And the potential problems it creates
Diagnosis based approaches
Normally when you receive treatment or are going to an evaluation for any pain or symptoms that you are experiencing, you will often, at the end of the assessment, receive a diagnosis for your ailment. The question is, is this always helpful? Let us find out.
Working with establishing a diagnosis is a key concept in most treatments, because it lets us know what we are dealing with and what the current problem really is. And with a proper diagnosis we can also establish a timeline for how quickly you can recover from your problem, as well as which treatments would be most effective based on scientific studies aimed at that specific problem. It is critical in certain situations such as exercise induced rhabdomyolysis, cancer or heart problems, as well as many other serious disorders. So, lets be clear, we are not discussing these topics today, even though in some ways they are still relevant to what we are about to discuss. What we are about to discuss in particular, are disorders of the muscles, bones, ligaments and connective tissue.
14 years ago, I decided to dedicate and specialize myself to the approach of diagnosing musculoskeletal disorders, following an internationally well known system which in Norway and many other countries - it is included in the studies and further specializations for medical doctors within that field. Working for many years since, I have reached a form of realization that this approach is limiting much of the potential for success of a treatment if you only accept the current problem at hand in this way. In other words, you may miss vital points which would improve the patient’s problems drastically in some cases, and in others they may very well not heal completely without it.
Let me give you an example, some years ago I treated an athlete, which had just days before been diagnosed with inflamed bursa (which is a fluid filled sac meant to decrease friction from muscles and tendons that are overlying the bones). She was diagnosed by a doctor who was specialized in sports. Based on this finding, the doctor reported to her, that this would last for 6 months. As a professional athlete, this was not good news for her. When doing my own assessment, I could see that her pattern was tilted in a way, which put too much load on the outside of her painful hip. My treatments were then directed at trying to correct this faulty alignment, rather than trying to work locally around her hip – which is the standardized approach based on the diagnosis. After 1 week and two treatment sessions, she was without any pain or limitation and had already returned to full training. And this is my point, these types of malalignments occur, and they can destabilize the body in such a way, that certain structures are put under strain and THEN an injury may occur. So, there are in many cases, an underlying problem which is already there, but not necessarily causing the patient any problems because they are adapted to this type of compensated movement patterns. But this type of holistic understanding of how a problem develops are not a part of a standardized treatment approach based on this diagnosis. Why is that?
Well, there are good reasons for this, and the general one being, complexity. It is easier to make an approach for therapists and doctors, which have few treatment options which are relevant to the local problem. Trying to understand how almost every single muscle in the body has an ability to decompensate a symmetrical pattern makes for very poor textbooks. Because these patterns are highly individual, meaning a person may develop their current problems or rather, their current diagnosis, in different ways. What we should aim to do, is to try to understand in which way this pattern has developed for each patient, and what we can do to improve upon this. Often, in these situations, it’s important to have a broader understanding of the problems the patient have experienced earlier as well, as they may hold the key for how this has developed. Some key concepts to this approach may be understanding myofascial lines, which are muscle lines and how they connect through the body, as well as understanding the concept of compensation. Both topics will be covered in other videos which will be added in the description below once it is in place.
Understanding the problem in the right way
Now, do I mean that examining and arriving at a diagnosis is wrong? Absolutely not. But it is important, that it is not a limiting factor for the treatment. We must try to understand the contributing and limiting factors which are affecting the current diagnosis. But in our current approach with using the diagnostic model, many potential beneficial treatment effects are not being used, because we get stuck into only looking at the problematic area, without trying to understand it’s development and how previous injuries or faulty movement patterns may lead to the current problem. So, as in most things in life, the more you know, the more probable a favorable outcome will be. At the same time, it is important to understand, that many direct treatment approaches may still have excellent effects, these situations are usually the less complicated cases. My point being. Even if a diagnosis is set, and the direct treatment - which is only limited to that diagnosis is failing. Then it is probably a more complicated pattern in play, which requires a different approach. It does not necessarily make the diagnosis wrong, but its perspective is too limited for what the patient is suffering from. So, for us to achieve a higher probability for success, we need to understand the problem from a different point of view.
The approach requires effort and thought
Is this an easy approach? Absolutely not, because it opens an approach where you must consider many more aspects then you have before, but this is also the beauty of the system. You are rewarded for your ability to pay attention to the patient. And your influence is greater, because you know there is an opportunity you did not see before. It requires a lot thought, and ability to rationalize how things develop, and to make an individual hypothesis for your specific patient, where the key to your success lies in the effect you achieve by adapting your treatment to the specific needs of your individual patient.