How I Work

I look for what is relevant, not just what is abnormal

A finding can be real without being the main reason you hurt.

A disc bulge can exist without explaining all of your back pain.

A tight muscle can be present without being the thing that needs treatment.

An unusual movement can sometimes contribute to a problem—and sometimes be the body's way of working around something else.

Finding something abnormal is not, by itself, a reason to treat it. And changing something measurable is only meaningful if that change connects in some useful way to your symptoms, function, or ability to manage the problem.

So I am usually asking two separate questions:

What do I see?

and

Does it actually matter to the problem we are trying to change?

That second question is where much of the examination happens.

The most useful findings are the ones we can test

Suppose reaching overhead reliably produces your familiar shoulder pain.

I may support the shoulder blade differently, change the position of the arm, alter something at the neck, use hands-on treatment, or test whether a nerve is involved.

Then you repeat the same movement.

If one of those changes repeatedly alters the familiar pain, it gives us a reason to take that finding seriously.

It does not prove that we found one perfect cause.

But it tells us where there may be something useful to work with.

If changing something does not affect the problem, that matters too. It may mean the finding is less important than it first appeared, or that we need to look somewhere else.

Treatment gives us information too

Not every question can be answered during the first examination.

Sometimes we have enough evidence to begin treatment without having enough evidence to claim that we fully understand the problem.

That is normal.

Then the treatment itself becomes another source of information.

Did the symptom change in the way we expected?

Did the improvement hold after you went home?

Did a particular activity become easier?

Did an exercise give you more control?

Did something unexpected happen that the original explanation does not account for?

A treatment response can strengthen an idea.

A poor response can weaken it.

The goal is not to defend whatever I thought on the first day. It is to keep getting a better map.

I may look at the problem through several different lenses

Not every person needs all of these approaches.

I use the ones that appear relevant.

I do not automatically try to “correct” everything I see

This matters especially with movement.

If someone moves in an unusual way, it is tempting to assume that the movement is wrong and should immediately be corrected.

Sometimes changing it helps.

Sometimes it does nothing.

And sometimes changing it actually makes the symptom worse.

When that happens, the unusual movement may be serving a purpose—perhaps helping the body avoid another sensitive area or work around a limitation.

So I would rather test what happens than assume that a more “normal-looking” movement is automatically better.

That is also why I do not want treatment to become an endless exercise in consciously controlling every joint and muscle.

If a movement change is useful, the goal is eventually for it to become easier and more natural, not another thing you have to monitor every second.

Imaging is useful when it answers a useful question

If you already have X-rays, MRI findings or other imaging, I am interested in them.

I just do not assume that every structural finding explains every symptom.

Many structural changes can be important. Others may be incidental or only part of the picture.

So I try to compare the imaging with what is actually happening clinically.

Does the location fit?

Do the symptoms fit?

Do the neurological findings fit?

Does the way the problem behaves fit?

If the examination or treatment course raises a question that needs medical investigation, I may recommend that you discuss further evaluation—and whether additional imaging is appropriate—with the relevant medical provider.

Reassessment is part of normal treatment

I do not want a treatment plan to continue simply because it helped once or because we already invested time in it.

I am continually checking whether the things we are working on are actually changing.

Around every six visits, I deliberately step back and look at the case more broadly again.

With some nerve-related problems I do that sooner, because the apparent source can become clearer as the case changes.

I want to know:

Are we actually changing the problem?

Is function returning?

Does the current explanation still account for what is happening?

Is there something important we have not considered?

Does continued treatment here still make sense?

If treatment is working, the need for treatment should usually decrease over time. If it is not working, the plan should change rather than the endpoint simply moving farther away.

What happens when the plan is not working?

If the expected changes are not happening, I do not think the automatic next step should be more of the same.

I may re-examine the problem, change the working explanation, look more closely at nerve involvement, consider whether another part of the person's health has become relevant, or recommend evaluation by another kind of clinician.

Sometimes I need to research something unfamiliar.

Sometimes a medical question needs to be answered before we continue.

And sometimes the most useful conclusion is simply that I do not have enough confidence in my explanation to justify continuing treatment here.

That is not a failure of the process.

Continuing without a good reason would be.

Helping you get oriented is part of the work

When several explanations are in play, part of the work is sorting what has evidence behind it, what remains possible, what we can test here, and what needs another kind of evaluation.

I may not always be able to give one final answer.

But the situation should become clearer rather than more confusing.

You do not have to agree with me about everything

You may already have ideas about what is causing the problem, what testing you want, or what kind of treatment you prefer.

That is fine.

Different interpretations are often workable.

Different preferences are often workable.

What becomes difficult is when the conclusion cannot change regardless of what we find.

You do not have to adopt my model.

I just need enough room for what actually happens to influence what we do next.

What I consider my responsibility

I cannot promise that I will find one hidden cause or that a particular treatment will make the problem go away.

What I can reasonably be responsible for is the quality of the process.

That means taking what you are experiencing seriously, building an informed starting point, testing what can be tested, treating the things that appear worth treating, reassessing the plan, changing my mind when the information requires it, and telling you when another route makes more sense.

If I identify something that appears important and falls within what I treat, I expect one of three things to happen:

It improves.

We learn something meaningful about why it is not improving.

Or we change the model.

What I do not want is for an explanation to become permanent simply because it was convenient.