A Functional Paradigm for the Treatment of Spine-Related Disorders

While great credit goes to our nation’s traditional biomedical model for the advance of medicine and overall health of mankind, it has become evident that it has still not mastered the majority of musculoskeletal conditions. The statistics in recent years show that both disability and medical costs associated with spine-related disorders have skyrocketed.

Why is modern medicine failing in the diagnosis and treatment of these disorders? The problem lies in great part with its difficulty in describing changes in the anatomic structures causing the pain. In medical terms this is called the specific pathoanatomical diagnosis. For example, 85% of patients with low back pain are diagnosed with “non-specific,” or idiopathic, low back pain (LBP). The good news is that the majority of patients with these “non-specific” LBP conditions experience a favorable natural resolution within six to twelve weeks. But for patients who remain in pain, the frustration and anxiety affects them and their physicians. These frustrations are compounded by the often poor clinical outcomes and money spent on the overuse of musculoskeletal imaging (which can result in false-positive results with little clinical relevance), narcotic drug prescriptions, and surgery and other specialty referrals.

The Solution: Time. And Touch by a Musculoskeletal Specialist
The alternative approach used in chiropractic is finding the functional pathology of the human motor system and then making a functional diagnosis (1). These techniques identify the specificity of spine-related disorders, which conventional medicine is too often unable to do. If and when our healthcare system adopts these techniques to understand musculoskeletal pathology through a functional lens, we will see a decrease in spine-related disabilities and their medical costs.

Sarah Potthoff, DC
I gaze out through my own functional lens at every patient who walks into my office and recall what Vladimir Janda, the father of modern rehabilitation, taught us: “Time spent in assessment will save time and treatment.” As a result, I take time to observe a patient’s movement patterns and associate them with a kinetic chain to isolate the pain-producing tissues and biomechanical overloads so I can provide my patient with an individualized treatment plan.

I am also a firm believer in the guidance of neurologist Karel Lewitt, who said, “The hands are and always will be the most diagnostic and therapeutic tool ever invented.” My touch acts to guide my functional diagnosis in my assessment, and my hands are my tools in the treatment. Tailoring every treatment this way also engages the patient to be more and more active in the role of restoration of function and health.


Worsening Trends in the Management and Treatment of Back Pain
JAMA Internal Medicine, Sept 2013

Regional Interdependence: A Musculoskeletal Examination Model Whose Time Has Come
Journal of Orthopaedic & Sports Physical Therapy, 2007

The Emperor Has New Clothes


(1) Functional pathology and diagnosis are concepts developed by Vladimir Janda, PhD and Stuart McGill, PhD.


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