You Need the Right Diagnosis, not the Right Technique

To be honest, I’m tired of being asked over and over again what technique I practice. Before beginning treatment, patients often ask this, and I tend to respond back with the question: “What do you mean by a technique? I am a physical therapist and I do physical therapy.”

Then, after they have finished their session, patients repeat their question: “What kind of physical therapy do you do?”

I am often puzzled and ask again: “What do you mean by what kind of physical therapy? Physical therapy is physical therapy.”

They don’t understand so keep asking, “What you did was totally different than any other treatment I’ve received! What is it? What can I call it?”

I am almost tempted to name our treatment something totally crazy or overly special. Something like “TGMT- The Greatest Manual Therapy in the world.”

Just kidding.

When I refuse to name my approach or technique anything other than “manual therapy” or “physical therapy”, some of them insist and name it themselves: “You are ‘an orthopedic rolfer’” or, “This is deep tissue ART!” Some even nickname me the “torturer” or dub my treatment a “torture technique.”

Regardless, I usually just laugh and say, “Whatever,” not caring too much about nicknames or niche treatments.

I do respect that there are different approaches to physical therapy and that the founders of the practice, along with noteworthy practitioners over the years, have each developed a unique approach to give relief to the human body. However, I have a few issues with those who chase special techniques, and fancily named treatments: namely that they miss the importance of a correct diagnosis.

Above everything else, you need the right diagnosis. Anything else will be useless to you unless you get this right. For example, say someone knows a technique that works incredibly well on muscular issues. This knowledge and treatment won’t help you if your issue is actually with a joint or a nerve. Finding the right diagnosis is the beginning of the healing process. Unfortunately, a practitioner who knows how to do a fancy technique and applies that technique to any and all patients won’t be of any help to you. Real, effective physical therapy should always start with a thorough patient history intake and a comprehensive physical examination so that the issue can be diagnosed correctly.

Whether a technique is a hands-on technique or utilises a concept that analyzes human motion or posture, the fundamental basis is the same. They are both based on the core treatment philosophy of physical therapy: first, the analysis of posture and movement and, then, focused work on muscles, tendons, joints, nerves, and other tissues. This isn’t rocket science or something totally new and earth shattering. People hear of a physical therapy technique that is named something unique and don’t realise that it is nothing special; it is simply a traditional technique slightly tweaked and renamed by a founder or renowned practitioner motivated by greed and notoriety.

Alongside name brand medicine, there has been a rise in treatment gadgets. I get phone calls all the time asking if we have cold laser therapy or perform dry needling, whether we use a decompression machine or employ electric stimulation through a TENS unit. When I respond that we don’t, the person often loses interest; they are fixated on finding that specific treatment or gadget, confident that it will be the magic bullet that heals them. But, just like copyrighted twists on traditional treatments, these gadgets promise big results but don’t deliver. Afterall, what a patient needs isn’t a fancy gadget or patented treatment, but genuine, comprehensive care that focuses on a correct diagnosis and tailored treatment plan.

New concepts or techniques that emerge often overlook the multidimensional aspect of the human being. A thorough history intake and physical examination should include an assessment of physical, psychological, social, and spiritual aspects, and then incorporate these into the treatment plan. Recent research stresses over and over again the importance of a biopsychosocial approach to medicine over a laser focus on physical alignment, even if the current issue appears to be a simple muscle or joint problem. Every physical issue has psychosocial and emotional aspects that need to be addressed and considered so that the patient can heal on all levels, including the physical one. New, niche techniques tend to forget this, blinded by a laser focus on physical issues.

It’s true that I’ve learned various concepts and techniques during my two decades of physical therapy practice, and some of the techniques I apply to my patients are unique to me. I guess I could nickname them, “Youngsun’s technique”, but I don’t want to.

Afterall, as my mentor, Dr. Tim Fearon, once told me, “A technique is just a byproduct of ingenuity.” My techniques are evolving everyday, but they are still based on the core belief that you need the right diagnosis more than you need a special technique.