Diseasification Dilemma: Medical Massage Therapists Can Be Part of the Solution, pt. 1 of 3

written by Robert Truax, DO

What is disease?

The Merriam-Webster Dictionary defines disease as: 

“a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”

The Cambridge Dictionary defines disease as:

“a condition of a person, animal, or plant in which its body or structure is harmed because an organ or part is unable to work as it usually does caused by infection or a failure of health rather than by an accident.”

The medical community says diseases are symptoms with typical signs.

Someone presents with a complaint and if there is something clearly abnormal on the physical exam, under the microscope, on the x-ray, or in a blood test, then we have a disease.

Over the past hundred years, this definition has allowed scientists to

• notice abnormal findings,
• name them, and
• attempt to find treatments for each disease.

At times, a person has clear symptoms revealing the presence of a clear and concise disease and then a clear and defined treatment is prescribed, but it doesn't always happen so neatly.

It's most difficult when all available tests are normal but the patient doesn't feel normal and they want something done.

The temptation to be relevant, helpful, or not waste a patient's time is strong.

This is when the diseasification dilemma can surface.

One common example of diseasification is . .

• patient has a typical cold and they want something for it.
• The doctor prescribes antibiotics.

DILEMMA: Antibiotics are a bacteria-fighting medication. Prescribing them for a viral infection wrongly diseasifies a cold.

This diseasification is serious because it exasperates the rising antibiotic resistance.

Another example . . .

Medical conditions that are due to lifestyle choices, not disease.

DILEMMA: Diseasifying their situation might actually delay help because the person might rely on the healthcare team to treat their disease, rather than make personal decisions that may resolve the problem. 

 

Disease as Something to Change

An alternative understanding of the term disease is that it's not simply symptoms with signs, but a physical condition that requires something to change. Maybe the person needs surgery, medication, or physical therapy. 

If the ailment is worthy of being called a disease, then naming it should initiate something new for the patient.

If nothing is named or initiated, is it really a disease?

Of course, this definition has serious limitations because it excludes complicated health conditions with no known cure.

In the musculoskeletal (MSK) medical field, however, this understanding of disease can help guard against diseasification.

Sometimes a physician will name a disease but then say “there is nothing to be done.”

Or, they don't find an actual disease but will encourage changes in behavior such as “don’t exercise so hard”, implying there's a disease exasperated by exercise.

The patient leaves the clinic confused, often with the same symptoms as when they entered, yet still has no clear guidance as to how to move forward.

 

Case Study of Chronic Back Pain

A 38-year-old male came to my clinic with chronic back pain after seeing two spine physicians before me. 

The first diagnosed him with arthritis of the lumbars; the second added arthritis of the thoracic spine. 

He left both offices in the same pain with limited function, two diagnoses, and no hope or guidance.

He was on his 18th-year in the National Guard so he was not happy. His spine had been diseasified by both surgeons.

Consider: if he truly had a diseased spine, then you may expect the physicians to take definitive action and attempt to make changes to his spine. They didn't.

This means they really didn't know what to do with his symptoms and the limited, but real, changes on the MRI. So, they just told him to “do core and you don't need surgery.”

He was too active to be truly disabled but he was unable to do even a single full-body squat due to his back pain.

Rather than continue the diseasification, I searched for what was not healthy in his spine. I noted a very tight iliopsoas muscle and quadratus muscle as well as a few other imbalances.

Using Osteopathic Manipulation, I was able to improve his muscle and joint balance. 

Immediately, after this one treatment, he was able to do 5 full-body squats. 

He still had degenerative changes in his thoracic and lumbar spine but those were not the cause of his pain. Those were age- and genetic-related changes that may or may not have any relation to his past activities, current condition or future functionality.

I wasn't going to diseasify him further. Two weeks later, he followed up and was still improving. 

 

Somatic Dysfunctions Versus Disease

As a professor of Osteopathic Manipulation, I teach students and residents to look for somatic dysfunctions of the MSK system.

These are changes that occur in the neuromusculoskeletal system to adapt to changes in our health or disease process.

Dysfunction is the middle ground between health and disease. It's identified by careful palpation and appreciation of the changes under your fingers.

Dysfunction isn't a disease. But, too many dysfunctions could either

• present as though they were a disease OR
• accompany disease and make the disease presentation worse.  

Massage therapists can identify, diagnose, and treat dysfunctions of soft tissue; they do not identify, diagnose, and treat diseases (for more on this, see this Touchpoint.)

Much of what I do as an Osteopathic physician to treat dysfunctions is within the scope of a massage therapist.

My desire is that massage therapists learn to maximize their scope so more people can benefit from this non-invasive, low-risk intervention that has the potential to give clients relief from common dysfunctions that both physicians and patients mistake for disease. 

There is demand.

We want you to meet it.

 

Touchpoints

• Temptation to feel relevant, be helpful, not waste a patient's time can lead even physicians to diseasify their patient.
• Massage therapists work in the dysfunction zone.
• Guard against diseasifying your client.
• Massage therapists can identify, diagnose, and treat dysfunctions of soft tissue; they do not identify, diagnose, and treat diseases (for more on this, see this Touchpoint.)
• Much of what I do as an Osteopathic physician to treat dysfunctions is within the scope of a massage therapist.
• There is high demand for medical professionals who choose not to diseasify patients; but instead, bring balance to the musculoskeletal system when possible. This could either resolve what was misconstrued as a disease or make the disease more tolerable.
• I teach you how to do this in our Courses: Assessments, Breath, Positional Release and Muscle Energy.