By definition, diagnosis is “a determining or analysis of the cause or nature of a problem.”
Too often this definition becomes overlooked and a diagnosis ends up being a label applied loosely to a painful location. Foot pain becomes “plantar fascitis.” Pain on the outside of the knee becomes “iliotibial band syndrome.” Pain in the shoulder becomes “rotator cuff tendonitis.” These labels do not analyze or determine the cause of the problem. This tragic omission leaves people with stubborn, chronic injuries that recur, shift locations, or simply don’t resolve.
Rather than a location-based label, a diagnosis should be more of a story. Allow us to take you through the various chapters.
Chapter One – Pain Generator
When injured, pain is a common symptom. The actual structure (muscle, tendon, ligament, nerve, fascia, joint, bone) that hurts is considered your Pain Generator. A very important concept to remember: The Pain Generator may not be causing the problem. For example, Muscle One becomes painful when it compensates for Muscle Two, a weak neighboring muscle. Muscle One is the Pain Generator but is only painful because of Muscle Two’s weakness. Muscle Two is the real problem here.
Chapter Two – Contributing Factors
After determining the Pain Generator, Contributing Factors must be addressed. A Contributing Factor is something going on in the body that leads to dysfunction. For example, weakness, instability, and muscle imbalance in the body contribute to overload. These are Contributing Factors that we have some control over. Genetic make up and anatomy are Contributing Factors that we don’t have control over. Often, in an injury process, several Contributing Factors play a role.
Chapter Three – Perpetuating Factors
Perpetuating Factors are the environments your body experiences throughout the day. Identifying Perpetuating Factors is necessary for long-term success of your recovery. For example, you have neck pain and headaches during the week. The Pain Generator is a specific muscle group in your neck. The Contributing Factor is weakness of the neck stabilizing muscles. Stopping the diagnosis here would leave you with a recurring problem. When evaluating your workstation, we determine your computer monitor is too far to the right. You sit for hours at a time with your neck rotated to the right. The ergonomics of your workstation is a Perpetuating Factor that if left uncorrected, will lead you right back down the pain and headache path.
Chapter Four – Layers
Injuries usually aren’t simple and clear cut. Layers develop. As you have already seen, the Pain Generator often isn’t the only problem. Contributing Factors and Perpetuating Factors make sure of that. In fact, an injury can be developing – building Layers – long before pain is experienced. It usually begins with a Contributing Factor or Perpetuating Factor. When one structure begins to weaken or become less efficient, another structure simply picks up the slack. Eventually, though, the second structure begins to become overloaded. The work is then shifted to another structure and another. These are Layers. Finally, there are no other structures to shift the load to and pain ensues. Uncovering all of the Layers is critical when reaching a complete diagnosis. Importantly, the diagnosis is an evolving and ongoing process. It is only complete when all the layers have been identified.
Let’s revisit the definition of diagnosis: a determining or analysis of the cause or nature of a problem. By going through the steps of finding the Pain Generator, identifying Contributing and Perpetuating Factors, and then piecing the Layers together, you have yourself a complete and accurate diagnosis.