Given how often I see patients whose non-spinal pain is related to their spine, I make sure to investigate the spine as a possible contributor or cause. As I’ve said before, that investigation varies in time based on the case.

If I read a study on patients diagnosed with “patellofemoral pain syndrome” or “shoulder impingement” and there is no mention of clinically looking into the effect spinal movements have on the person’s complaints, I take that study with a grain of salt. I use the word “clinically” on purpose: you cannot rule in or out spinal involvement solely with an image. At least 25% of people’s shoulder and knee pain I see is actually a spine problem, addressed with moving the spine.

I also say “probably” in this post on purpose. If an orthopedic study looks at people who have traumatically fractured their tibias, that is a different ball game. Most orthopedic problems, however, aren’t obvious traumas. -- Laura

1. How long has it been this way?
2. What brought this about and what brings it about?
3. Is it limited actively?
4. Is it limited passively?
5. Is there pain with active ROM?
6. If so, when? If so, where?
7. Is there pain with passive ROM?
8. If so, when? If so, where?
9. How does the end of the ROM feel?
10. Is it consistently like this, or does it vary?
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There are more concerns regarding the whole patient presentation and problem at hand, but these focus in on range of motion (the entire motion available to a joint). Presumably I’m only discussing ROM with a patient if it’s problematic. This may seem like a lot, but it really only takes a few minutes to get these verbal and physical answers. Knowing the questions to raise is step one, knowing how to physically test it (the easiest part) is step two, and knowing how to interpret the findings is step three.
--Laura

There are many things that can go wrong with a joint. What I call joint derangement is when the joint isn’t sitting quite right - which I find to be the most common joint problem. Derangements vary widely in severity and can rapidly change. There could be structural changes in a joint due to arthritis or tears in ligaments or menisci. These (and many other examples) are addressed in their specific ways.

​Joint capsule problems are less prevalent. The patients I’ve seen with capsular problems (manifested primarily as pain and tightness at the end range of a joint’s movement(s)) are mostly patients with frozen shoulder and patients who are older. There are distinct ways to address this problem as well. Capsular tissue problems tend to take considerably longer to fix than derangements. -- Laura

Yes, injured structures can be fragile, but your spine is not inherently fragile. It is no more fragile than your ear, knee, or foot. The spine is well designed, just like the rest of your body, to withstand considerable demand. And it is just as resilient as the rest of you to bounce back from injury.

Things go wrong. Things happen. We get ear infections. We twist our knee. We break our foot. We injure our spines too. And when things go wrong anywhere in our body, they are almost always fixable. Stop telling people spines are fragile. And stop listening to people who tell you they are.
​-- Laura

Joints behave differently loaded (weightbearing) versus unloaded (non weightbearing). This applies to extension, flexion, etc. - all planes of motion. Just picture your ankle: if you are moving your ankle while lying down, you are moving your foot as your leg is stationary. But if you are squatting in standing your leg is moving as your foot stays stable. These are quite different ankle joint movements, with different forces.
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I assess and treat patients using repeated movements. I am SPECIFIC with the exercise I investigate as well as with the one I prescribe a patient, which includes whether the movement is performed loaded or unloaded. Loaded knee flexion may have no effect for a patient, but unloaded knee flexion may prove beneficial. Loaded lumbar extension may make a patient’s symptoms worse, yet unloaded lumbar extension may work. Because I consider loaded and unloaded movements different, I have more movements available to me. While that may seem overwhelming, it’s not. There are patterns and clues in the history and mechanical exam that lead me (by implementing the method) to explore one movement compared to others. --Laura

Hamstring pain is posterior thigh pain. Quadriceps pain is anterior thigh pain. IT band pain is lateral thigh pain. Adductor pain is groin pain.

Of course it fits that people who aren’t clinicians would label pain using structures they know. And it’s obvious most people can name big muscle groups! My issue is when clinicians inappropriately do it.

If the patient uses this language, in an effort to create rapport, I may use it with interactions with that patient as well. Mimicing language can be a nice therapeutic tool that is easy to implement. (I typically will adopt the patient’s word for describing his or her own symptoms, for example; my favorite instance being my patient who referred to his radiating leg pain as his “lightning bolt.”) I’d prefer, however, to use the correct language if possible since accurate patient education regarding his or her problem is key to a successful outcome.

I do not use these terms to refer to these parts of the body outside of that specific patient context, though. Yes, if the patient has true hamstring, quad, ITB, or adductor pathology, these words are clearly apropos. But those patients (especially among non-athletes) are rare. In most cases a patient’s posterior, anterior, or lateral thigh pain or groin pain is referred pain from the spine or hip. --Laura