In the physical therapy profession, imaging in the form of X-ray and MRI are regular assessments that we request and include within our patient model. Imaging is done, generally, to rule in or rule out certain conditions and to help make a medical diagnosis. Many patients believe that their physical therapist needs to see their X-ray or MRI in order to get appropriate treatment. This is often not the case! Imaging is simply another assessment in which the details therein are considered right alongside other in-clinic details, such as your squat/lunge or night-time pain, that physical therapists use to understand your biomechanics.
Physical therapists are trained to evaluate and treat people without diagnostic test results, full-stop. We do not need radiographs or MRIs to accurately assess and treat your conditions! The medical diagnoses and imaging findings are respected by the therapist, but therapists do not evaluate, prescribe exercises, or otherwise treat based on your imaging. Just as a picture of someone will not tell you a person’s story, a picture of a body part will tell a physical therapist very little about the entirety of the biomechanics of that region!
Additionally, all kinds of “incidental findings” in asymptomatic people can be found in all areas of the body with medical imaging. These findings include disc herniations, spinal stenosis, nerve compression, arthritis, hip and shoulder labrum tears, rotator cuff tendon tears, meniscus tears, signs of inflammation and tendonitis, and others, in asymptomatic people. These types of findings are in all populations – young, old, athletic (recreational to elite level), military, musicians, dominant and non-dominant sides, etc. Below is a summary of a literature review’s findings on spinal MRIs in asymptomatic populations1. As you can see, the prevalence of these findings on MRI does increase with age, but again, these are people without symptoms. Many people are walking around with “abnormal findings” with zero pain.
Pain and injuries are complex and experienced differently by everyone. A physical therapist relies primarily on a physical assessment and detailed history to determine the most appropriate treatment for someone. Each patient, even ones with the same image findings and medical diagnosis, will have a different physical presentation, location, quality, and intensity of symptoms, aggravating movements, physical activity history, stage in the healing process, personality, goals, etc. None of this can be gained from an X-ray or MRI, but all of it is important when treating someone.
So, when is imaging necessary? The most consistent time I send out for imaging is when the expected progression of recovery has stalled or regressed. As a doctor of physical therapy, I am very well trained in expected healing times of tissues. If timing is off for healing and has been so for some time, I request for imaging to add another assessment to the list in order to better fully understand what we are dealing with.
Thanks for reading,
Dr. Marcus PT DPT
“Maybe if I just buy this standing desk, things will be better!”
Does this sound like you? If so, this article is tailor-made for you.
Let's go through many of the questions one-by-one. Maybe some of these will be of help to you if you are considering a standing desk.
Question 1: “Do you think I should get a standing desk?”
Generally speaking, yes! Though my reasoning won't be what you might think. As with any tool, it’s not really about the tool, it's about the intent behind using the tool. For many, the intent of having a stand-up desk is because they have back pain and are looking to stop sitting for most of their day. For others, it’s about improving overall health and wellness by standing more, as standing burns more calories than sitting. It all depends on what your intent is! First, find out exactly why you want a standing desk and then you can figure out why one might be for you (or not!).
Question 2: “What are the main benefits of a standing desk?”
It allows an opportunity for changing your movement patterns throughout your day.
If you were to sit or stand with “perfect posture” at work for an entire year, both would have their own set of problems. For the person who stands all day, their feet would start to really hurt; then possibly their knees or low back. Before long, they’d need to sit!
For the person who sits at work for an entire year, they eventually need to get up because their back and knees start to hurt.
For both parties, it’s not the fact that they are standing or sitting all day in a “perfect posture,” it’s that they need an opportunity to change their position to really feel better!
A standing desk that has the option to be both in a low and high position allows for both of these individuals to either sit or stand depending on how they are feeling. The key for them is more motion throughout the day! The key benefit for a desk that goes up AND down is that you can adjust your body more throughout the day, and more varied motion throughout your day is the KEY to longevity!
Question 3: “Why shouldn’t I get a standing desk?”
So, are standing desks amazing? YES! They are a great tool in the arsenal of a healthy individual. They allow for more movement throughout your day, of which is an absolute blessing! But don’t go thinking that just because you’re standing all day long, you will automatically feel much better. The key is varied motion every day, from both the office, to the yoga mat, to the gym, and to the couch!
More movement is always better.
Now if you’ll excuse me, I’m gonna get to my stretches after finishing this blog post.
Thanks for reading,
Dr. Marcus PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.