Whenever Someone Says "I Feel It," I Immediately Ask "Where?"

​The speed with which I say that is noteworthy considering years ago that question wasn’t high on my list. When you effectively probe patients about their symptoms (most notably via a good verbal history), you’ll notice it’s actually not that common for people to have a symptom in only one isolated spot. A man might come see you because the front of his right knee hurts, but with questioning you find it’s also sometimes on the left knee and his back gets tight sometimes. Or a woman has left neck pain but when you do movement testing she notices right neck pain too. Or a kid says the outside of his elbow hurts but, yes, the inside of his elbow is tingly.

Where the symptom is is extremely important - regarding someone’s history, during the physical exam, and during repeated movements. The pain someone is describing could be in a completely different area (for example, wrists hurting with prone lumbar extension) or it could be relevant. Where the pain is matters in terms of both diagnosis and treatment; if I didn’t have that information I’d be lost. Most importantly, it tells me information about which structure is misbehaving (significantly, joint vs musculotendinous tissue), which movements are likely to be beneficial, and how to interpret the effect of movements. -- Laura