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

Doctors and physiotherapists focus one-sidedly on the spine and its intervertebral discs when assessing back pain. 

The power of the radiological image, reinforced by the rapid medical-technical development of the last decades, has led to the fact that diagnoses of back pain in orthopaedics are based almost exclusively on imaging procedures of the spine. Physiotherapists also still focus too one-sidedly on the spine.

However, several researchers point to the lack of a clear correlation between radiological findings and clinical symptoms, which is reflected in the guidelines for medical and paramedical professions.

The official term "a-specific back pain" also indicates that no clear cause can be found for most back complaints, despite the levied imaging that is often obtained.

Obviously, radiological diagnostics that focus exclusively on the spine are not sufficient to formulate truly effective treatment goals. Apparently, radiological diagnostics of the spine alone is insufficient to determine the exact cause of back pain. This is probably why the results of current surgical, conservative (exercise therapy) and pharmaceutical treatments for back pain are disappointing.

A solid diagnosis is a thorough prerequisite for effective treatment.

PhysioNovo therefore emphasises that

  • only clinical findings provide information about function and condition (pain - mobility - strength) of the musculoskeletal system.
  • only radiological findings provide information about anatomical structures of the tissue - there does not have to be a connection with clinical symptoms - they become primarily important when considering surgical reconstructions.
  • Tissue structure is subordinate to function and condition.
  • clinical findings reveal close correlations between symptoms and motor findings. This leads to sound diagnostics and real treatment goals.

© Paul Geraedts 2020

Neuropathic vs. ligamentar/articular pain

The term neuropathic/nerve pain is based on an 18th century assumption that nerve fibres can spontaneously activate due to excessive mechanical stress. This is the basis of the International Association for the Study of Pain (IASP) classification that such extraordinary activation of nociceptive afferent fibres in a spinal nerve or its roots leads to perceived pain in an arm or leg. Diagnoses such as lumboradicular and cervicoradicular irritation syndrome are current examples of this outdated view. However, this ectopic activation has never been demonstrated in a clinical setting.

Thus, according to the current state of science, nerve fibres cannot depolarise when subjected to mechanical stress; they merely serve to transmit action potentials. Only stimulation of a sensory organ can lead to depolarisation.

Animal experiments show that low mechanical elongation or compression of a few grams (25 to 50 g) of peripheral nerve fibres leads to irreparable damage (sensory and/or motor deficits). Damage to peripheral nerve tissue is usually irreversible because damaged nerve tissue barely recovers.

There is increasing clinical evidence of radiating pain as ligamentous/joint pain, which can be explained on the basis of scientific anatomical and physiological principles through clinical reasoning. Furthermore, the symptoms of ligamentous/joint pain are very similar to theose of neuropathic pain.

This scientific fact has major consequences for clinical diagnostics. The cervical and lumbar irritation syndrome, intervertebral stenoses and hernias lose a large part of their diagnostic value. The multifaceted picture of radiating complaints in arms and legs such as paraesthesia, reversible loss of strength, a subjective feeling of numbness can no longer be explained as nerve pain.

© Paul Geraedts 2020

The spine - an "indestructible" skeleton

The spine is built in such a way that it can carry heavy loads and absorb high loads from the arms and legs. The best examples of this particularly high load-bearing capacity can be found in (high-)performance sport.
The stable construction of the individual elements (vertebral bodies, intervertebral discs, longitudinal ligaments), arranged in a highly resilient double-S shape and combined with little movement of the individual elements, make this very high load-bearing capacity possible.

In addition, the spinal column provides excellent protection for the spinal cord and the outgoing peripheral nerves. The best example of this protective function is severe scoliosis with extraordinary spinal curvature without neurological symptoms. 

The spine itself is effectively protected by a sophisticated network of highly sensitive and extremely strong ligaments and capsules in combination with the bony construction of the vertebral bodies and intervertebral discs.

In contrast to this robust construction, radiological images show a vulnerable spine with frequent abnormalities. Stenoses of the intervertebral foramina leading to the entrapment of outgoing nerves, intervertebral disc protrusions, vertebral fractures without traumatic cause (osteoporosis), hernias and spondylolisthesis are frequent diagnoses of back pain. Clinical examinations do not confirm this susceptibility. 

© Paul Geraedts 2020

Joints - pillars of motor function

The versatility of the human motor system is largely determined by the dynamic movements of the arms and legs, i.e. indirectly by the mobility of the shoulder and hip joints. The spine has a predominantly 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 correctly dosed and their load capacity taken into account, the joint load can increase enormously.

At the same time, however, they are extremely sensitive due to a sophisticated articular neurological system. Over- or incorrect loading immediately causes a decrease in performance, joint and radiating pain and loss of strength.

But if the load is too low, the joints also become ill. Moderate but above all correct loading is necessary to keep joints healthy.

Joint restrictions, however slight, immediately lead to compensatory motor activity, usually in the spine. This affects its active stability and can cause back pain.

PhysioNovo builds the load on a joint taking into account its physiological load capacity in accordance with the biomechanical properties of the joint. 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 due to their biomechanical structure and their functionally close connection to the large joints.

© Paul Geraedts 2020