You Are Not Your Diagnosis
- Laura Welch
- Jun 10
- 3 min read
At a continuing education course, the Canadian physiotherapist teacher poked fun at my class saying, "Oh you Americans, you are always pathologizing everything." We all chuckled and I thought, is that really a cultural thing? It does seem like the majority of us want a name for what we are experiencing; a "This hurts, so what do I call it?" approach. Maybe it's easier to say you have spinal stenosis instead of telling your friends and family your back hurts sometimes. Labels help us organize our thoughts and even our expectations, which isn't always a good thing. In my experience, these diagnoses often hinder progress because people are left feeling powerless. It feels more out of your hands if you have a small rotator cuff tear diagnosis than if you have a general shoulder pain diagnosis.
Luckily in the medical field, there is a shift to delay taking x-rays and MRI's because they have realized that findings could be irrelevant to the symptoms. Even more so, things can be discovered that are completely harmless, such as cysts, but may become worrisome due fear of the what-if's. The diagnoses that are found on film do not occur in isolation. Take a disc herniation, for example. Disc herniations come about for MANY reasons, some of which include bending at the spine repeatedly, weak deep abdominals (including pelvic floor), stiff ribcage, weak glutes, poor breathing mechanics, poor nutrition and hydration, and the list goes on. Having a herniated disc diagnosis is only the tip of the iceberg. It doesn't tell us how or when symptoms occur. Perhaps, it's not related to our symptoms at all. One thing we do know is that abnormalities or degenerative states increase with age, which makes sense. As we get older, our skin changes, our hair changes, our nails change, and so do our insides!
Some of my favorite kind of studies are the ones that talk about all the funky things we discover about people's bodies in those that have no pain. Here is a snapshot of studies like these and what they found:
Spine: In one study, they took MRI's of 98 asymptomatic people's lumbar spines. The results found the 52% of them had a disc bulge at at least once level, 27% had disc protrusion, 1% had an extrusion, and 38% had more than one disc abnormality. They also found that disc abnormalities increased with age. The best line is taken from their conclusion in which they state, "...the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental." (1)
Hips: This study looked at hip abnormalities in folks with no hip pain. They took MRI's of 48 asymptomatic people with the average age of around 38 years old. They found many abnormalities, including 69% that had labral tears and 24% that had chondral defects. They also noted that the prevalence of abnormalities increased with age. (2)
Knees: This study had a larger sample study of 115 asymptomatic people, which means 230 knees. Their MRI results showed abnormalities in 97% of the knees: 30% had meniscal tears, 57% had cartilage abnormalities. These are in people without pain! (3)
Shoulders: This study looked at 53 asymptomatic people between the ages of 45-60 years old. Their MRI results showed consistency with previous findings in other studies, which was 55%-72% of this cohort having superior labral tears. (4). Another study states that asymptomatic rotator cuff tears are commonly present in the opposite shoulder of the painful shoulder side. (5)
This is something so important to understand: in physical therapy, we treat function, not pain. Initially, this may sound disappointing because the whole point of getting physical therapy is because something hurts. Here's the secret: the majority of pain is related to task-specific movement strategies that are suboptimal or are too much load/speed/intensity to the tissue. This is why you will ALWAYS hear me ask questions related to tasks such as, "When do you feel your pain? What were you doing just before you starting feeling your pain?" Treating pain as its own entity is a game of whack-a-mole and although provides temporarily relief, it almost always leaves you dealing with those symptoms again.
This is NOT a shame of surgical interventions because we all know someone whose life was changed for the better thanks to surgery. But this is a call for hope and for understanding that your diagnosis isn't the final word. Insidious onset of symptoms, meaning symptoms that develop overtime that are not due to a recalled specific injury, can happen from faulty mechanics and stressors overtime and do not necessarily come from what we see on imaging. There is always progress to be made. All it takes is finding the driver of the symptoms.
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