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Are you a good driver?

I often use this analogy when discussing injuries and pain with patients. Most healthcare providers are taught the biomechanical model of musculoskeletal disorders. After residency and fellowship, I left with the notion that most issues are related simple anatomy and or biomechanics. For example, my shoulder hurts so there must be something wrong like a tendon problem, muscle tear, etc. It’s almost like you have a car that has run well for many years and now you start to hear a knock or that you are veering off to the left. Naturally you would take your car to a mechanic, they diagnose the car, and more often than not in comes down to a “parts problem.” Let’s say the brake pads are worn down and there is uneven wear on the tires. Simple solution is to replace all of the above. You then come back a year later with the same problem and you replace the parts and everything is fine again…for now.

Getting back to the example, the medical model will often “diagnose” things with imaging. Let’s say an MRI is ordered and it showed some mild degenerative changes around the rotator cuff tendons with some “bone spurs” that may be causing the tears. You try some physical therapy, massage, chiropractic care, injections and the pain gets better! Three to six months later the pain comes back and you do not respond to the conservative route and undergo a surgical debridement. Your pain gets better again! However, the pain returns in 2-3 years. What do now? Perhaps you should replace the shoulder? That should do it!

  • So is it only a parts problem?
  • If so, how many times can you replace the part?
  • What if the parts are “normal” on MRI?
  • Does a normal MRI mean it’s not the parts?
  • Does how we use our bodies (or our are parts) make a difference?

One can see how this model has its limitations when it comes to the human body. I think that we can all agree that there is a certain amount of “wear and tear” that comes with using our parts. However, this is a cost we all have to bare as people that walk, jump, sit, stand, run, etc. So why not learn to become a better driver? Is it sustainable for the 21 year old you to drive the same way when you are 50? I think it’s really important for people to think about this.

The next time you have an injury and seek treatment ask yourself this important question.

Does this treatment make me a better driver?

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