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According to Chou et al. in Annals of Internal Medicine 2007; “providers should not consider X-rays, MRIs, or CT’s unless there is nerve damage or other red flags.  We should focus on the results of our history and examination to guide us through treatment and less on structural abnormalities.”

It is important to understand the implications of structural abnormalities to guide our treatment; these findings should not dictate treatment.  Treatment should encompass an orthopedic diagnosis, a functional diagnosis, and/or activities or ADL’s that relate to the patients chief complaint.  I always remind myself that I’m a problem solver.  I guide my treatments to meet my patient’s goals.  They don’t usually care what shoulder anterior impingement or upper crossed syndrome is, but they do want to get a plate out of the top cabinet in their kitchen.  We need teach our patients how to meet their goals without focusing too much on their structural abnormality.

Chou, R et al., Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine 2007; 147:478-491

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