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Old 02-28-2013, 07:44 AM   #37
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Originally Posted by Posture Guy View Post
I have zero problem with a client getting imaging. I do think imaging diagnostics like MRIs are overused, especially in cases of minor to moderate pain. If a client is worried and fretting about the condition of their spine, I encourage them to get an MRI and find out.

But if they ask me if the results of the MRI will change my work with them, the answer is no. The MRI doesn't show the problem. It shows the RESULT of the problem. The problem is the spine has become fundamentally mispositioned. The discs wouldn't displace otherwise. So in case, I have two fundamental objectives:

1. Prescribe the appropriate corrective exercises to bring the body back to postural and functional balance.

2. Listen to the client's instincts and allow their wisdom to drive the process.

If I give a client an exercise that is posturally indicated but causes a mild increase in their symptom, that's their body telling me it's not ready to do that movement or position yet. We listen to that and find another way to get where we want to go.

My bottom line, if a client asks me if they think they should get an MRI, I tell them there are two fundamental circumstances in which I think that's absolutely appropriate:

1. Given the symptom presentation there is a distinct possibility of an issue that requires immediate medical or surgical intervention. When we're talking about mild to moderate back pain, that is beyond rare.

2. If the client is so mentally wrapped around the axle that they just "have to know". If it gives them peace of mind, great.
Originally Posted by Chas Tennis View Post
When it comes to diagnosing an injury or chronic condition I believe in imaging. Without imaging there is usually hardly any certain information on the damaged part of the body. I believe that the statistics of false positives and false negatives with imaging, when added to the other diagnostic information, gives the best probability for an accurate diagnosis.
I'm of the paranoid school, so I did get the imaging, which showed this:


Spondylitic changes L5-S1, with a left paracentral annular tear and small associated posterocentral disc herniation. Mild diffuse degenerative facet hypertrophy. No stenosis demonstrated.

I've tried McKenzie, doing it everyday for a month. While both the extension and flexion exercises felt good while doing them and for a very short time after, no real benefits long term.

Now I've got the Egoscue book. And the McKenzie book is still lying around. And two other books on back pain and a sheet of exercises recommended by a PT. There is TOO much information and too many exercies to choose from now, too many paths to try (some of them conflicting) leaving me confused and frustrated after a year of persistant back pain.

What to do? When? How often? Oh, how I wish there was one clear path to take, even if it was a hard one.
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