When to get a diagnosis

[Jason Donaldson]

I have noticed over time that questions here about injuries, pains, etc. sometimes result in the advice "you need a diagnosis", but are sometimes met with "you do not need a diagnosis". I am not questioning the advice; rather, I am wondering whether one can determine this prior to asking.

Does it vary by type of presentation? Is the determination available to a lifter striving for self-sufficiency? Are there principles involved that are accessible to the individual lifter, or is it a matter of experience and acquired wisdom?

Is this perhaps a complex enough matter that it warrants a podcast episode?

Thanks.

[Strategerie]

I have noticed over time that questions here about injuries, pains, etc. sometimes result in the advice "you need a diagnosis", but are sometimes met with "you do not need a diagnosis". I am not questioning the advice; rather, I am wondering whether one can determine this prior to asking.

Does it vary by type of presentation? Is the determination available to a lifter striving for self-sufficiency? Are there principles involved that are accessible to the individual lifter, or is it a matter of experience and acquired wisdom?

Is this perhaps a complex enough matter that it warrants a podcast episode?

Thanks.

The majority of situations seem to be split into whether you can train effectively through the issue (probably doesn't require a diagnosis) or not. There are exceptions to this, of course, like if there's a chance we could be dealing with cancer. In those cases, I don't think anyone here would recommend against a medical workup with some sort of diagnostic imaging. This place isn't a hivemind though, so you'll still get conflicting ideas with anything that relies on adequate presentation details.

Keeping in mind that most things will heal given enough time, my threshold for seeking advice is lower when time and training has not solved an issue. Would also love to hear about this on a podcast though!

[Griffin727]

My 2 cents is this. If you are say injuried with knee pain. This could be from simple inflammation, from moving wrong to a torn acl. No matter the cause, I feel one needs to take a acute break for 48 hours to a week. After this one needs to start a linear process of rehab. These movments are the same as the LP (squat, press, pull). These must be done in a fashion that doesn't impead the healing process, but yet forces the area to heal. If this cannot produce some form of progess in around 12 weeks, a professional input with diognisc tools such as a mri is needed. Surgery is used to put you in a position to heal, not just fix you. If only it was that simple. No matter what a LP is necessary for rehab and strength. That's what makes the novice program so brilliant. It is simple and the most effective way to rehab and get stronger. Maybe the PT profession will use this information and stop the process of milking insurance, but I don't see this happening due to moral and ethical matters. As for principles needed to apply this, honestly its an experance and a intelligence issue. People who never took there squat from 135 to 405 and bench press from 95 to 300 will not understand the process of how the 4 major tissues excluding parts of the nervous system can adapt and grow.

[TommyGun]

I have noticed over time that questions here about injuries, pains, etc. sometimes result in the advice "you need a diagnosis", but are sometimes met with "you do not need a diagnosis". I am not questioning the advice; rather, I am wondering whether one can determine this prior to asking.

Does it vary by type of presentation? Is the determination available to a lifter striving for self-sufficiency? Are there principles involved that are accessible to the individual lifter, or is it a matter of experience and acquired wisdom?

Is this perhaps a complex enough matter that it warrants a podcast episode?

Thanks.

One of the best responses I have heard from Rip to a question along these lines is
(and trust me, I am neither implying he would say it in this instance nor am I putting words in his mouth)
is: if the injury is interfering with your sleep get it looked at. Clearly this is not applicable to all situations but
I like the overall guiding principle assuming the lifts can be completed. And yes, a good topic for a podcast episode.

[Will Morris]

One of the best responses I have heard from Rip to a question along these lines is
(and trust me, I am neither implying he would say it in this instance nor am I putting words in his mouth)
is: if the injury is interfering with your sleep get it looked at. Clearly this is not applicable to all situations but
I like the overall guiding principle assuming the lifts can be completed. And yes, a good topic for a podcast episode.

The thread title is an interesting question. My thought on it is that a "diagnosis" by itself, offers you, oftentimes, nothing of utility. The diagnosis is simply a term that is being used to describe the impairments you have or the clinical presentation. Then, you have the confounding variable that more often than not, the "diagnosis" itself is unmistakably wrong. You don't know how many times I have had a patient referred to me with a diagnosis of "trapezius strain" and the person actually has very strong signs of a cervical radiculopathy.

Instead of a "diagnosis", I would submit that the question that should be asked is, "When should I get a professional assessment?" If you agree that the terminology rarely impacts the situation, then the old adage in emergency medicine rings true here: you don't need to make the right diagnosis, you need to make the right decision. But, then, we have to take into account that physicians oftentimes don't know the right decision to make when it comes to management of musculoskeletal injuries. You can't fault them for that, since the overwhelming majority of their bandwidth needs to be taken up with being able to recognize signs and symptoms of serious disease. Their adherence to validated management strategies for low grade ankle sprains is really not important. It is frighteningly common for a relatively low grade musculoskeletal injury that presents to a family medicine provider to be met with an immediate referral to physical therapy, not because the physician REALLY thinks physical therapy is the right treatment for you, but rather because they don't have the time to deal with it. If you come back after the referral to therapy runs out, they might be modestly more interested into looking into it more.

All that to say, this isn't an easy question to answer. The most truthful answer one can give is this: if you feel concerned about your own health or safety and you wish to get a medical assessment, please do. This isn't to say that you are likely to be overwhelmed by the quality of care that you get, in fact, most patients are drastically disappointed as to the quality of care they get for musculoskeletal conditions, unless the provider orders advanced imaging and makes referrals. But, then you have the imaging facilities mucked up with a bunch of inappropriate imaging orders and referrals to orthopaedics and sports medicine docs that have nothing really of substance to offer a lot of these referrals. The patient was initially happy to be sent to a specialist, but then they are unhappy at the specialist because the specialist isn't going to operate on their grade I ankle sprain from four months ago.