Using a biopsychosocial approach means – we need to take into account so many factors we may not be able to identify causation

Using a biopsychosocial approach means – we need to take into account so many factors we may not be able to identify causation

We’ve been taught that to provide the ‘best care’ we’re suppose to diagnose the patient with a condition and then identify and treat the cause.

Yet to this date we’ve been unable to make any causative links between injury occurrence, biomechanics, tissue damage, pain and treatments that try to allieviate any of these factors.

One of the reasons for this may be that the body isn’t as simple as we’re taught. That there may be so many different factors that could impact whether someone develops an injury or pain that it becomes almost impossible to apply causation.

This is only a problem if you rigidly hold onto the idea that we need to identify a specific cause in order to provide treatment.

Nearly every musculoskeletal condition you can make an effective, evidence based treatment plan without ever identifying the specific reason it occurred. Some of the most common conditions we see like plantar heel pain or patello-femoral syndrome, no-one knows what exactly causes them. Yet we don’t complain that it can’t be treated unless we identify the ‘exact cause’.

As an example, say someone presents to you with plantar heel pain. You don’t need to identify a specific cause to know that the best initial treatment is getting the patient to continue exercising to tolerance and then we choose whether stretching, ice, strengthening, taping and/or foot orthoses are the most appropriate for the patient.

Problems arise when we overeach and falsely attribute the heel pain to be caused by their ‘low arches’. Not only do we have evidence that currently disproves this theory, that information can influence patient behaviour from activity avoidance to completely restructuring their life around their ‘bad feet’.

So it’s worth thinking. Do I always need to identify a specific ’cause’ in order to best treat my patients? The answer is probably not…

Alex Murray Podiatrist

Alex Murray is a Podiatrist working in private practice and the founder of website Making Sense in Podiatry. He's passionate about helping other clinicians make sense of evidence and clinical practice with a core philosophy of exploring the complexity of human beings, embracing the uncertainty of clinical practice, and avoiding overly reductionist thinking. In addition to his undergraduate degree from La Trobe, he also holds a Post Graduate Diploma in Sports and Exercise Medicine from the University of Otago. He has experience with both national and international athletes and has recently transitioned to focusing primarily on helping the general population and local athletes manage their pain and achieve their goals.

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