What's in a diagnosis?

Recently, a medical student asked me if he diagnoses a patient with rotator cuff tendinopathy, can I recommend a youtube video of exercises that he could then recommend to his patient.  We had a lengthy discussion about this.  As his question and, in general, this type of a question comes up frequently in our everyday practice as physiotherapists, I thought it would be worth exploring this.

Here are some examples of the type of questions we encounter:

“I have sciatica...do you treat sciatica?” 

“My friend/aunt/cousin/neighbour also had disc problems/tennis elbow etc and they improved faster/slower than me...why is that?”

“What do you do for a rotator cuff tear?”

A very quick but thoroughly unsatisfactory answer to these questions is that “it depends”.  Yes, people hate to hear it and we hate to say it. 

In the medical world a diagnosis can be very specific.  In a few words, the physician can describe the exact cause of the problem (especially with infections) and they can prescribe the right medication for that specific issue. 

In a lot of the cases physiotherapists would see,  a diagnosis is just basically naming the area that hurts.  So if you have rotator cuff tendinopathy, it basically means that one or more of your rotator cuff tendons is inflamed/irritated.  That is important information.  We can treat that in all sorts of ways to decrease the inflammation.

However, the more important question is why did it become irritated in the first place?  Some people end up with rotator cuff tendinopathy simply because of overuse of those tendons.  In that case, just decreasing the inflammation will often do the trick.  However, that’s not the only reason to have rotator cuff problems.  It is possible that due to poor posture you have had changes in the mechanics of your shoulder.  That is, your entire shoulder is moving in a different, non optimal way.  If we just treat your tendons to decrease the inflammation, but not work on all the other issues, you will have rotator cuff tendon problems over and over again. 

The same reasoning applies for sciatica.  Do you have sciatica because your nerve root is pinched at the spine due to degenerative changes or because one of your muscles along the path of the nerve is compressing it, causing irritation? 

Just like there are a thousand reasons why your car may be making that “clicking” sound, there can also be many different reasons for your leg pain.

This is why your situation will be different from another person’s sciatica or tennis elbow or rotator cuff strain.  This is why I would not generally recommend a youtube video of exercises for everyone with rotator cuff tendinopathy.

And...this is why if you ask a physiotherapist about your “pain”, the only way that he/she can give you a satisfactory answer is after a thorough history taking and physical examination.