What to Expect

 

We strive to make your experience in the office as comfortable as possible.  Below is a summary of what to expect:

Initial visit:

After signing in at the front desk you will fill out the necessary intake-form.  This form asks questions about your current problem, personal health history, surgeries, medications, and family health history.  Please bring any necessary medical records (MRI reports, X-ray reports, etc.) with you.  You will also want to bring comfortable clothing.  For example, shorts and/or a tank top.

History:

This is when you tell me in your own words the story of your injury/condition: what happened, when, under what conditions, treatment you have had, and your response to previous treatment.  I will also ask you specific or individualized questions to better understand how your problem happened.  This information is an important part of solving your problem.

Exam:

After the history is taken we now know where to start with the exam.  The musculoskeletal exam consists of functional tests/screens, orthopedic tests, neurological tests, soft-tissue assessment, and joint assessment.  I use these different data points to figure out what’s wrong.

Whenever possible, I will find a test (motion or position) that reproduces your symptoms.  Based on this test, I know what structure is being overloaded.  For example, if while watching you lunge I see you lean forward, a weakness in the hamstrings is suspected. If this also causes you knee pain, a link has been established between the weakness in your hamstrings and your knee pain.

Diagnosis:

All the different data points from the history and exam are evaluated and assessed like puzzle pieces.  The data points are put together in the right way in order to determine an accurate diagnosis.  This is an art and a science that requires objective, critical thinking and a great deal of experience with musculoskeletal problems.  What I come up with is a four-part diagnosis as follows:

  1. Determine exactly what structure is responsible for your pain. I need to know exactly what part of what tissue is irritated or damaged and in what way.  For example, there are many structures that can cause knee pain; the patellar tendon is one possibility.  If this were the case, I would also need to determine if the tendon is inflamed, degenerated, or both.
  2. Determine what has gone wrong to overload that structure.  Knowing your knee hurts is different from knowing why your knee hurts.  If your knee hurts your body is sending off pain signals for a good reason.  Something in your knee is getting overloaded and has been damaged.  It is critical I figure out where the overload is coming from.  Usually, there is scar tissue, weakness, or nerve entrapment altering movement and load patterns.   I look for these problems.
  3. Identify perpetuating factors.  I also need to address if there is anything else that is contributing to your pain.  Stress, posture, exercise, structural problems, diet, etc.  all should be identified as early as possible.
  4. Attach a common, recognizable name.  In the example above, patellar tendonitis is an appropriate generalization of your condition.  However, in reality, a specific and accurate diagnosis requires much more than the recognizable name.

Explanation

Once I’ve determined your diagnosis, I’ll explain it to you in a detailed manner you can understand.  It is really important to me and to your progress that you understand what’s wrong and how we can fix it.  Also, at this time I’ll let you know how many treatments I think it will take to solve your problem.  If you have any questions about your diagnosis or the proposed treatment please don’t hesitate to ask and I can answer them at this time.

Follow-up Visit

With each visit there is an ongoing diagnostic and treatment process.  I constantly monitor your situation and adjust treatment as necessary.  Follow-up visits take approximately 10-15 minutes.

Discharge

When your problem has been resolved, you will be discharged from care.  At that time we will review what the problem was and what you can do to minimize your chances of the problem recurring.

Maintenance

Not all problems have 100% resolution particularly if there is too much continued load (i.e. work demands) or underlying pathology.  If this is the case, maintenance treatment may be necessary.  Maintenance schedules vary widely from patient to patient.  I do everything I can to avoid this possibility.

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