Vail Daily health column: Why a medical diagnosis offers false comfort
June 8, 2015
We talk to our friends, comb the Internet and possibly consult with a physician. Alas we have it; the diagnosis: a rotator cuff tear, plantar fasciitis, a herniated disc. There is comfort in having a definitive answer, something to explain our pain. Does having a label for our pain, though, truly resolve the problem? Somehow we have come to believe that having a diagnosis is akin to having a cure. Knowing what you have is only a fraction as important as knowing why it happened.
According to a recent study conducted by the Institute of Medicine, we spend $750 billion dollars a year on medical excess (unnecessary, redundant and scientifically ineffective tests, procedures and treatments). We aim our attention at symptoms. If it is inflamed, we inject it and rest; if it's tight, we stretch and release it; and if it's worn down, we pursue surgery. Although these can be good options, none of them address the underlying cause.
The recurrence rate of surgically repaired rotator cuff tears is approximately 50 percent.
We assume the rotator cuff is weak. After surgery, we focus on strengthening the cuff. In many cases the supraspinatus (the most commonly torn muscle in the rotator cuff) is overworked. A fall onto the shoulder can shut down the deltoid, so the supraspinatus picks up the slack. Eventually it tears because it can't handle the extra work. Assuming the muscle is weak can significantly worsen the problem.
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The average duration of plantar fasciitis is two years.
It hurts in the foot, so that is where we focus all our attention. The brain has chosen to use the calf instead of something else. What isn't working upstream? If, for example, someone sits at a desk for hours on end, in time, their brain can forget how to use the glute. The calf is in the same chain, so the brain decides to use it instead, ultimately over-stressing the plantar fascia. Until the underworked/overworked muscle pairing is righted in the brain, the calf will drive the bus, and the plantar fascia will pay the fare.
According to a recent study published in the Journal of the American Medical Association, we spend $85.9 billion dollars a year trying to treat back pain.
There are roughly 640 skeletal muscles in the body. Yet when it comes to back pain we resort to "release the psoas, stretch the piriformis and strengthen the core." What if the psoas is so weak that it locks down in an attempt to create some form of stability? Quite commonly the piriformis works on behalf of the psoas. Many back pain exercise protocols include the "clamshell." This exercise strengthens the already over-performing piriformis. Pair this with release of the psoas, and we are 100 percent exacerbating the problem: releasing what is already weak and strengthening what is already overworked.
With time limitations and insurance constraints, we are encouraged to follow a rigid set of algorithms to guide our care. We follow protocols that treat all patients as essentially interchangeable. For instance, with plantar fasciitis we may try: icing, stretching, yoga toes, exercise, rest, laser therapy, ultrasound, night splints, dry needling, steroid injections, trigger point therapy, HOKA shoes, orthotics and more. It's like the Infinite Monkey Theorem of healthcare — throw everything at it and something may stick. Finding the true combination of underworked/overworked muscle can resolve plantar fasciitis in a few sessions.
The cure lies not in diagnosis but in diagnostics. The art of the physical exam and listening to the patient's history have been replaced by technology, tests and more tests. We keep looking at the disease instead of at the patient who happens to have that disease. We also get tunnel vision. It hurts "here," so why look anywhere else? The fact is that it's all connected and it's driven by the brain. Focusing only on symptoms puts Band-Aids on the problem, while finding the source gives us a cure. Retrain the brain or live with the pain.
Physical therapist Julie Peterson, owner of Concierge Physical Therapy, has a background in manual therapy and functional movement. She is the only specialist in the valley certified to perform neurokinetic therapy. She can be contacted by email at info@conciergePTcolorado.com.
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