That's where a Clinical Specialist comes in.
Currently in Canada, there are less than 50 certified Physiotherapy Clinical Specialists.
I qualified as a Specialist in bone, muscle and joint disorders in 2013. I specialize in the diagnosis and treatment of most types of pain and injury. It’s not unusual to be referred to me for a second opinion when your case is particularly tricky and not responding to treatment.
When I review your case, I usually find one of three reasons why your treatment has not be working.
You haven’t followed the treatment plan properly.
The wrong treatment was prescribed.
The wrong diagnosis was made.
Here are some examples of the wrong diagnosis, and getting the patient back on the path to recovery.
Diagnosis: Lumbar Stenosis
Steven* arrived with a diagnosis of lumbar stenosis. This is essentially a narrowing of the spinal canal in the low back. It causes back pain and pain radiating into one or both legs. It occurs when standing or walking, with relief when sitting. Steven had an x-ray confirming the presence of stenosis. But when I first met with him, he made it clear that his pain was always better when walking and standing and worse when sitting. From this we determined that he did indeed have stenosis in his low back, which was completely non-symptomatic, and that something else was causing his pain.
This happens quite often, when a particular finding on x-ray turns out to be unrelated to your pain. Once we got Steven on the right treatment path, his pain reduced quite a bit. The treatment that he required was vastly different than the treatment we prescribe for stenosis. Had we not made this distinction, it’s likely his condition would have worsened, not improved.
Diagnosis: Cervical nerve impingement
Jessica* had neck pain and severe radiating pain into the left arm. When I first saw her it was very clear that she was experiencing a herniation of one of her spinal discs with impingement on a nerve root. Because of the severity, and her inability to work due to the pain, she chose to have a privately funded MRI, rather than waiting for months. The report from the radiologist was unclear, in that it did not describe what we were expecting.
I’ve been in practice for more than 20 years. I’ve learned that “if it walks like a duck and quacks like a duck, it’s a duck.“ I called the radiologist to confirm, and he agreed that yes, there was a disc bulge impinging a nerve root and that the way he wrote the report may not have made that clear. With that information in hand we were able to schedule Jessica for a specific nerve root injection that drastically reduced her pain within a few days. Getting the diagnosis right is vital. Otherwise, ineffective treatments are offered and time is wasted.
Diagnosis: Shoulder instability
Rachel* had a fall and injured her shoulder. She started physio but was not progressing fast enough after 10 weeks. As a musician, her shoulder was preventing her from performing and having a great impact on her life. Her therapist referred Rachel to me for a second opinion.
As it turns out, Rachel had suffered a partial dislocation of the shoulder joint, which resulted in an unstable “ball and socket“. Her shoulder instability was particularly irritable and would not respond to the typical shoulder rehab required for a simple sprain or strain.
We had an MRI done just to confirm there was no damage to the joint itself. With that confirmed, we were then able to start her on a set of shoulder exercises that specifically improve the stability of the shoulder. It took a number of weeks of slow, steady work on her part to start to turn things around. After three months, she had regained most of her function and was able to start playing music again.
The diagnosis was quite difficult to make in this case, even though physiotherapists commonly treat shoulder instability . Once we confirmed the underlying problem, she was able to begin the proper recovery.
If you’re struggling with persistent pain in spite of a treatment program, consider seeing a Physiotherapy Specialist to get your diagnosis right.
Note: You do not need a referral to see a physiotherapy specialist. You can book yourself in directly.
(*Names have been changed, though these are actual cases.)