Can We Better Predict and Treat Pain Before it Becomes a Bigger Problem?

When was the last time a check-up with your family physician involved a “functional examination” in order to minimize or prevent future injuries and degenerative arthritic conditions of the joints? The answer is probably never!

With the current method of evaluating a patient, one basically walks into an office, sits or lays stationary on a table, and responds to basic questions. This is followed by some palpation and/or basic range-of-motion testing directed to the area of complaint. This method of assessing a patient is somewhat simplistic and outdated, yet is still widely used today. What could a stationary examination possibly tell about the cause of your pain? Have we become a society that merely treats pain comprised by people who only seek care when they feel pain? To put it simply, the answer is sadly yes!

It’s become human nature to wait until we feel pain and then seek treatment for it. What if we could use a more functional way of evaluating a patient to not only help treat the root cause of a problem, but to also use it as a marker to better predict and prevent future injuries altogether?

Let’s look at what impact this type of screening could have on a patient by using an actual case study from my office. What can you determine by referring to Figure A, which represents a female patient standing still while undergoing a stationary examination by her family physician? Nothing, other than what the patient is telling her physician. By the time I see a patient who is experiencing lower back pain, he or she has completed a course of care that includes rest, x-rays and medication prescribed by a family physician. For a rehabilitation program, TENS, ultrasound, and a heat pack are the general course of care.

Figure A

Figure B

Now, let’s look at Figure B, which depicts a patient who is undergoing a functional rather than a stationary examination. What, if anything, do you see here? Do you see her feet bilaterally pronate inward, her right knee heavily collapse inward, her right hip collapse on that same side, her left hip rotate outward, her low back rotate counter-clockwise (as is indicated by seeing less of her right arm), and her low back being more upright as a result of a loss in lumbar extension? Even if this patient were to not even say one word to me, I would have this information available while performing a more practical functional evaluation.

Why, then, are we still so “old school” in our management of patients, and why are we more focused on treating pain rather than defining the root cause and possibly preventing future problems? This patient’s back was repeatedly being strained over time, but the true root cause wasn’t in her back. Rather, a weakness in her right gluteal region created these faulty mechanical stressors and predisposed her to injury.

“It’s become human nature to wait until we feel pain and then seek treatment for it.”

Figure C

Besides determining the root of her low back problem, a functional assessment using Figure C can become a predictor of future problems when coupled with peer-reviewed research and a thorough patient history. Let’s look at the patient’s right knee. We know that the knee is a hinge joint that is only designed to straighten and bend, yet this knee is having a large amount of medial force and torque put on it. If the patient’s mechanics are left untreated, they will likely lead to medial meniscus and ligament damage as well as an arthritic knee and – if severe enough – a possible knee replacement. Now, looking at the pronation of her feet, we can predict that she is at a higher risk of plantar fasciitis as well as bunion formation from the increased medial stress on the heel and on the joint of her big toe.

Diverting our attention back to the patient’s original complaint, we already know that she is experiencing a chronic sprain/strain of her lower back. But what if I were to tell you that she is a postal worker that carries approximately 80 pounds of mail strapped to her side, walks great distances, climbs stairs, and routinely bends throughout the day. If her faulty mechanics won’t even let her properly support her own body mass, how can we expect the added weight of the mail, coupled with the rigors of her daily activities, to not herniate a lumbar disc at some point in time?

In conclusion, we need to distance ourselves from only seeking care when we feel pain. Making this simple change will only help increase our own quality of life. This author, however, does recognize that no matter how much educational material is given to a reader, there will always be those who, for whatever reason, still only seek care when they feel pain. One can only hope that, at that time, a proper functional evaluation and treatment plan are performed to thoroughly assess and treat the circumstances that arise, and that the patient’s quality of life hasn’t significantly diminished over time.