Diagnostics: What They Do, and Where They Fall Short

So, you hurt yourself. Let’s say it’s your lower back. What are your options?

Wherever you start, the goal is the same: diagnose the injury. But let’s ask a deeper question—what is the purpose of diagnostics?

Traditionally, diagnostics aim to find the cause, explain the source of the pain, and determine the most effective treatment. But here’s the catch: when we say, “find the cause,” what if we’re stopping too soon? What if we’re identifying what the problem is (e.g., a disc herniation or joint issue) and never asking why it happened in the first place?

Let’s explore how we uncover both the what and the why.

Five Diagnostic Tools: Finding the What and the Why

There are five common ways to diagnose injuries. Each has strengths and weaknesses, but only one digs deep enough to uncover the root cause.

1. Imaging (MRI, X-Ray, CT Scan)

Imaging is excellent for showing the what—which tissue is affected and how. For example, an MRI can reveal a disc herniation. But does it explain why the herniation occurred? Not really.

Imaging is most useful in these scenarios:

Suspected broken bones (e.g., from a fall)
Soft tissue injuries from trauma (e.g., a car accident)
Deeper pathologies (e.g., cancer or systemic illnesses)

For chronic conditions like lower back pain without a traumatic event, imaging falls short. It identifies the “what,” but it rarely uncovers the “why.”

2. Lab Work

Lab work is crucial for identifying systemic issues like infections or conditions that might refer pain to your back (e.g., kidney stones or cancer). For lower back pain specifically, 5-10% of cases involve these internal referrals.

Because it’s a smaller percentage, lab work is often used to rule out organic problems after other diagnostic tools are explored.

3. Symptoms (Patient History)

Doctors often say, “80% of a diagnosis comes from a good history.” Think about how quickly your primary care doctor might diagnose strep throat after asking a few questions.

The same applies to musculoskeletal issues. For example, if you describe numbness down to your foot and pain while sneezing, it’s highly likely that you have a disc issue based on your symptoms alone.

While this strongly points to a what, it doesn’t address the why or provide a long-term solution.

4. Palpation and Special Tests

Palpation (hands-on assessment) and specific diagnostic tests can confirm or rule out certain conditions. These tests are graded for specificity (“Yes, you have this”) and sensitivity (“No, you don’t”).

For instance, tests for a rotator cuff tear can be predictive. But here’s the issue: they still only identify the what.

Let’s say you have a rotator cuff tear. Why did it happen? Was it due to a ribcage that wasn’t moving well, forcing your shoulder to compensate excessively? That why remains unaddressed unless we dig deeper.

5. Movement (The Missing Piece)

This is where traditional diagnostics fall short. Movement assessment evaluates how your body functions as a whole, not just in isolated parts.

Here’s the reality:

5-10% of pain cases stem from internal or organic issues (e.g., kidney stones, cancer).
10% stem from chemical issues, such as inflammation or hormonal imbalances.
The remaining 80-85% are musculoskeletal dysfunctions, often stemming from how you move and compensate over time.

If most injuries are movement-related, doesn’t it make sense to prioritize movement as a diagnostic tool?

Diagnosing Through Movement

At our clinic, we use a movement-based approach called the Selective Functional Movement Assessment (SFMA). This framework categorizes movements into four buckets:

Can you perform the movement? Yes or no.
Does the movement cause pain? Yes or no.

From there, we pinpoint areas of dysfunction and ask why:

Is a joint restricted?
Are tight fascia or muscles limiting motion?

Your body compensates for restrictions, often leading to pain in other areas. For example, if your hips lack mobility, your lower back may compensate, causing chronic back pain.

Why Movement Matters

Movement reveals the why behind your pain. While imaging and special tests diagnose the what, they rarely address the root cause.

This explains why so many interventions—pain meds, injections, or even surgeries—offer only temporary relief. They treat the symptoms, not the source.

A Personalized Approach to Pain

Pain is unique to every individual, and so is the solution. Non-specific treatments like “the three best exercises for back pain” might work for someone, but not for you. Why? Because you don’t have a “back problem.” You have a movement problem, specific to your body and lifestyle.

The Takeaway: Diagnose Smarter, Not Harder

By combining traditional diagnostic tools with movement assessment, we uncover both the what and the why behind your pain.

Correct the dysfunction, retrain your body to use its newfound movement, and you might just be surprised at how quickly chronic pain becomes a thing of the past.