While hundreds of thousands of people are getting pain-related surgeries every year, most should never happen. Here’s the typical scenario: A person has pain near or around a joint. He/she takes the usual path to a medical practitioner, who orders an x-ray or MRI that finds a structural variation like a meniscal tear, a labral (cartilage) tear, arthritis or—the most feared phrase for a peripheral joint—“bone on bone.”
If this has happened to you or a loved one, you know what comes next. You are shown an image of a decreased joint space or some structural variation that your doctor identifies as the cause of your pain. What do you know about imaging tests? Craving relief, you are in no position to interpret the images, and are completely dependent on the practitioner’s presentation of the facts as being the facts.
For most medical practitioners, the diagnostic test is the Holy Grail for determining the cause of pain. So when a decreased joint space or an altered joint structure shows up on a diagnostic test, that becomes the diagnosis. Any discussion about where the pain exists, what causes the pain to increase or decrease or whether the pain is simply associated with performing a particular activity has no bearing on the diagnosis—yet every one of these indicators is critical to determining whether the cause of the pain is muscular-based or structural.
Diagnosis can be so much simpler.
The best physical test to indicate whether a structural variation is the cause of pain at a peripheral joint is looking at its range of motion. This simple test supersedes any other diagnostic test finding.
Let’s start with a brief understanding of what makes up a joint. A joint typically consists of two bones that meet one another. The ends of the bones make up the two surfaces of the joint. In most cases, a space is maintained between the two joint surfaces by a cartilage-based tissue such as a meniscus (in the knees) or labrum (in the hips and shoulders). The key is that a joint space is always present to allow the joint to go through it’s normal range of motion. The bones actually move one on the other—what we call “gliding.” The slightest bit of joint space is all that is necessary for the joint to function properly.
Here’s the problem with diagnostic tests: MRIs and x-rays can’t show very small amounts of joint space because they are not performed in a magnified manner. They are simply actual-size images interpreted by a person with the naked eye (and maybe a pair of eyeglasses).
My approach to assessment is much simpler and more effective. The body produces very clear physical symptoms if no joint space exists: a major loss of range of motion…and at the end of the range of motion, it feels like a bone is hitting another bone, stopping any further motion. If full range of motion exists—even when there’s pain—the integrity of the joint is still intact, and you can’t blame the pain on any structural abnormality.
The bottom line: Pain is nearly always an indication of a tissue in distress. If a joint can go through its full range of motion, then there’s no distress of the joint and pain can’t be coming from a structural element of that joint…no matter what shows up in any imaging tests.
You may just need knee exercises, not knee surgery, for example. I’ll write more about how you can ease your pain in future posts.