412 | The Lies That Linger: Harmful Diagnoses Medicine Won’t Let Die

·26 min·2 clips

Dr. Jen reveals why common diagnoses like degenerative disc disease often mislead patients and worsen their pain.

The episode begins with Dr. Jen promoting the Pelvic Floor Foundations course and a discount for listeners. The hosts then introduce the topic of harmful diagnoses that medicine won't let die. They argue that imaging often reveals normal age-related changes that are incorrectly blamed for pain. Dr. Dom mentions research showing similar imaging results in people with and without pain across joints like the knee, back, and shoulder. The discussion first focuses on chondromalacia patellae, with Dr. Jen citing a cross-sectional study finding no significant difference in patellar cartilage defects between people with patellofemoral pain and healthy controls. She references a consensus statement advising against using the term due to its implication of cartilage damage. Dr. Dom shares a personal example of having squinting patellae without knee pain. The conversation shifts to degenerative disc disease, illustrated by a story of a patient in her 30s whose physical therapist recommended imaging for reassurance, leading to a scary diagnosis and recommendations for injections and surgery. Dr. Jen notes that studies show disc herniations and degeneration are common in asymptomatic individuals, with one finding 81.4% of pain-free people having disc herniations. They discuss how labeling can prompt unnecessary tests and surgeries, referencing a YouTube comment about someone having 10 back surgeries. Next, they address rotator cuff tears, citing a study where asymptomatic tears were twice as common as symptomatic ones, and 48% of full-thickness tears were asymptomatic. Guidelines recommend against routine imaging for shoulder pain without specific indications. Dr. Dom shares his personal experience of a suspected rotator cuff tear that healed without intervention. Finally, they critique shoulder impingement diagnoses, explaining that tests for impingement cannot distinguish between pathologies and that reduced subacromial space is often seen in asymptomatic people. They mention that surgical procedures like subacromial decompression have not shown superior outcomes to physical therapy alone. The hosts conclude by emphasizing that imaging is only part of the story and advocate for conservative treatment focused on function. They reference a past guest, Andrew Diedelbach, who recovered from a large disc herniation without surgery. The episode ends with a call to share the information and another promotion for the pelvic floor course.

As heard by us

A spine diagnosis becomes a grounded look at what medical images can explain, and what they cannot.

Medical labels can feel like a second injury when imaging turns pain into a frightening forecast. The Optimal Body anchors that tension in a woman in her thirties who was already in physical therapy for back issues, had begun to improve, and then left a doctor's visit shaken by…

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If a scan makes your back pain feel like a countdown to surgery, this conversation is for you.

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