Welcome to Touchpoints Blog

written by Robert Truax, DO

"In the musculoskeletal health field, knowing a specific diagnosis doesn't mean there's a definitive specific treatment; and not having a specific diagnosis doesn't mean there's no effective treatment."

One of the main roles of the medical system is to diagnose and treat disease.

To accomplish this, physicians learn to develop a differential diagnosis (Ddx). 

A differential diagnosis is a process of considering all the reasonable causes for a patient’s condition; then systematically honing in on the main disease.

It's a 5-step process.

Differential Diagnostic Steps

1. Notice what I see, hear, and smell on arrival.

   A patient limping into the ER is probably different than a patient who arrives by ambulance with a brace on their leg, lying on a backboard.

2. Listen to the patient’s story.

   As they're speaking, I start considering some conditions to be less likely and others more likely. It's during this time that I decide where the...

written by Robert Truax, DO

“Sam, I'm referring a patient to you with Thoracic Outlet Syndrome (TOS) for myofascial release.”

As I sat down at the community desk, Sam reached for her medical massage pathophysiology textbook to read up on TOS.

When I glanced back at her, she looked scared.

She read aloud that "TOS was a condition that involves either an obstructed subclavian vein often causing a blood clot or a compressed nerve, both treated through surgery."

She looked back at me like . . . "you want me to massage someone with this?"

Ah . . . fear of the surgical condition.

While surgical TOS fits that definition, 98% of TOS isn't that severe and is amenable to massage therapy.

It's typically a combination of tight:

• scalenes,
• upper trapezius,
• sternocleidomastoid, and
• pectoralis minor

that wrap (a bit more tightly than it should) around the brachial plexus, causing non-specific nerve symptoms (numbness, tingling) and neck-shoulder discomfort.

This type of TOS...

written by Robert Truax, DO

I dislike the term overuse.

Merriam-Webster dictionary defines exercise . . .

Noun: regular or repeated use of a faculty or organ

Verb: to use repeatedly in order to strengthen or develop

From an exercise physiological perspective, exercise is only exercise if the body is engaged in some form of exertion and the exertion is repeated so as to improve overall performance.

So, exercise is the use of muscles over and over again.

The most common diagnosis of a musculoskeletal (MSK) problem is overuse injury . . . and injury is disease.

To put this in a syllogism . . .

Exercise is use, over and over again to exertion. In other words, overuse.

Overuse is a disease.

Therefore, exercise is a disease.

Do you see the problem?

There's no objective criteria for an overuse injury.

A non-traumatic shoulder pain or hip pain is often diagnosed as an overuse injury. Yet, the term overuse is so non-specific that you don’t know what it actually is.

This makes it ripe...

written by Robert Truax, DO

What is disease burden?

If you had a disease(s), you'd endure the challenges directly impacting your body which could be mild to substantial. That's not all you'd endure. You'd also manage:

• the side effects of the treatment,
• the logistics of ensuring you consistently get the treatment,
• the burden that others have to take on in order to get you to treatment,
• the expense of the treatment,
• the loss of income caused by needing to take time to get the treatment.

Your health is impacted by more than the sum of the disease symptoms. 

One of the main tasks of the physician is to reduce the burden of the disease.

• When you have cancer, tumors are usually removed to reduce the tumor burden so that chemotherapy and radiation don't have as much cancer to fight. 

• An orthopedic surgeon will drain an abscess in an infected bone prior to starting antibiotics so there's less bacterial burden for the antibiotics to fight.

• In diabetes,...

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...

written by Robert Truax, DO

Client: “So, what's wrong with me?”

You want to answer but you have “massage therapists shouldn’t diagnose!” running through your mind and you hesitate.

When I, as a physician, am casually talking to a massage therapist about how they handled an issue with a client, sooner or later, they feel compelled to add the pesky clarification, “but I didn't diagnose.” 

This is apparently hammered into you as students, haunting you throughout your career either through instructors reminding you, or fellow massage therapists wagging their finger at you. 

Let’s get real . . . 

You Diagnose All the Time

The truth is . . . you diagnose all the time.

In school, your instructors taught you to notice tissue texture differences, recognize a tight muscle, and then relax the muscle.

Basically, you diagnosed and treated.

Then, they tell you not to diagnose.

This mixed messaging can hinder you from...