MRI recording of the cervical spine of a patient without neurological and with minor orthopedic clinical findings (slight rotation limitations), but with significant movement limitations of both shoulder joints and radiating symptoms in both arms. Severe deformities of the cervical vertebrae damage the nervous system and thus cause the radiation symptoms according to the radiological conclusion. Multiple operations did not lead to any improvement of the clinical symptoms. Professional exercise treatments significantly improved both the mobility of the shoulder joints and the radiating symptoms (with the patient's consent, data known to the author).

Clinical versus radiological diagnosis

The power of imagine

The official name "unspecific back pain" suggests that orthopedics lack the ability to diagnose back pain solidly, a basic requirement for effective treatment.

Both spinal surgery and conservative exercise treatments disappoint. Pain therapies are also not a solution. And finally, the lack of agreement between clinical findings and the results of imaging procedures suggests that doctors and physiotherapists focus too one-sidedly on the spine with its intervertebral discs.

The rapid medical-technical development of the last decades in orthopedics has led to the fact that diagnoses for back pain are almost exclusively based on imaging methods of the spine.

However, several researchers point out the lack of a clear connection between these results and clinical symptoms, which is reflected in the guidelines for medical and paramedical professions. Incorrectly planned treatments based solely on radiological findings are becoming increasingly reality. .

PhysioNovo emphasizes the high value of the clinical assessment and classifies it as significantly more meaningful than a purely radiological picture because:

clinical findings provide information about the function and condition (pain - mobility - strength) of the     
  musculoskeletal system.
radiological findings only provide information about anatomical structures of the tissue - there doesn't have to be
  a connection with clinical symptoms. - they are primarily important when considering surgical
  reconstructions.
anatomical structure is subordinate to the function and condition of the tissue.
clinical assessment reveals close relationships between symptoms and findings of clinical
  assessment.

The paradox of nerve pain

Due to modern scientific anatomical and physiological knowledge of nerve fibers, excitationoutside the sensory organ is not possible. They only serve to transmit the stimuli of a sensory organ. 

Extraordinary mechanical stress on peripheral nerve fibers generally leads to their damage which manifests itself in radicular symptoms as irreversible sensory and motor loss of function.

Symptoms in arms and legs that radiate in a variety of ways, such as paresthesia, reversible loss of strength and a subjective feeling of numbness, are usually associated with reduced joint function (articulate symptoms). An improvement of these functions then leads to a reduction of these symptoms.

In (orthopedic) medicine, the hypothetical and scientifically unconfirmed assumption dating back to the 18th century that nerve fibers can be excitated by mechanical stress and thus triggers a "nerve pain" (neuropathy) still prevails.

Current examples of this view are the lumboradicular and cervicoradicular irritation syndromes. Alois Brügger (Brügger 1980) introduced the term "pseudoradicular syndromes" for these symptoms, which is still used today.

Current radiological diagnostics, which “confirmherniated discs, spinal stenosis and trapped nerves, confirm this view.

The visual power of razor-sharp radiological images is convincing. Rational clinical values based on scientific facts remain too unrecognized by this. 

These paradigms of "unmistakable" radiological diagnostics and neuropathy lead to unsound diagnoses and thus to incorrectly set treatment plans

The spine - an indestructible skeletonThe spine

The stable construction of the vertebral body, the intervertebral disc and thelongitudinal bands, combined with low movement, ensure an extremely high axial loading capacity.

Thus, the lumbar spine can carry up to 1.5 tons of weight. Higher loads lead to fractures of the vertebral body rather than damage to the intervertebral disc. Intervertebral discs can only prolabe (herniated discs) after severe trauma.

The outer layers of the intervertebral disc are closely linked to longitudinal ligaments and are extremely sensitive (paradiscal innervation). The inner layers are barely permeated and contain sporadic sensitive nerve fibres, which probably have a proprioceptive function.

Also at the vertebral body the endothelia and periosteum are the most sensitive. The ratio of density of sensory fibres of endothelia and periosteum - bone marrow - cortical bone is 100:2:0.1.

Contrary to radiological results, constrictions of the intervertebral foraminae are hardly biomechanical. As a result, the outgoing peripheral nerves are excellently protected. Severe scolioses with extraordinary spinal bendingwithout neurological failure clearly show this protection of peripheral nerve tissue.

Joints - pillars of motor function

The versatility of human locomotion is largely determined by the dynamic movements of the arms and legs, thus indirectly by the mobility of the shoulder and hip joints. The spine has a static, supportive and connecting function. A stable trunk forms a good basis for the individual arm and leg movements, and connects them at the same time.

Joints have the ability to adapt to a balanced load. If the load is dosed correctly and the load capacity is taken into account, the joint load can be built up enormously.

At the same time, however, they are extremely sensitive due to a sophisticated articular neurological system. Overburdening directly causes a decrease in performance, joint and radiating pain and loss of strength.

But if the strain is too low, the joints also become ill. They need a moderate, proper load to remain healthy.

Joint restrictions, however slight, immediately lead to compensatory motor activity, which affects the stability of the spine and can cause back pain.

PhysioNovo builds up the load on a joint correctly and responsibly, taking into account its load capacity and in accordance with its biomechanical properties. In this way, motor performance can be safely improved, sore muscles rarely develop and pain in the joints and limbs is relieved.

PhysioNovo is based on the articular-neurological system of subchondral bone, ligaments and joint capsules and takes into account the functional relationships between bones, joints, muscles and fascia.

In addition to the mobile shoulder and hip joints, there are also the slightly mobile sacroiliac (SI), scapulo-thoracic (ST) and vertebra-discal joints. These joints play an important role in back pain because of their biomechanical structure and their functionally close connection with the large joints.