​Diagnosing a problem is always the most important step. Then you match the treatment to the diagnosis. When we diagnose orthopedic disorders we can think of 3 main categories: mechanical (or functional) problems, structural problems, and inflammatory problems. A huge problem I see in medicine is problems being diagnosed as structural or inflammatory when in fact they’re mechanical.
What do I mean by mechanical? Problems that are affected by movement, usually fixed with movement, and, significantly, not structural or inflammatory. My skill set is in treating these problems, which are >90% of problems. (My skill set is also in diagnosing which problem you have to begin with. If it’s structural or inflammatory, I refer you to a clinician who treats those.)

A structural problem is like a fracture, tear, stenosis, or dislocation. They cannot be fixed with movement; they need a separate treatment approach. I’ll say this again: very often people’s tears, etc. are diagnosed as structural and recommended a structural-problem solution like surgery when in fact the tear is not structurally unsound. Instead, the tear is causing or is related to a mechanical problem, which can be fixed with movement. People move and function just fine with “structural” problems “diagnosed” by imaging all the time!

Inflammation won’t be fixed with movement. In the acute stage inflammation can often be fixed with rest/time. In a sub-acute or chronic phase, other anti-inflammatory treatments may be necessitated.

Some may argue that central sensitization is its own category, which I'm fine with. But a central processing problem such as that may be better classified as a neurological versus an orthopedic disorder. There’s room for debate.

When I assess patients I’m asking: is this mechanical, structural, inflammatory, or other? By asking the right questions, listening, and expertly moving patients (when safe), we can figure it out. If someone has a structural or inflammatory problem, they won’t get better with movement. But they are the outliers, and you have to use repeated movement testing (when safe) to discern if someone’s tear, for instance, is truly a structural problem or a more easily fixable mechanical one. -- Laura

If there is continuous assault on your body, there can be a continuous inflammatory response. Think of something piercing your skin. As long as it’s there, it’s likely your body will continue to fight it with inflammation. Or if you’re constantly exposed to a personal allergen (environmental, food, etc.), that can also happen.

The same premise applies to what can be called mechanical problems (most orthopedic problems). When a joint is not moving well, it can produce inflammation as a primary response, or there can be inflammation secondarily. Same goes if a nerve is not moving well. I don’t typically see tight or injured muscles directly causing long-standing inflammation, but they could secondarily.

The crux of the matter is: you can treat the inflammation or you can treat the source. Sometimes you’ll want to do both, but unless there’s a strong argument to do so, I prefer focusing time and energy on the cause. It can take work sometimes to find the source considering all the facets of the human body, but there is a reason someone has never-ending inflammation - and it’s usually fixable. When it comes to the musculoskeletal system, it’s usually joints not moving well, which we address with specific movement. -- Laura

Inflammation is rarely the main cause of complaints. And before any symptoms are addressed with pharmaceutical anti-inflammatories or injections, a quality clinical exam must be performed. Typically a mechanical problem will be found - which is treated with targeted movement. While inflammation may indeed be present, it almost always resolves once the real mechanical cause is resolved. Inflammation is usually therefore a symptom (not a cause).

If a patient does not respond to mechanical care, chemical (anti-inflammatory) care may be indicated. I have suggested anti-inflammatory measures in just 4-5 patients in the past couple years. So if your knee keeps swelling, for example, the question is why. A joint disturbance (derangement) can easily cause consistent inflammation. So can any number of problems.

​I clearly remember one patient years ago who had years of knee pain with episodes of swelling that got so bad she had it drained many times. An avid runner, she was sidelined. The issue was coming from her low back and after 5 visits of different movements, her knee was good to go. Once her muscles had their electricity restored in the spine they could control to the knee so it didn’t reactively hurt and swell. -- Laura