Hitch Fit Living Magazine Volume 7 - July/August 2016 | Page 35

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.
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 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. So what gives?