Tissue diagnosis vs. Functional diagnosis

When you go to the doctor, you’re usually getting what I call a tissue diagnosis. Examples include achilles tendonitis, hip bursitis, rotator cuff impingement, etc., They describe a part of the body and a type of irritation or injury.

This is also what people are looking for when they ask to get an MRI or x-ray for their pain. We want to see it and feel like it’s finite and controlled and tangible. The results on that image may say “grade II tear of the distal fibers of the medial collateral ligament” or “moderate disc herniation of 2 cm laterally displaced into the intraforaminal canal”.

Still a tissue diagnosis. A tissue diagnosis is a local injury viewed in isolation.

When you come to ROOTS (or any quality movement system focused professional) you’ll additionally receive a functional diagnosis. We still use tissue diagnoses; it’s important to know what tissues are inflamed or causing you pain. Plus, they act as clues for the functional diagnosis.

My real question is, WHY is it causing you pain. If we don’t work to resolve things at the system level, despite improving the tissue irritation, you’ll just put the same pressures back on the same thing. And then it comes back.

This is how we end up with “I’ve just got a bad back” claims. I hear it all the time. “Oh it’s genetic, my dad has a bad back too.”

Or, hear me out, could it be that both you and your dad are primarily sedentary and have similar patterns of dysfunction?

Could it be that your back isn’t “bad” and is really just doing the best it can, begging you via your symptoms to give it a break?

Could it be that just getting a massage or accupuncture once a week is missing the entire point of the muscle ache your body is communicating to you with?

Hint: it’s not normal to need to do anything every week to not be in pain, whether that’s massage, Pilates, chiropractic, or physical therapy.

…In comes the functional diagnosis.

The functional diagnosis aims to tell us why something is happening. Maybe you don’t have enough mobility in your hips and the body is trying to pass off the extra work to a neighbor (the lower back). Maybe you have too much mobility and aren’t controlling the forces moving through your pelvis so they end up loading on the joints of your lower back instead.

The functional diagnosis might be: lumbopelvic dysfunction second to hyper/hypomobility of bilateral hips without control of lower extremity load patterns across lateral diagonal, or destablized planes and positions of movement.

This is what you come to see ROOTS for.

Tissue diagnoses and tissue release are easy. You’ll find it everywhere. Massage, chiropractic, stretching, acupuncture, ultrasound, cupping, laser, magnets, etc., The list goes on and on.

Hint: they’re all passive. You’re receiving exclusively.

It’s not wrong to use tissue centric treatments, I use some of them all the time. But they need to be embedded within the system, the functional diagnosis.

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BREAKING DOWN TREATMENT OF THE FUNCTIONAL DIAGNOSIS:

For this “bad back” I might start with some release of irritated systems with joint mobilizations, muscle release, stretching, or nerve exercises.

As soon as symptoms improve (1 session if I can), we minimize manual work on the table and move to…

Reinforcement of these systems via creating accessible range of motion or stabilization where needed.

We’ll train across all those ranges listed (lateral, diagonal, destabilized) and anything else we find along the way. The goal is to correct the issue, but to teach YOU how to spot it so YOU can correct YOURSELF.

At this point in treatment (weeks to months depending on the person) we should have no pain, and substantially expanded access to our base range of motion/stability/control. You feel great!

The last step is to reload together.

We did all this work to resolve the functional diagnosis. Let’s test it. When I put you back into your back squat and load it up the same way or have you run 5km or go up and down the stairs holding weights…what happens?

If I can throw you movements you’ve never done and the systemic dysfunction is no longer present, this is my discharge point.

There’s infinite ways to get from point A to point B but if the systemic issues aren’t addressed, you’re not getting anywhere.