That statement might sound a little extreme, so let me clarify it a bit. First, our clinic deals with pain and injuries. So this post is about diagnoses for musculoskeletal conditions. Hopefully, it’s obvious that if you’re dealing with pain caused by something like cancer, your diagnosis is VERY important and you need to get the appropriate treatment based on that specific diagnosis. Secondly, there may be a time when your diagnosis is even important for musculoskeletal injuries. But those scenarios are rare. Most of the time, when a patient walks into our office with a specific diagnosis, I keep it in the back of my mind but it usually doesn’t play a role in treatment. I’m sure this is a little confusing so let me start with an example.
Why A Diagnosis May Not Matter Let’s use shoulder impingement as an example. We have seen dozens and dozens of patients that have been diagnosed with shoulder impingement via x-ray or MRI. Shoulder impingement is believed to cause pain when a part of the shoulder blade rubs against the tendons of your upper arm and/or shoulder muscles. So one would think that this diagnosis would be key for treatment. Unfortunately, pain is a lot more complex than what is seen on an x-ray. With all the shoulder impingement causes we have seen, many have improved with muscle therapy techniques such as Active Release, Graston Therapy or Functional Dry Needling.
A large number have also improved with repeated movements (McKenzie Method) , where the patient moves their arm in a specific direction over and over again several times a day. Another group improves with treatment to the neck, as shoulder pain is often referred from a problematic neck. Sometimes, our treatment isn’t helpful for a patient so we send them out for an anti-inflammatory medication or injection. In the vast majority of all of these patients, they end up being completely functional after treatment and usually 80-100% pain free after 2-8 visits. But, if we were to do a repeat x-ray, I would bet money that the x-ray would look exactly the same as before. So, if the pain was caused by their diagnosis of shoulder impingement, none of these patients should have improved with our treatment or the medication/injections.
Why A Diagnosis May Lead To Unnecessary Treatment. So what gives? The problem with musculoskeletal diagnoses is that it is very rare to have no abnormal findings, even if you are completely pain free. MRI studies have repeatedly shown that 40-75% of PAIN-FREE individuals have disc bulges or disc herniations. Fifty percent of PAIN-FREE males over the age of 50 have a rotator cuff tear in their shoulder. Almost seventy percent of PAIN-FREE individuals have a hip labrum tear. If we relied on diagnoses, this would mean unnecessary therapy, injections or surgery for all of these patients, despite being pain free.
So if diagnosis isn’t the main part of examination, what is? Classification. Categorizing a patient’s symptoms into a pain syndrome class is where modern medicine is heading in regards to musculoskeletal injuries. Is your problem due to a joint issue (a derangement classification)? Then you may need repeated movements or adjustments. Is it due to a problem with a muscle (dysfunction)? You would respond well to muscle therapy and exercises. Is the it constant, does not change with movement and worsening? It may be chemical irritation, which would need rest, an injection or anti-inflammatory medications.
Our goal isn’t to change x-ray or MRI findings, our goal is to get patients to have a functional and pain free life. If you have pain, don’t worry about your diagnosis. Let somebody classify your condition.