Where's the Pain
The Alley Mugger
One of the better stories describing the manual therapist’s approach to diagnosis was offered by Dr. Jason Brown (if it came from another source, my apologies). I’ll do my best to recall it below:
Walking home one evening, a man takes a shortcut through an alley. Unfortunately, he is assaulted by a wrongdoer. The villain flees the scene and the man calls for help. When the police arrive they take down all the information the man can recollect and start their search. The police will clear the area, look for clues, and make it safe. Then, they will proceed to hunt down the criminal.
In this story, the wrongdoer is what caused the problem. The man, bruised and battered, represents the symptoms. When the police show up they investigate, or take a thorough history, and start by cleaning the area up - that is, treating the symptoms. What the police do next defines the type of diagnosis and ultimately care the man receives. If they simply set-up a perimeter and monitor the area it’s like a doctor addressing only the area of complaint. That area may be safe again, but only for as long as the police (doctor) watch it. While important to ensuring the safety of other who might walk this path (reducing symptoms), it fails to address the cause of the ordeal. The police (doctor) will also send out a team to follow clues along a trail which will ultimately lead to the criminal’s hideout. Here, is where he takes refuge. From here is where he originates. Here, is the source of pain. This is the diagnosis and the correct treatment for the patient.
Whether this source is musculoskeletal, neurogenic, rooted in beliefs of pain systems, emotional, psychological, or something completely different, this is where a physician needs to focus treatment to maximize success.