It has been said that “Treatment without diagnosis is malpractice”.
And it is true that in todays’ practice of modern healthcare, diagnosis provides the over-riding foundation which directs both the type, amount and sequencing of treatment interventions.
Our obsession with diagnosis is evidenced by the explosion of diagnostic tests that are performed every year.
However, not only can the increase in CT and X-ray scans pose a health risk, they can be misleading. Consequently the surge in CT and MRI scans has failed to boost diagnostic rates.
And yet, even if CT, MRI and ultrasound scans did increase the accuracy of your diagnosis, this may not be enough to improve treatment outcomes.
The reason is because while x-rays and scans might tell you what the source of your problem, they do not tell you the cause. In other words, they give you the what, but not the why.
And although it is important to know which structure or tissue is the origin of your pain or problem, it is perhaps more important to know why. Because unless the cause of your ailment is corrected, your problem will always return even if you replace the injured body part.
I spoke about this phenomenon in my blog The Surprising Cause of Pain. In modern healthcare, we strive to name your diagnosis. That by putting a label on your condition, we can somehow better encapsulate, understand and manage your ailment. However, in so doing, we risk becoming blinkered to other possible sources, causes and implications of your injury.
Being given a diagnosis often gives the impression that it is just one tissue, one structure or one body part that is at fault, when in reality, it is often many tissues, structures and body parts that contribute to the cause of your physical problem.
A case in point is osteoarthritis. Osteoarthritis refers to inflammation and the subsequent breakdown of the surface covering of the bone ends at joints. What perhaps is not so well known is that along with this, the underlying bone begins to breakdown.
Bony projections (called osteophytes) form at the joint margins.
The membrane lining the inner part of the joint (synovial membrane) becomes inflamed and swollen causing excessive fluid to be secreted.
Joints become red and swollen.
The capsule and ligaments that hold joints together may become lax.
Muscles either spasm or become flaccid causing muscle imbalance and joint mal-alignment.
Nerves become hypersensitive and restricted.
Connective tissue (fascia) becomes taut and fibrotic.
Blood flow may be compromised.
The surrounding environment may become acidic.
Even your brain can become stressed, sensitized, reactive and magnifier of your pain.
And so the cycle of chronic pain begins and is perpetuated.
And this is not even to mention the incorrect motion in other parts of the body which may have led to the abnormal or excessive forces that caused the osteoarthritis in the first place.
The same goes for any injury whether it be a muscle strain, a joint sprain, disc injury, tendinopathy, bursitis or other condition.
I had a classic case of this a couple of weeks ago. Ann was suffering with intense inside right knee pain that came on “for no apparent reason” a couple of weeks before. So painful was Ann’s knee that I had to see her at home because she was unable to put weight on her right leg to walk.
Ann reported that she had had an MRI which revealed a burst Baker’s cyst (fluid filled sack behind the knee). This finding didn’t match Ann’s knee pain as a burst cyst would generally lead to pain, tightness and swelling behind the knee and Ann’s pain was on the inside just below the knee joint.
On examination, Ann’s right knee was indeed red, swollen and exquisitely tender on the inside of the knee just below the joint line. This corresponded to a different inflamed bursa (fluid filled sack called the Pes Anserine Bursa).
After applying cold packs and teaching Ann how to use crutches so that she didn’t weight bear on her right leg, Ann left to have another MRI for confirmation. This MRI revealed that she had a torn inside cartilage and this was the diagnosis that was given to Ann as a cause of her pain.
So Ann then underwent an arthroscope to “repair” this inside cartilage. To my surprise however, Ann returned to me two weeks later. Despite having an arthroscope, Ann’s pain hadn’t changed. In effect, the arthroscope may have corrected a condition, but this condition wasn’t the source of Ann’s pain.
On retrospect, I shouldn’t have been surprised, as again the MRI didn’t match Ann’s signs and symptoms; that of redness, swelling and intense pain just below the joint line on the inside of Ann’s knee over the area of this bursa.
Furthermore, on close questioning, it became clear that Ann’s knee pain was being caused by the way that she was sitting. So Ann was put on intense program to treat the inflamed joint tissues (synovium), fascia (connective tissue) nerves, muscles and bone surfaces. Ann was also shown how to sit and walk without aggravating her knee.
Two weeks later Ann left for overseas with minimal pain.
For the best, fastest, most complete recovery, it is essential that all the implications, complications and contributions to your ailment are adequately addressed, treated and resolved.
This is referred to as the Bio-Psycho-Social Model of Healthcare. It refers to the fact that the best outcomes will be achieved only when all the Biological, Psychological and Social factors have been taken into account and solved.
For optimal healing and recovery you must treat the muscle, the joint, the connective tissue and the nervous system.
You must correct the biomechanics, posture and movement patterns.
You must optimise the psychological and social environment to enhance recovery.
Yes, a diagnosis is important. But even more important is that the “diagnosis” given from an investigation such as an x-ray or scan is confirmed by a comprehensive assessment and professional clinical examination.
It is then critical, that all the information gained is used to devise a treatment strategy or Recovery Action Plan that treats and corrects both the source and cause of your problem.
This is the only way to achieve the best, fastest, most complete recovery possible.
If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994).
We would love to help you get back to living freely and without pain.
Wishing you the best of health and life.
Director, Bodywise Health
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
· Rebates are available through your private insurance extras cover;
· For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).
References available on request