Trust your body, not the film
Don’t trust your imaging!!
A patient just called, in a bit of a panic because she went to a chiropractor. She was told “it’s pretty bad” and he recommended that she not do the exercises I prescribed because of what he saw on her X-Rays. She was really upset because she said (about the exercises), and I do quote specifically “they felt really good and were helping”.
This brings up a very important point, you should not make clinical decisions regarding your pain only based on imaging! It does not tell the whole truth. I could fill an entire page easily with examples of this. Patients with rotator cuff tears on MRI but the actual shoulder pain was coming from their neck (not the shoulder). Patients with backpain and bad imaging, but the pain was actually coming from a kidney stone. If I treated these people based on their imaging without a good clinical exam and looking at how the symptoms responded to what I did, they would not have got better. It would be like trying to treat a heart attack by rubbing your arm.
Some providers mean to instill fear. They do that to justify their treatment recommendations. Or, maybe they just believe it’s “bad” and have a doom and glom perspective. Then they covey this to their patient. (There are papers written about the clinical biases clinicians have and how it affects the treatment they render). This patient WAS GETTING BETTER. Her range of motion was improving, and her pain was improving too, but she wanted to stop doing that exercises because another provider said it was a bad idea based solely on an X-Ray. I provided her some more education and the peer reviewed clinical research. I pointed out the evidence that backed up what we were doing, and way, she said “oh good. Thank you, because it was really helping”.
Trust your body, trust the clinical response. If you are getting better, in a lasting manner, what you are doing is likely good. I’m not into band aids or doing something that makes you better for 5 minutes but is making you worse over time. That is NOT ok. However, if what you are doing is helping consistently and you’re getting better over time, trust in that. Imaging is a fine tool, but on its own can be very misleading. Ok, off the soapbox.
On another note, to all the providers out there. Please stop instilling fear in your patients. You know the effects of patient beliefs on your outcomes, and you know a hyped up sympathetic nervous system can make an overall pain experience worse. Choose your words carefully as you provide education. “Degenerative disc disease” sounds gnarly and scary, incurable; “normal wear and tear, aging” is a lot more palatable and way less threatening. If you’re motivated to look up a paper “sticks and stones may break my bones but diagnostic labels can hamstring me forever”. It is very compelling as it discusses the ramifications of diagnostic labeling.