The Possibility of Your Joint Pain Coming From Your Back and Spine. By: Heather Stewart, PT, MSPT

At Advanced Rehabilitation, our physical therapists are experts in treating both the spine and joint pain. At times, it can be uncertain why you are having pain or where pain is coming from. A recent study found that even when patients don’t feel their joint pain is from the spine, there is a 43.5% chance that is still the case. The research published in the Journal of Manual and Manipulative Therapy sheds light on the prevalence and implications of extremity pain with spinal origins. Understanding this connection is crucial for effective diagnosis and management to lead to positive outcomes of such conditions.

Therapists who are trained in Mechanical Diagnosis and Therapy (MDT) apply a system of diagnosis and patient management techniques that apply to acute, subacute, and chronic conditions of the spine and extremities. It offers a reliable and practical approach that focuses on “what patients need” and not on “what therapists want to do”. The McKenzie Method is a biopsychosocial system of musculoskeletal care emphasizing patient empowerment and self-treatment.

The study from Rosedale et al, in 2020, was conducted utilizing a combination of clinical examinations, diagnostic imaging, and patient-reported outcomes. The therapists were trained in Mechanical Diagnosis and Therapy and analyzed patients presenting with joint or arm/leg pain to determine the cause of pain. One of the key findings of the study was the significant prevalence of extremity pain secondary to spinal pain. Contrary to conventional belief, they determined 43.5% of participants had a spinal source of symptoms such as disc herniation, spinal stenosis, or facet joint dysfunction. This highlights the importance of considering spinal health in the assessment of extremity pain, as overlooking spinal involvement can lead to misdiagnosis and inadequate treatment.

While some patients exhibit classic radicular symptoms, such as radiating pain, numbness, or weakness, others present with more subtle symptoms, making diagnosis challenging without a comprehensive assessment of spinal function. This variability underscores the need for a focused approach to evaluation.

By targeting spinal and joint dysfunction through the Mechanical Diagnosis and Treatment, a physical therapy evaluation can get to the cause of pain and determine a plan of care to maximize long term recovery. This approach not only alleviates symptoms but also improves biomechanics, reducing the risk of recurrence and enhancing overall musculoskeletal health.

Collaboration between healthcare providers, including physical therapists, primary care physicians, and other disciplines enables comprehensive assessment, individualized treatment planning, and coordinated care delivery. By recognizing the spinal component of extremity pain and implementing evidence-based manual and manipulative therapy interventions, clinicians can effectively address the underlying cause, alleviate symptoms, and improve overall patient well-being and satisfaction. If you have spine or joint pain, see your doctor or one of our therapists at Advanced Rehabilitation for a full evaluation to determine the best plan of care.

1. Rosedale R, RastogiR, Kidd J, et al. A study exploring the prevalence of Extremity Pain of Spinal Source (EXPOSS). Journal of Manual and Manipulative Therapy, 2020; Sept 28(4):222-230.

2. Karel YHJM. GGM S-P. Thoomes-de Graaf M, et al. Physiotherapy for patients with shoulder pain in primary care: a descriptive study of diagnostic and therapeutic management. Physiother. 2017;103 (4) :369-378.

3. Cannon DE, Dillingham TR, Miao H et al. Musculoskeletal disorders in referrals for suspected cervical radiculopathy. Arch Phys Med Rehabil. 2007; 88: 1256- 1259.

4. Heidar Abady A, Rosedale R, Chesworth BM, et al. Application of the McKenzie system of mechanical diagnosis and therapy in patients with shoulder pain: a prospective longitudinal study. J Man Manip Ther. 2017; 25 (5); 235-243