Is Having a Clear Diagnosis Important for Managing Spinal Conditions?

When it comes to managing spinal conditions, the question of how important a clear diagnosis is has been a point of debate within the physiotherapy community.

For some, a precise label for a spinal issue is seen as essential to charting the right course of treatment.

For others, the focus lies not on the label but on understanding the contributing factors and mechanisms behind the injury.

So, which approach serves clients best?

The Role of Diagnosis in Spinal Care

There’s no denying that in certain situations, having a clear diagnosis is crucial. Specifically, if a ‘red flag’ is suspected or confirmed through imaging or other clinical tests, an accurate diagnosis becomes imperative.

Red flags are signs of serious underlying issues such as fractures, infections, or cancers, which require urgent medical attention.

In these cases, a diagnosis IS crucial!

However, outside of these scenarios, the need for a precise diagnosis is less critical.

Spinal conditions, such as non-specific low back pain or certain forms of sciatica, are often multifactorial. They result from a combination of physical, lifestyle, and psychological factors, commonly known in the Physiotherapy world as the Bio-Psychosocial Approach.

In such cases, focusing solely on a diagnosis can mislead clients into believing that treatment hinges on "fixing" a singular issue.

This is where the concept of a “working diagnosis” becomes valuable.

The Power of a Working Diagnosis

A working diagnosis doesn’t aim to pin down a condition with absolute certainty. Instead, it’s a practical, evolving hypothesis based on the client’s history, clinical presentation, and response to treatment.

From my perspective as a manual therapist with a strong biomechanical approach, this process is incredibly valuable. It allows me to identify the mechanisms and factors that may have led to the injury in the first place, such as poor movement patterns, muscle imbalances, postural stressors, or non mechanical factors like their social and mental condition.

By understanding the “why” behind the injury, we can create a comprehensive, individualized treatment plan that addresses the root causes rather than just treating symptoms.

This is particularly important for long-term results. If a client only seeks to “fix” a diagnosis, they may be inclined to stop treatment as soon as their pain subsides. But if they understand the underlying contributors—and how our work is designed to address them—they’re more likely to stay engaged in their rehabilitation journey.

MRI Scans: Are They Always Reliable?

One important consideration is the role of MRI scans in managing spinal conditions. While MRIs are often seen as the "gold standard" for imaging, research has shown that they aren't always reliable in identifying the actual cause of pain.

For example, studies have found that many people without any back pain at all still show disc bulges, herniations, or other abnormalities on MRI scans. This highlights a key issue—just because something appears abnormal on a scan doesn’t necessarily mean it’s the source of pain.

As a result, over-reliance on MRI findings can sometimes mislead both clients and clinicians, leading to unnecessary worry or invasive treatments. (Brinjikji et al., 2015, "Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations.")

This is why, at Physiologic, we prioritise a holistic approach that considers clinical presentation, functional movement assessments, and the client's lived experience—rather than relying solely on imaging results.

Empowering Clients for Better Results

Another crucial advantage of this approach is client empowerment. When clients are involved in the process of understanding their condition—beyond a label—they’re more likely to trust our clinical reasoning. This trust plays a key role in compliance.

When clients believe in the process, they’re more likely to adhere to advice, attend sessions, and follow through on prescribed exercises. This active participation ultimately leads to better outcomes.

Rather than fostering dependency on the therapist to “fix” them, the focus shifts to collaboration.

Clients become more proactive participants in their own recovery. They’re not waiting for a diagnosis to change before taking action—they’re already on the path to improvement.

Conclusion

To summarise, a clear diagnosis is vital in cases where red flags are present. But for the majority of spinal conditions, especially those without serious underlying pathology, a working diagnosis that places the focus on addressing root causes serves a greater purpose.

It shifts the focus from labeling the condition to understanding its underlying causes, empowering clients, and fostering long-term solutions. This approach builds trust, enhances compliance, and, ultimately, produces better outcomes for clients. At Physiologic, this philosophy underpins our commitment to providing quality, client-centered care for spinal and sports injuries alike.

ABOUT THE AUTHOR

Ryan Tan, the Clinical Director and Spinal Physiotherapist at Physiologic Hong Kong, brings over a decade of expertise in sports and spinal physiotherapy. He holds a Certificate of Spinal Manual Therapy (COSMT), an intensive qualification dedicated to advanced spinal care, as well as being trained in Osteopathic Spinal Manipulations (OMT).

Ryan’s extensive background includes working in renowned Complex Pain Clinics in London, where he specialised in managing complex spinal conditions, working closely with Pain Consultants & Spinal Neurosurgeons.

Here in Hong Kong, he collaborates with leading Orthopaedic Spinal Specialists to deliver comprehensive and effective treatments for individuals suffering from persistent Spinal (Neck and Back) Injuries. If you have a complex spinal injury that remains unresolved, contact us for a thorough and obligation-free assessment!