A Missed Step in Physical Medicine

A Missing Step in Physical Medicine

It can be confusing to determine what provider to see at what time when we are having pain.  I’m often asked, “Who should I see?”.  Do you see my chiropractor, your doctor, your physical therapist, your massage therapist or someone with a soft tissue specialization?  All are good options with emphasis on different solutions.

I think what we are a truly looking for are answers to the question of pain.  The questions are of, what is wrong, what can be done about it and, what can be done prevent this from happening again.  I would like to present the best answer that I have found after over 22 years in this profession.  That answer is “It Depends”.   I realize that this isn’t that answer that you were looking for.

The presence of adhesion if often not a consideration when being evaluated by a provider.  Whether the problem associated with mechanical restrictions of the moving parts can be difficult to answer without the appropriate knowledge base and experience?   I’m not saying adhesion is the answer but a question that needs to be on the list.  The question needs to asked at the appropriate time.

It’s difficult to decide what to do when something hurts.  I have a hopeful vision that eventually,  as the science of soft tissue continues to evolve,  specialized manual therapists will become valued as a step in the diagnostic evaluation of those painful conditions that often evade conventional medicine.  In this hopeful vision view of a world of physical medicine everything works for the benefit of the patient.

As we wait for my Utopian vision to come true I am providing a very brief view of  the expertise of medical and licensed providers related to the care of muscloskeletal conditions This list by no means fully reflects these providers education and expertise. Each provider has valuable interventions that are appropriate depending on a case of muscloskeletal pain.

The Medical Doctor (MD):
Most are not experts in musculoskeletal pain.  MD’s can provide valuable anti-inflammatory solutions that can pave to way to successful therapy appraoches. They have the particular expertise in determining if musculoskeletal pain is associated with an internal pathology.   Some common tools for medical intervention for musculoskeletal pain include muscle relaxers, pain killers, and anti-inflammatory medications such as injections and oral steroids.  Often an intervention of a medical doctor provides a chemical solution to a mechanical problem.

These providers have the ability order diagnostic imaging studies such as x-rays or MRI scans.

The Osteopath (DO):
This is a medical doctor that is trained in the physical manipulation of the joints and soft tissues.   Some common tools for medical intervention of musculoskeletal problems include muscle relaxers, pain killers, and anti-inflammatory medication such as injections and oral steroids and varies musculoskeletal manual adjustments and hands-on manual therapy.

These providers have the ability order diagnostic imaging studies such as x-rays or MRI scans.

The Physical Therapist (DPT):
These providers have a wide scope to cover in physical medicine.  Physical therapists have a seemingly daunting scope of patient cases and a vast knowledge base to go with it.   Physical therapists work with patients that range from aches and pains to, neurological rehabilitation such as stroke victims and orthopedic rehabilitation such as total knee replacements.

The tool box of the physical therapist can vary from provider to provider.  Some common tools for intervention from a physical therapist include stretching and strengthening protocols, exercise prescription, dry needling, taping techniques, aquatic therapy, neurological therapies, electronic stimulation, ultrasound and traction, and varies models of manual therapy.

The Chiropractor (DC):
These providers have a wide scope of practice.  The primary focus of  hands-on treatment is spinal manipulation to address what they diagnose as spinal segment subluxation.  Today, chiropractors can be found working in scopes that address a variety of conditions throughout the musculoskeletal system.

The tool box of the chiropractor varies from provider to provider.  Some common tools include high velocity spinal adjustments, low velocity spinal adjustments, activator adjustments, taping techniques, ultrasound, heat therapy, stretching or strengthening protocols, exercise prescription and various models of manual therapy.

These providers have the ability order diagnostic imaging studies such as x-rays or MRI scans.

The Massage Therapist (LMT):
These providers have a scope where they manipulate and treat the soft tissues of the body.  Massage therapists have an entry level education requirement that can start at 500 hours of education.  These providers do not have the scope to diagnose a condition.  They assess your condition to determine whether your presented condition is contraindicated to their massage or manual therapy technique.

Some common tools and techniques include relaxation massage, deep tissue massage, myofascial techniques, cupping,  lymphatic drainage, cranial sacral techniques, taping techniques, and various manual therapy techniques.

The Manual Therapy Specialist:
These are providers that are often and hard to find.  They are hidden in four of the five provider descriptions.  These providers are the skilled manual therapists that include the observation and manual therapy skills to detect the presence of adhesion in tissue. They could be a DO, DPT, DC or LMT.  Their skills often include a view that is a missing link in physical medicine.

This missing link is a step in the process that can drastically save time and money.  This step can detect problems that cannot be detected with imaging studies, orthopedic tests and nerve conduction studies.

Dave Edwards-Smith