, and we certainly don’t recommend pills for your complaints. Instead, we will listen to you and examine you thoroughly as only a physical therapist in one of our offices has been trained to do.

Getting to the Root of the Problem

So, what can be determined by a physical examination? First of all, we will look for the cause of the pain by looking at how you move.

  • What is stuck?
  • What is weak?
  • Are there any restrictions in your fascia or peripheral nervous system?
  • Are there restrictions in your joint capsule or just a trigger point in your muscle belly?

Once we find the source of your pain, we will begin treatment right away. When you start to see the results of our treatment, you will rest easy knowing that not only has the problem been diagnosed, but the root of the problem has been discovered and treated as well. It will be then that you realize that diagnosis by exam is a much more efficient way to treat musculoskeletal pain than diagnosis by any machine or technology.

With four locations from Crestview to Destin, Florida, our physical therapists are trained specifically to perform extensive physical examinations to diagnose your problems as well as discover and treat the root of those problems. Orthopedic & Sports Physical Therapy Center has expertise in assessing, diagnosing, and treating the real issues that cause medical problems.  Let Orthopedic & Sports Physical Therapy Center, LLC be your first resort to treatment, rather than your last. We are dedicated to delivering quality treatment that will get you back in shape as soon as possible.

Choosing the Right Exercise

Choosing the Right Exercise

Did you know that there is a right and wrong way to exercise? Everyone’s body is built differently and operates uniquely at different stages of life. Choosing the right exercise regimen is just as important as the exercise itself. So, you read an article in a fitness magazine that illustrated a workout regimen for women over the age of 50 – well, while I’m sure that there were a lot of helpful tips and core principles in that article, it isn’t realistic to think that any one workout regimen is right for all women over the age of 50. I get those same fitness magazines, and even enjoy reading them, but my knowledge of the human body and how it works began to evolve when I went to Physical Therapy school in my early twenties, and has evolved even more now that I have been practicing for 24 years. Take it from me, the right exercise regimen for you is one that is catered individually to you, your health and your body’s makeup.

The Wrong Exercise Regimen Can Lead to Injury

I have always gone to the gym to work out, even as a young man. Now, having been in my profession for as long as I have, when I go to the gym it can be very disconcerting to see people doing exercises that are actually doing their body more harm than good. They believe that these exercises are building muscle and increasing the strength of their joints, but in reality these exercises are ultimately leading to the breakdown of their joints and muscles, potentially leading to injuries in the future. I have tried approaching these people to offer helpful advice, explaining my background and knowledge of the human body and its mechanics, but I am often met with hesitation. They usually have a story about a personal experience and how they were taught these exercises by a ‘professional.’ Oftentimes, the clients of these ‘professionals’ end up being of patients of mine or one of our other therapists.

There Is a Science to Exercise

exercise-gymThere is more to exercise than just the mechanics of movement. The brain is largely involved in determining which exercises are right for us. In my experience, I have learned that the nervous system likes certain patterns of movement and there are certain patterns that can be detrimental to our bodies. This information may seem foreign to personal trainers and others who consider themselves experts on exercise, but this type of knowledge comes from being educated on the pathology of the human body. That knowledge, paired with 24 years of experience developing individualized exercise regimens for patients of all ages and backgrounds, is how we get our patients on the right track and help to prevent injuries and unnecessary breakdown of muscles and joints in the future.

The Right Exercise for the Right Injury

There are certain exercises that are best for physical ailments that occur over time {without injury} and certain exercises that are best for injury induced physical ailments. These ailments that occur over time can easily be a direct result of the wrong exercise regimen. That breakdown of the muscles and joints will ultimately lead to injuries in the future. Are you following the right exercise regimen for your body? Don’t wander off into the gym and try to figure out these things on your own.

With four locations from Crestview to Destin, Florida, our physical therapists are true professionals that are qualified to get you on the right track with your exercise regimen. Orthopedic & Sports Physical Therapy Center has expertise in assessing, diagnosing, and treating the real issues that cause medical problems.  Let Orthopedic & Sports Physical Therapy Center, LLC help you determine which exercises are beneficial to your body and which ones to avoid. Take our advice now rather than later and avoid injuries in your future.

Understanding Musculoskeletal Pain

Musculoskeletal pain occurs in joints, bones, muscles, tendons, and ligaments. Unrealized by many, pain is actually a symptom, not a problem itself; unfortunately, many medical professionals treat pain by immobilizing hurting joints. This approach causes more problems than it resolves; seek orthopedic professionals with an interest in discovering the source of pain and treating the root of the problem to effectively resolve musculoskeletal pain.

Why Musculoskeletal Pain Comes Back

Issues to the musculoskeletal system cause musculoskeletal pain; joints, bones, muscles, tendons can all associated with musculoskeletal disorders. In traditional western medical treatment, the area where pain occurs is viewed via imaging (usually an x-ray); the patient is prescribed pain medicine and is recommended to discontinue use of the injured joint or limb for a period of time. Soon after treatment and patients begin reusing their limbs, the pain returns.

Orthopedists see this scenario play out time and time again; a patient seeks medical intervention due to joint pain. Upon reviewing the patient’s medical history, it is revealed that the patient suffered a previous episode of pain or had a previous injury to a specific joint (injury is one of the common cause of musculoskeletal pain); the prior ailment was “treated” via immobilization in a sling or a brace for a period of four to six weeks.

Following the immobilization period, patients report that their caregiver removes the boot or sling (whatever was being used to stabilize the joint) and declares the patient’s injury to be healed. Patients report being encouraged to resume normal physical activity, which, when they do so, results in renewed pain and problems.

Problems Caused by Joint Immobilization

sling
Obviously, this course of care (injury, immobilization, reuse) is problematic for several logical reasons:

  • Joints after immobilization are weaker due to lack of use
  • Muscles atrophy and ligaments stiffen when constrained / not used
  • Joint fluid congeals when not in use
  • Joints scar during immobilization, which leads to loss of joint mechanics
  • Activity after immobilization causes stress

Even your brain’s neurological control over the musculoskeletal group that is immobilized suffers as it becomes clouded due to lack of use in commanding the unused joint. The result is poor coordination following the removal of a sling, boot, or brace.

The culmination of these mental and physical factors is an increased risk of re-injury and of chronic joint pain.

Accurately Addressing Musculoskeletal Pain

The reality is that immobilizers like braces are too often used to remedy the symptom of pain. Problematically, this solution serves two undesirable purposes:

  • Braces temporarily silence pain – Pain is a good thing as it communicates that there is a problem; when pain is silenced via bracing or medication, then the patient’s chances for re-injury increase
  • Braces can cause joint atrophy – As previously illustrated, lack of use can cause more harm than good in the long run.

The real objective, thus, should be to remedy joint painthrough a thorough assessment of all of the pain-causing structures surrounding the joint. Muscles, ligaments, tendons, fascia, and nerve roots should all be explored in assessing and diagnosing musculoskeletal pain. It is essential to look at the brain’s protective responses associated with a painful point.

Proper assessment must also include looking at the hard-wired protective reflexes that tend to become hyper-aroused when a joint has been hurting for a prolonged period of time. Such reflexes can lead to muscle spasms that persist long after an injury has healed. There is a great deal more to diagnosing and treating musculoskeletal pain than most physicians provide.

As noted, far too many in the medical community are content to image the source of pain, immobilize it, and “treat” it with pain pills. This temporary measure to address musculoskeletal pain is ultimately ineffective.

The physical therapists at the Orthopedic & Sports Physical Therapy Center in Florida are determined to facilitate change in these expectations. OSPTC physicians will evaluate the painful joint, will explore the anatomy that could be causing the discomfort, and will determine precisely what is causing the problem.

OSPTC patients don’t sit around waiting for a brace to minimize their pain. At the OSPTC, the process is very patient-involved; patients play an active role in getting rid of their pain, getting moving, and beginning a life free of pain. 

With four locations from Crestview to Destin, Florida, the Orthopedic & Sports Physical Therapy Center is the place to go for sports injuries and for expedient therapeutic recovery. Become an active participant in mitigating your pain; seek the safe, competent and complete relief offered by the experts at the Orthopedic & Sports Physical Therapy Center, LLC where the only thing you’ll need to brace yourself for is quality care.

Seeing is Believing: Pain Isn’t Always Visible

Far too often, patients experiencing pain are prematurely convinced of a narrative perpetuated as a result of imaging (ex: an MRI revealed a bone spur); however, some ailments are normal products of aging and other factors meaning they may not be the causes of pain at all. Only by using a skilled observational approach, such as those implemented at OSPTC, can the causes of pain accurately be identified.

Why Musculoskeletal Pain Comes Back

The problem with western medicine or medicine performed in the United States is that there is an apparent failure to or at least a failure to attempt to understand the causes of pain and to treat that pain at its source. Believe it or not, despite their comprehensive training, most doctors receive very little educational support in diagnosing and treating pain-causing disorders. This claim is supported in a recent publication titled, A Nation in Pain: Healing Our biggest Health Problem, by Judy Foreman.

girl-leg-painIn her work, Judy claims, “Pain is a bigger problem than heart disease, cancer, and diabetes, combined!” This is the problem that I experience on a daily basis; patients come in to the clinic with an issue that is causing pain. They have already been processed through a system that merits seeing a medical doctor at which point they get an MRI or X-ray, and taking pain pills; the subsequent prescription is for pain pills for anywhere from four to six weeks, yet the results yield no evident relief.

I find it interesting that when I first meet with a patient and inquire, “What are you here for today?” that the answer is always the same. Responses I receive such as, “I have herniated disc,” and “I have a bone spur,” reveal that the patient has already received professional medical information that leads them to believe they are broken.

To this I ask ‘why?’ Just because one has been told that an MRI or X-ray shows an anatomical variation, which invariably must be the cause of their pain that does not make it so. The reality is that most changes seen on an MRI or X-ray show normal changes within the human body that are the result of aging but that have no bearing on pain.

The Placebo Effect

Considering the following claim that MRIs and X-rays are no good at diagnosing pain complaints. Those are useful only if my therapist and I are unable to find anything wrong during our routine therapy exam. The real problem is that once you have viewed your X-ray or MRI, you start to believe that what is happening is abnormal and the cause of your problems. Once you start to believe this, it is difficult to remove your pain through conventional intervention.

This is because 30% of any treatment is placebo, which means that if something is meant to work, it will work to a degree of up to 30% because you’re relying on the narrative that it is intended to work (and therefore, it must work). On the contrary, if you do not believe the placebo narrative, there is a 30% higher likelihood that any proposed intervention that it will not work.

The Significance

So, why is this issue concerning? It’s problematic because 30% of treatment left subject to the placebo effect is actually the most important part of any treatment you try. In other words, if you visit a surgeon or physician and are made to believe that you have a bone spur, then you will not believe that any treatment for any ailment other than a bone spur is beneficial.

Thus, before you accept the diagnosis resulting from imaging or even another MD or chiropractor, consider the healthy, non-invasive, results-driven alternative approach of a physical therapist at the Orthopedic & Sports Physical Therapy Center (OSPTC), and let their doctors figure out why you are really in pain, and let them help you fix it.

With four locations from Crestview to Destin, Florida, the Orthopedic & Sports Physical Therapy Center is the place to go for sports injuries and for expedient therapeutic recovery. Rather than relying on images, these medical experts read your body’s signals to understand what problematic before treating real issues. Let Orthopedic & Sports Physical Therapy Center, LLC diagnose, treat, and resolve issues causing you pain.