Are you looking for a Fixer or a Coach?

The British Journal of Sports Medicine recently published an infographic that put my thoughts and beliefs about non-traumatic musculoskeletal (bones and the muscles/tendons/ligaments that connect them) healthcare into a picture. 

Let’s imagine a patient undergoing two different scenarios:

Our imaginary patient’s name is Roxanne.  She is 23. She is a teacher, a wife and a Army veteran.  She has had more than a few injuries from sports growing up, the requirements of the military and general life.  She began experiencing low back pain and like most people thought it would go away.  The pain continued and started to interfere with her ability to sleep which began to impact how she interacted with her husband and students.  After a month, she decided that she had enough and was going to schedule an appointment with a chiropractor. 

Scenario 1: Roxanne makes an appointment with Dr. A.  After a brief discussion about her back pain, Dr. A recommends imaging, so Roxanne has an x-ray taken of her low back.  When Dr. A examines the x-ray, they notice that Roxanne has structural changes of her spine and tells Roxanne that she has “degenerative disc disease, degenerative joint disease and the spine of an 80 year old”.  Remember that Roxanne is 23 years old.  Roxanne hears the word “degenerative” and believes that this means her spine is fragile and damaged.  She takes this to mean that she needs to be extremely cautious about moving her body.  Very concerned and slightly panicked, she asks Dr. A about her treatment options.  Dr. A recommends passive therapies such as adjusting/manipulation, massage and other therapies that require Roxanne to visit Dr. A frequently.  While these therapies can feel good and may relieve Roxanne’s low back pain, they enforce a dynamic that Dr. A is “fixing” her and that she may require care for the rest of her life to remain pain free.  

Scenario 2:  Roxanne makes an appointment with Dr. B. Dr. B takes more time discussing Roxanne’s lifestyle, beliefs on pain, learns about her social circle, job, and health history along with how her low back pain started and progressed.  Together Roxanne & Dr. B discuss the parts of Roxanne’s life that may be contributing to her pain as well as options to change them.  Dr. B takes the time to educate Roxanne about why imaging isn’t always necessary and frequently leads to emphasis being placed on structural changes (remember degenerative disc & joint disease) that are frequently seen on imaging of people who don’t have low back pain.  Meaning that the changes on imaging may have zero impact on whether someone is experiencing pain.  Dr. B starts Roxanne’s treatment with finding ways for Roxanne to move her low back with less pain.  She is given exercises to perform at home to decrease her fear of moving and improve her strength.  Dr. B may occasionally use the same passive therapies as Dr. A.,  but the therapies are not emphasized as the “cure” to Roxanne’s pain.  As the initial exercises become too easy, Dr. B teaches Roxanne more difficult exercises to continue challenging her and improving her strength. 

If you were experiencing low back pain, which of the two scenarios would you want to experience?

Personally, I would choose Scenario 2 all day everyday.  This scenario would mean that I would have to do more work than Scenario 1 but I would be gaining the tools to manage any future pain I may have more effectively. 

Professionally, I want to be Dr. B.  I want to listen to your concerns, learn about how they are impacting your life, understand how your lifestyle may be impacting your body and give suggestions on ways that may improve your resilience.  I want to empower you to move, that’s why my business is called Empowered MVMT.  Learn more about the services offered at Empowered MVMT here.

Move better, live better. 

- Dr. Emily

Emily Rausch

Emily Rausch


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