What Does A Bashed-in Car Door Panel & An MRI Have In Common?
By Mitchell Yass, DPT
On first inspection, this would seem to be a very strange question. But the similarities in diagnosing the cause of car troubles are not very different from diagnosing the cause of symptoms in the human body.
The mechanic attempts to look at the symptoms of the car that lead to him figuring out what component is creating the symptom and limiting the normal function of the car. The same should hold true for the physician trying to figure out what tissue is creating the symptom preventing normal function of the body. But that is not the case in most instances.
The medical establishment sees the MRI as the gold standard for identifying the cause of pain. There is little to no attempt to perform a clinical evaluation to correlate tissues to symptoms. The problem with depending on the MRI is that it finds structural variations that have nothing to do with the cause of pain. Positive findings such as herniated discs, arthritis, stenosis, meniscal tears and rotator cuff tears become the diagnosis and treatment follows based on these positive findings. The American College of Physicians in February recommended that MRIs no longer be used to identify the cause of back pain because there is little to no correlation between back pain and positive findings such as herniated discs and stenosis, In fact, they determined that in 85% of cases of people coming to primary care for back pain, this was the case. The failure rate for back surgery based on positive MRI findings is now around 70%. Studies regarding surgery for fractured vertebrae and arthritis in the knee have all shown no difference whether the person got the real surgery or a mock surgery.
Patients are blind to the idea that these pictures they are being shown with herniated discs and bone on bone in a knee or hip joint are simply showing variations to the normal structure but that these variations are in most cases not creating the symptoms such as pain that they are experiencing. A person being presented with this information sees the picture or result and says it must be the cause of my pain because it exists. And because they have no medical background to determine whether the physician is correct or not, they must comply with the wishes of the physician and move down a path toward epidural nerve blocks, pain management or surgery. If the patient just had an understanding of how you can get a positive picture that showed a structural variation and it not be the cause of their symptoms, this would certainly explain why people don’t on the whole respond well to treatments for these variations.
Here is a metaphor that will explain why the MRI should be eliminated for determining the cause of pain and why clinical evaluations trying to link a cause to a symptom are the correct method for diagnosing and treating pain.
We look at a car and I bash in the driver’s side door panel and then I take the air out of all the tires. I get in the car, turn the car on, put it in drive and the car doesn’t move. We say to the orthopedist or neurologist what’s wrong with the car and they say, “The door panel is bashed in. You need a new door panel. It is obvious that the door panel is bashed in. Let’s take a picture of the car. You can see in the picture that the door panel is bashed in.” Now I would hope that the average lay person would come to the conclusion that the bashed in door panel is not stopping the car from moving when it is on and in gear. It is obviously the flat tires. To make this determination, you look at the symptoms in this circumstance. The car is on and the car is in drive but it doesn’t move. These symptoms can best be answered by the flat tires then the bashed in door panel even though the bashed in door panel does exist and is very obvious. How about if you get in the car and you turn the ignition and you get click, click, click. Is this an indication that the cause of this symptom is a bashed in door panel? I hope not. This symptom is more indicative of a bad spark plug or weak battery. How about if the symptom were you turn the key and the engine tries to start but doesn’t turn over. Again, probably not the bashed in door panel again. You are probably out of gas.
You see in every one of these cases, the bashed in door panel was present and could easily be identified but the symptoms were not indicative of the bashed in door panel as the cause of the symptoms. Therefore if you were to treat the bashed in door panel, in every one of these cases, the function of the car would not have been improved and the symptom would have continued. The bashed in car door is the herniated disc, arthritis, stenosis, meniscal tear, rotator cuff tear and every other structural variation found on an MRI. They exist and can be found whenever an MRI is taken but they have nothing to do with symptoms in most cases. What you have to appreciate is that the orthopedist and neurologist are educated and experienced in replacing door panels. If the cause of pain were due to a muscle, they can’t see that because they only see bashed in door panels.
The evidence continues to grow regarding this issue. If there is one reason for the meteoric rise in those suffering from chronic pain, I believe the use of the MRI to find a cause for pain is the primary cause. The answer is clearly to understand that every symptom is created by a specific cause and that every cause creates a specific symptom. My practice is based on identifying what tissue is creating the pain signal. Once the distress of the tissue creating the pain signal is resolved then there is no reason to evoke a pain signal and pain is eliminated. I have shown that in 90 to 95% of cases, the tissue creating the pain signal is muscle and only targeted strength training can resolve the distress of muscle.