Jarlo Ilano
01-26-2004, 04:24 AM
Herniated/slipped/bulging/protruding/sequestered discs.....pinched nerves....weak connective tissue... migraines...shoulder impingement...arthritis....carpal tunnel...subluxation..radiculopathy..bone spurs..sciatica...tendinitis...bursitis....
This is just a small list of the things patients tell me they have when they first come in to see me for physical therapy. I greet them and ask "What are we going to work on today? What's bothering you?" And a majority of them begin by saying "My doctor says its (insert diagnosis here)". I then nod, and say that I'm more interested in what they think the problem is. A lot of them pause, and seem bewildered. We then try to get through what particular symptoms they have, and what seems to ease or aggravate those symptoms. Some people never get that far, and continue to state their diagnosis, no matter what question I ask.
In the health care professions, we are trained to procure the correct diagnosis. We will scan, probe, poke, and prod until we pronounce to the patient "You have this!" Then we prescribe a treatment based on the diagnosis, and move on to the next poor afflicted soul that needs our magical diagnostic skills. The patient then wears this diagnosis like a badge, identifying themselves to doctor, nurse, pharmacist, and therapist. "I have an L4 bulging disc with subsequent left radiculopathy" is a sign stamped to their forehead. This is obviously useful in treating illnesses such as bacterial infections, metabolic disorders, and other such disease processes. But, unfortunately, does not fit well in the "common" occurrences of shoulder, neck, and back pain complaints.
I cringe everytime a patient tells me that they have a disc or pinched nerve problem, because I know that so often no matter what we do or what I explain to them, many will always come back to "but what about my disc?" Sometimes I want to scream, and say that if your disc was the primary problem and the nerve was really pinched, your foot would be dragging and you'd be urinating down your leg, and you wouldn't be in therapy, you'd be in the operating room getting that obstruction cleared!
Health care providers want to get to the diagnosis, because then it gives us the proper plan for the patient. With Diagnosis "A" we can prescribe "B" drug, give "C" exercise, and tell them it will take "D" long to recover. Sounds reasonable. Unfortunately, for some, once the diagnosis is set, it seems that brains shut off and nothing else is considered.
Patients want a diagnosis, because then they can put a name to their particular pain/complaint, and get a feeling that they can get treated in the above A,B,C, fashion and be done with it. Sounds reasonable. Unfortunately, some can get branded with ARTHRITIS or BULGING DISC, and brains shut off and they never get beyond that. Especially when the initial treatments fail to give the desired results in the desired amount of time.
In the vernacular of CST, this is SISSified thinking.
If you have some sort of pain or limitation in your daily activities, it is not because you have "bone spurs, sciatica, subluxation" or any other such diagnosis. Broadly speaking (and barring any other pathological concerns beyond musculoskeletal issues), it is because something is interfering with proper movement. The interesting part is determining what the interference is. Too tight? Too loose? Not coordinating well? How is this irritating vulnerable, pain producing structures? How is this preventing smooth movement? Treatment is then not geared toward "the disc", but toward the distinctive concerns of the individual patient.
Go beyond your diagnosis.
A short story expresses the danger of a diagnosis. A woman came into therapy to see a good friend of mine, and immediately told him of her "disc trouble". Her complaints were of a consistent back and leg pain, with difficulty walking, and forward bending. He went through a thorough exam and found some things to work on at her hip. She stated "my hip is not the problem, it's my back, I've had disc problems for years". He carefully explained his rationale and related how these restrictions at the hip can cause the symptoms she is experiencing. After a couple of treatments, she no longer had any signficant pain in walking, and minimal restrictions in her back mobility. Success, right? A pat on the back, a small word of thanks? None of the above. She simply stated "I still get this small pain every once in awhile in the morning then it goes away. You didn't work on my back, that disc is still bothering me."
There are so many good people available here to help with whatever physical restrictions are occuring in the individual. Let them relieve you of the burden of your diagnosis.
Thanks for listening,
Jarlo
This is just a small list of the things patients tell me they have when they first come in to see me for physical therapy. I greet them and ask "What are we going to work on today? What's bothering you?" And a majority of them begin by saying "My doctor says its (insert diagnosis here)". I then nod, and say that I'm more interested in what they think the problem is. A lot of them pause, and seem bewildered. We then try to get through what particular symptoms they have, and what seems to ease or aggravate those symptoms. Some people never get that far, and continue to state their diagnosis, no matter what question I ask.
In the health care professions, we are trained to procure the correct diagnosis. We will scan, probe, poke, and prod until we pronounce to the patient "You have this!" Then we prescribe a treatment based on the diagnosis, and move on to the next poor afflicted soul that needs our magical diagnostic skills. The patient then wears this diagnosis like a badge, identifying themselves to doctor, nurse, pharmacist, and therapist. "I have an L4 bulging disc with subsequent left radiculopathy" is a sign stamped to their forehead. This is obviously useful in treating illnesses such as bacterial infections, metabolic disorders, and other such disease processes. But, unfortunately, does not fit well in the "common" occurrences of shoulder, neck, and back pain complaints.
I cringe everytime a patient tells me that they have a disc or pinched nerve problem, because I know that so often no matter what we do or what I explain to them, many will always come back to "but what about my disc?" Sometimes I want to scream, and say that if your disc was the primary problem and the nerve was really pinched, your foot would be dragging and you'd be urinating down your leg, and you wouldn't be in therapy, you'd be in the operating room getting that obstruction cleared!
Health care providers want to get to the diagnosis, because then it gives us the proper plan for the patient. With Diagnosis "A" we can prescribe "B" drug, give "C" exercise, and tell them it will take "D" long to recover. Sounds reasonable. Unfortunately, for some, once the diagnosis is set, it seems that brains shut off and nothing else is considered.
Patients want a diagnosis, because then they can put a name to their particular pain/complaint, and get a feeling that they can get treated in the above A,B,C, fashion and be done with it. Sounds reasonable. Unfortunately, some can get branded with ARTHRITIS or BULGING DISC, and brains shut off and they never get beyond that. Especially when the initial treatments fail to give the desired results in the desired amount of time.
In the vernacular of CST, this is SISSified thinking.
If you have some sort of pain or limitation in your daily activities, it is not because you have "bone spurs, sciatica, subluxation" or any other such diagnosis. Broadly speaking (and barring any other pathological concerns beyond musculoskeletal issues), it is because something is interfering with proper movement. The interesting part is determining what the interference is. Too tight? Too loose? Not coordinating well? How is this irritating vulnerable, pain producing structures? How is this preventing smooth movement? Treatment is then not geared toward "the disc", but toward the distinctive concerns of the individual patient.
Go beyond your diagnosis.
A short story expresses the danger of a diagnosis. A woman came into therapy to see a good friend of mine, and immediately told him of her "disc trouble". Her complaints were of a consistent back and leg pain, with difficulty walking, and forward bending. He went through a thorough exam and found some things to work on at her hip. She stated "my hip is not the problem, it's my back, I've had disc problems for years". He carefully explained his rationale and related how these restrictions at the hip can cause the symptoms she is experiencing. After a couple of treatments, she no longer had any signficant pain in walking, and minimal restrictions in her back mobility. Success, right? A pat on the back, a small word of thanks? None of the above. She simply stated "I still get this small pain every once in awhile in the morning then it goes away. You didn't work on my back, that disc is still bothering me."
There are so many good people available here to help with whatever physical restrictions are occuring in the individual. Let them relieve you of the burden of your diagnosis.
Thanks for listening,
Jarlo