silly question .. I'm sure but from your training, you can literally Feel perhaps if there is inflammation between 2 discs in the lumbo sacral region?
Often lower back pain is hard to diagnose or so I've been told , but you are saying that often you can simply with your hands be able to specifically feel the area where there is inflammation .....
Are you mostly relying on the patients response to your questioning or can you often identify a compressed nerve, a herniated disc or some other malady simply with your hands?
I've obviously had no training in such things so there's no way I would be able to know whether this would be something that is simple to identify with touch or if there are certain tell tale signs to the problem.
I dont think youre feeling the actual inflammation between the disks, but the inflammation of the surrounding tissues.
LBP is not as difficult a diagnosis as some practitioners make it sound. Its just that most practitioners dont have the thorough musculoskeletal training to differentiate the different causes, some of which I mentioned above.
A herniated disk vs. a strained muscle vs. a ligamentous injury all have very specific patterns. The pain perception is different, the location of pain is different, the mechanism of injury is often different. You need to hunt for these small clues that will reveal what is causing the pain in this patient.
Good imaging...a closed supine MRI...can be very helpful in diagnosis as well, so can 3-view standing X-rays. But you need to be specific in what you want the radiologist to comment on. Often they just give you the standard read of a film. I always ask them to comment on pars defects and the laminal structures as well. Something they are more than capable of doing but something that not everyone ordering lumbosacral xrays would necessarily care about. Not so to a DO.
Another thing about LBP is that every type of injury or cause of pain has very specific characteristics. One of the ways this becomes apparent is when a patient comes to your office saying they have pain and can no longer work, but their description of pain, freedoms of movement and "Acted" restrictions of movement arent consistent with the injury they are describing and arent even consistent with eachother. These cases get tricky when imaging studies are inconclusive.
But if a patient comes in describing a neuropathic pain in certain areas of the back and shooting down the leg I can pick it apart.
1. I know where the nerves are and where they send their pain information into the lower extremity
2. I know what movements should make the pain worse
3. I know what movements should alleviate the pain
4. I know that if this injury does indeed exist there will be palpable changes in the tissues overlying that vertebral disk/segment
5. I know the reflexes associated with this pain
6. I know what positions I place the patient in will decompress or alleviate restriction
7. I know where to push to exacerbate the pain
8. I know the questions to ask that only a patient with a true complaint will answer correctly
On more than one occasion I have seen a patient with a complaint of pain whose story doesnt make sense. They are describing pain that accompanies a herniated or bulging disk...but the pain pattern down the extremity is from a verterbal segment 2-3 away from where they say the pain starts. Then the reflexes are normal when they shouldnt be. The patient walks into the office in one position that they say is "the only way I can walk without pain", but I know this particular position will cause increased pressure on the intervertebral space at that level and should be causing MORE pain. On top of all that, the mechanism they describe for injury...often falling at work...doesnt fit the injury pattern.
So finding the true cause of the pain is an absolute must. You owe it to the patient, the patients employer and really to the taxpayers...sad to have to say that, but its true.
If you never find the true cause of the pain how can you effectively treat it?
What do *most* physicians, MD and DO do with a patient with low back pain? 3 weeks of PT. Shotgun the problem. "Evaluate and treat" on an Rx to the therapist...see you for a follow up. Malpractice IMO.
Even if you dont do OMM (for whatever cop-out excuse reason) you should AT LEAST remember your osteopathic physical exam skills and be able to determine the exact structure...bone, disk, soft tissue...that is the cause of the this patients pain. Your treatments and treatment plan will be more effective...more cost effective as well. You will help more people. You will get people back to work quicker...the majority of patients want to be pain free and get back to work. You will be able to do the right thing when it comes to patients looking to cheat the system. You will instill confidence in your patients that you know what to do...you didnt just do the same thing as so many other doctors.
The reason that many OMM specialists (or even DOs who are confident and good at OMM) get the "last resort" patients is not because OMT is magic. Its not because DOs are 'nicer' or that we take more time with our patients.
Its because we have the training to investigate musculoskeletal injury and pain to the very precise cause. We have the training to take all these pieces of information and get to the very root of the problem, and more often than not we have some form of OMT that can treat that problem.
Whether or not that DO has remembered the training and has the ability to treat it an entirely separate issue.
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SO what I have described above is just some of the things that you will learn in DO school. Certainly the field of OMM covers much more as far as different body areas, other types of problems and numerous treatments...all the while being incorporated into the full medical curriculum taught at 125+ allopathic schools.
So tell me again why 'DO' is considered a backup?
Sound like it should be the norm...patients should be demanding the most comprehensive care available.
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