From Dr. Tyler Ideus
June 10, 2021
At LPSM we pride ourselves on our Blueprint and how we cooperate with the patient on its execution.
In today’s world of treating musculoskeletal pain and dysfunction, there are a ton of really great therapies that a lot of really good therapists can apply. Despite this, I commonly hear things like, “Oh, I tried X, and it didn’t work.”
This makes me think to myself, “Well X has worked many times for many people, but X isn’t a universal therapy that can just create miracles and fix everything 100% of the time.”
There are two things that create long-term success when dealing with pain syndromes:
- Expertise in clinical evaluation
- The patients’ willingness to take an active role in dealing with the issues.
So, the effectiveness of X depends on its application, and its application is based on an evaluation. If the evaluation isn’t extremely detailed, X will have a much less likely chance of actually working. Not because X is bad, but because it was applied to something it has zero ability to help. Unfortunately, with all the advancements in technology, which does help tremendously at times, the physical exam has been somewhat weakened.
It’s all too common to hear phrases like:
- “Well the MRI says I have X.”
- “I got treated for X and just got some treatment.”
I follow up with asking how the patient was evaluated, and they typically reply that there was no real evaluation.
Like I have said a million times, there are multiple studies that show there are people with positive MRIs that have zero pain and people that have pain that have negative MRIs. Hopefully, we can conclude that MRIs are horrible at diagnosing pain syndromes. Again, it is the job of a skilled clinician to take into account an entire person, not just one image from a machine.
When I was first in school I was able to observe what an evaluation should and could be. Like most things in life that are really worth having or achieving, the only way to get good at it was hard work, a lot of time and a financial investment.
Pain is something that is so multi-faceted that one has to understand biomechanics, neurology, nutrition, medication interactions and psychology. One also has to understand what can be helped by conservative means and what needs to be referred out. With each missed question during the history, each missed orthopedic test and each missed functional test, the likelihood of treatment being successful goes down.
At LPSM one of the most important, if not the most important thing, we pride ourselves on is the ability to perform a thorough evaluation. It is our hope that each time we apply treatment X that X will be successful not because it is a miracle treatment but because it was applied to the right situation. The miracle never lies in the treatment itself but the decision making of what specific treatment/exercise Rx is the exact right one for each unique situation out of thousands of treatment options to choose from.