Thanks for this. It's such a challenge, keeping up a strong functional body as one gets older. I've researched what seems to be appropriate PT as I wait for both a doctor and PT appointment for what seems obvious to be a shoulder tear. Fortunately I am overall quite healthy. Glucose allways low. Last insulin was not as recent but was very low. I am finding your education on this subject very helpful. Thank you much.
My imaginary showed a full thickness tear in my supraspinatus 9 yrs ago and was told I needed surgery, I kept working out and went to physical therapy for 6 months and have had no trouble since. At the time it was very painful.
Great message. Degenerative Disc Disease on an MRI report is the worst example of this in my practice. Not only is it an authoritative sounding diagnosis but it is entirely nonspecific and does not even really pretend to know what the cause of someone's pain is, while still leading the person to believe they are broken beyond repair.
I appreciate you stressing the idea of the 'clinical puzzle'. Trying to solve the puzzle with only one piece leads to disaster. The most satisfaction I get as a therapist is when a clients history, presentation, physical assessment (and if relevant, imaging) converge to reveal the whole picture. Like a detective figuring out whodunit.
Interesting! As a foreigner living here I have often remarked to a friend who is an orthopedic surgeon that no Doctor I have seen palpates or uses musculoskeletal physical assessment and ROM to determine potential problems. I have a painful rotator cuff problem in addition to an L3/L4 problem and am due surgery on both. In my case the MRIs established the condition correctly. However the initial spine Dr completely ignored the very obvious sacroiliac and piriformis pain which can easily be established by using the established manipulation test. My question to my Dr friend was why are these established tests not used and why is the no hands on approach so prevalent.
I have had two MRIs over two years and a X-ray on my knee, meniscus tear further wear on my cartilage. Thus had a Durolane 3ml injection, further injections in the future plus an arthroscopic clean up mentioned. I will see how my knee feels in 2-4weeks. Plan to see my GP for his opinion if/when necessary. I suspect a knee replacement in the future and prefer done younger (58) than older.
Working in a supermarket it's interesting how many older people come in with knee replacements; arthritis & sports related. I wonder if too much & too little exercise plus the too much inflammation (diet, alcohol, stress, poor sleep) effect the biology physiology of the body.
This resonates strongly from the work-injury side of medicine.
In occupational cases, the MRI finding often becomes the organizing principle of the entire claim. Once a structural label is attached — “tear,” “degeneration,” “disc bulge” — it can subtly shift expectations about recovery, work capacity, and even identity. I’ve seen patients whose functional decline tracked more closely with fear of structural damage than with objective exam findings.
What makes this particularly challenging is that work status decisions, disability duration, and sometimes litigation begin to orbit around those imaging words. The MRI stops being a diagnostic adjunct and becomes a narrative anchor.
The hardest clinical work is often reframing: helping patients understand prevalence data, restoring confidence in movement, and redirecting attention toward functional progression rather than structural perfection.
Appreciate you continuing to emphasize context over image.
Thanks for this. It's such a challenge, keeping up a strong functional body as one gets older. I've researched what seems to be appropriate PT as I wait for both a doctor and PT appointment for what seems obvious to be a shoulder tear. Fortunately I am overall quite healthy. Glucose allways low. Last insulin was not as recent but was very low. I am finding your education on this subject very helpful. Thank you much.
My imaginary showed a full thickness tear in my supraspinatus 9 yrs ago and was told I needed surgery, I kept working out and went to physical therapy for 6 months and have had no trouble since. At the time it was very painful.
Great message. Degenerative Disc Disease on an MRI report is the worst example of this in my practice. Not only is it an authoritative sounding diagnosis but it is entirely nonspecific and does not even really pretend to know what the cause of someone's pain is, while still leading the person to believe they are broken beyond repair.
I appreciate you stressing the idea of the 'clinical puzzle'. Trying to solve the puzzle with only one piece leads to disaster. The most satisfaction I get as a therapist is when a clients history, presentation, physical assessment (and if relevant, imaging) converge to reveal the whole picture. Like a detective figuring out whodunit.
Interesting! As a foreigner living here I have often remarked to a friend who is an orthopedic surgeon that no Doctor I have seen palpates or uses musculoskeletal physical assessment and ROM to determine potential problems. I have a painful rotator cuff problem in addition to an L3/L4 problem and am due surgery on both. In my case the MRIs established the condition correctly. However the initial spine Dr completely ignored the very obvious sacroiliac and piriformis pain which can easily be established by using the established manipulation test. My question to my Dr friend was why are these established tests not used and why is the no hands on approach so prevalent.
I have had two MRIs over two years and a X-ray on my knee, meniscus tear further wear on my cartilage. Thus had a Durolane 3ml injection, further injections in the future plus an arthroscopic clean up mentioned. I will see how my knee feels in 2-4weeks. Plan to see my GP for his opinion if/when necessary. I suspect a knee replacement in the future and prefer done younger (58) than older.
Working in a supermarket it's interesting how many older people come in with knee replacements; arthritis & sports related. I wonder if too much & too little exercise plus the too much inflammation (diet, alcohol, stress, poor sleep) effect the biology physiology of the body.
Thankyou.
Dr. Luks, this is an important and timely piece.
This resonates strongly from the work-injury side of medicine.
In occupational cases, the MRI finding often becomes the organizing principle of the entire claim. Once a structural label is attached — “tear,” “degeneration,” “disc bulge” — it can subtly shift expectations about recovery, work capacity, and even identity. I’ve seen patients whose functional decline tracked more closely with fear of structural damage than with objective exam findings.
What makes this particularly challenging is that work status decisions, disability duration, and sometimes litigation begin to orbit around those imaging words. The MRI stops being a diagnostic adjunct and becomes a narrative anchor.
The hardest clinical work is often reframing: helping patients understand prevalence data, restoring confidence in movement, and redirecting attention toward functional progression rather than structural perfection.
Appreciate you continuing to emphasize context over image.