Do We Need to Diagnose the Cause of Your Pain?

One of the key things that patients expect when visiting a physiotherapist is a diagnosis. But is a diagnosis necessary, and is it even helpful?

I came across this thought online recently. Until then I'd thought that of course you need to send a patient away after their first consultation with a diagnosis, or at least a plan for differentiating between potential diagnoses, such as a referral for imaging.

It's certainly true that the research encourages physiotherapists to in some instances be quite broad in their diagnoses, to represent the fact that for some conditions the precise anatomical source of pain can't be definitively determined, even with orthopaedic tests and imaging. As such, we provide very helpful diagnoses such as "lateral hip pain" and "non-specific low back pain".

There has also been a push to change what we call certain diagnoses in some cases, because the previous name makes it sound worse than it is, and may even contribute to making the pain worse and last longer! For example "whiplash" sounds scarier than "motor vehicle accident-related neck pain". "Flexion loading disorder" sounds like it's less manageable than "flexion loading pain".

Then there's a diagnosis that sounds scary because of the surname of the person that first described the condition. I'm looking at you Sever's disease!

While we're talking about tractional apophysitises, I could probably count on one hand the number of times patient have been able to recall correctly the diagnosis "Osgood-Schlatter's syndrome" or "Sinding Larsen Johansson syndrome" (yes I had to google to check the correct spelling of that one) one week later.

So is a diagnosis ever necessary?

Well, yes, there are plenty of times that a diagnosis is definitely necessary. It would be pretty poor practice to be treating knee pain without worrying about a diagnosis, when it turns out you've ruptured your ACL, for example.

But maybe a diagnosis isn't always necessary. Maybe there are certain situations where it would be better to discuss things that we find in our examination that we think are likely to be contributing to the pain, rather than picking a diagnosis. After all, it should be the examination findings that drive a physiotherapist's treatment rather than simply the diagnosis.

Whether or not diagnosis is helpful is likely to depend on the diagnosis, as well as psychosocial aspects of the patient (such as their mood, their past experiences etc). Recognising this is something I'll have to begin practicing and getting better at. But the idea of occasionally foregoing a diagnosis when it may actually be unhelpful to provide one is a new and interesting one that deserves to be explored further.