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Does a diagnosis matter?

As a Doctor of Physical Therapy, I treat many conditions and ailments and receive a ton of questions about injury prevention and solutions. I’ve heard just about everything under the sun, but I’ve been noticing a particularly interesting trend recently. Within the past month, I’ve had several people come into the clinic after self-diagnosing their injuries. They ask my opinion about what to do about their ___ , with questions such as “should I get an MRI”, “should I get in to see a surgeon” to confirm the diagnosis.

Although this is quite a loaded question, my answer was surprisingly simple every time. I just so happened to shock every one of them…

When it comes to minor injuries, I am less worried about getting the exact diagnosis. We would be far better off solely focusing on solutions.


Now you may be confused with this statement, as it goes against practically everything we’re doing in the current healthcare system. We throw the majority of our money at developing ways to more accurately diagnose people once injured and ill, but we forget the ultimate priority of making folks feel better. While these two things can often go hand in hand, I’d argue that a diagnosis should not be viewed as an end-all-be-all path to one’s successful recovery.

Let me explain.


Does a Diagnosis Really Mean Anything?

Before going any further, it’s important to clarify that this post is just focused on minor musculoskeletal injuries…NOT major illnesses or complications that warrant immediate surgery. Even still, there will be cases when a diagnosis proves useful, but it’s a lot less likely than what one might think. I’m by no means saying that diagnosing an injury is bad…it’s just not as detrimental to the rehab process.

Pain is extremely complex. So much so, that many experts don’t have all the answers. This is especially prevalent in areas like spinal health and chronic pain. Consequently, providers that do try to focus on a diagnostic mindset occasionally get it wrong. For those who do hit the nail on the head, it sometimes still isn’t helpful for the patient or his/her outcomes.

The example I always return to is the idea of diagnosing a ‘bulging disc’ for a back pain patient. Research shows that a whopping 84% of asymptomatic patients have some form of spinal abnormalities that can be seen on imaging. Unfortunately, the ones who receive a diagnosis of bulging discs or scoliosis tend to suffer more than those who are unaware of any abnormalities to begin with. Why is this the case?

Researchers are now saying that these things we see in the spine as we get older are basically “wrinkles on the inside.” We do not experience pain as our skin loses some elasticity and forms wrinkles so we should not inherently expect that just because a spine shows some age-related changes that we should have pain!

Unfortunately, many patients and medical providers aren’t thinking like that. Once they get hold of an image or diagnosis, the damage has been done. For patients, this label can lead to a spiral of fear, stress, avoidance behavior, and ultimately the dependence on pharmaceuticals or invasive interventions. This same downfall can occur with other musculoskeletal injuries but this is just one of the most common examples.

More often than not, the diagnosis does not dictate the treatment. Instead, in rehabilitation we have to focus on what solutions make you feel better, because 2 people with the same problem often respond differently to the same treatments.


What Does Matter?

Now that we know that specific labels aren’t exactly helpful for one’s health outcomes, what then should we be focusing on? In my opinion, there are 3 important steps to this process. While this may be a slight oversimplification, this ‘formula’ will be relevant for nearly every minor musculoskeletal injury out there.


1) Locate the root cause of your pain.

If you want to recover quickly and fully, it’s time to widen your scope. If you’re only narrowing your view on the area that hurts, you may very well miss the underlying cause of your pain. I frequently come across clients who try desperately to strengthen/stabilize/recover the localized region of their injury and have never thought to look up or down the chain. This is a classic case of wanting to put a bandaid over an injury that requires much, much more. When you ‘chase the pain’, this can lead you through a maze of trial and error vs taking an arial view of the situation to find the best path.

What scares most people at this point is this means it’s going to take time, effort, and attentiveness. With today’s fast-paced, click-to-order mentality, this is a hard pill to swallow for most people.


2) Find solutions that will make you feel better.

Oftentimes, injury rehab is more holistic than we think. If you want to maximize the recovery of your injury, you must look at your life as a whole. Your success should be a priority. Progressively loading the injured tissues will be your best bet for a quick recovery. Outside of that, you should also reflect on the other dimensions of wellness. For example, did your recent stress levels play a role in your injury? What about your diet? Are you receiving the right equipment to do your job safely and efficiently? ARE YOU GETTING ENOUGH SLEEP?!

By looking at the big picture, you’ll be much more aware of what caused your injury and much more in-tuned with what you need to do differently. This is a process I help guide my clients through every day.


3) Construct a system to adhere to your new habits.

You’d be shocked at how low the adherence rate is for physical therapy. In one study, it was reported that only 35.0% of patients were highly adherent with home exercises in a short-term study of patients. I think part of this is the typical outpatient setting sets sometimes unreasonable expectations for patients. Most people can’t take an hour out of their work day 3 days a week for 6 weeks! And most people have an already busy enough schedule that adding on even 30 minutes of daily corrective exercises right from the start is a daunting task. It’s the same thing with dieting, most strict diet plans often fail because its not sustainable and doesn’t form long-term habits. Instead, start slow and work efficiently. I treat clients usually once per week and usually start with 3 corrective exercises to start doing right at home. We try to form a morning, lunchtime, or evening routine OR fit these into their regularly scheduled workouts.

In Closing,

When it comes to most injuries, we must stop obsessing over seeking accurate diagnoses. Not only are they hard to find at times, but they’re generally not helpful for one’s outcomes! The real priority should always be on finding sustainable solutions that will make a lasting difference. This is the mindset shift our culture needs so desperately. We need to turn our focus from sickness to health, from reactive to proactive, from labeling illnesses to empowering rehabilitation.


Sincerely,

Dr. K



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