To Image or Not to Image
The two articles attached quantify the staggeringly high prevalence — and shocking price — of musculoskeletal conditions in the United States. They also report that neck and low back pain account for the biggest portion of the spending.
One of the reasons so much money is spent is that MD first responders seld0m give a physical exam. Instead, they start the investigation with imaging, which is much more expensive, and not nearly as helpful.
Most musculoskeletal complaints are best assessed and treated by conservative practitioners who use touch and movement to figure out what’s wrong and improve it. It makes sense because musculoskeletal problems are movement problems.
In my view, the reason musculoskeletal problems cost so much is
- The disaster-mediation structure of the insurance and specialized medical fields.
- The symptom-and-pain-relief nature of most pharmaceutical interventions.
- The massive cost of (often irrelevant) imaging.
- Decisions about triage and treatment being made by a person who didn’t examine you physically or look at your movement, which results in more expensive interventions and diagnostics and less information about you and your condition.
Your first stop for a musculoskeletal condition should be a chiropractor or a DPT. Professionals in either of these fields will take a history, examine you physically, and be able to order imaging, give you hands-on help or refer you to an MD, if surgery or medication seems like it will be helpful.
Imaging is very helpful if you already have a diagnosis, and crucial if you’re considering surgery. Otherwise, what it reveals is often “incidental”, meaning that it isn’t what’s causing the problem. That leads to time and money wasted on unhelpful interventions.
Imaging is an example of one of the failings of “objective” science. Its “objective” finding often misses the point because it doesn’t measure the way you live and move, which is usually the source and solution to problems.
The scope of practice for chiropractors and PTs is approximately the same, but PTs tend to focus on strengthening and chiropractors on mobilizing. The best of these practitioners integrate mobility, strength, and most of all, coordination. Movement- and coordination-based treatment- generally relieves pain. But its best effect is to change movement and behavior. Effective movement is what heals.
Click here to sign up for my next Posture With Ease series, focused on whole body movement to support the neck, which starts on July 6th from 7:30-8:45. Each Posture With Ease class includes stretch, strength, coordination, breath, and guided meditation. And each class is fun.
Here’s the take-home: the physical examination you get from a trained movement and touch-based professional will usually yield your most specific diagnosis, strategic response, and longest-lasting effect. It will be more comprehensive than the care of an MD who can’t examine you manually, but can only prescribe palliative drugs and/or send you for imaging.
Even if an MD prescribes physical therapy, it will almost always be limited to one body part, which means you won’t get the whole-self coordination that’s crucial for you to get well and stay well.) That’s why your first stop should be to skip the MD until you’ve been evaluated and had a first course of treatment.
When you, and the people you care about, have physical issues, you deserve to get the quickest, most accurate diagnosis and the most effective care. Let me know if you need help, or if you have questions.
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