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Second Opinion

It can be quite daunting for patients to be able to sort through the range of treatment approaches that are available for musculoskeletal pains. We often follow recommendations based on the experiences of friends and relations. This can be helpful in arriving at decisions for yourself.

If your expectations have not been met by your present treatment, you may be trying to decide whether to continue or change direction. You may be thinking whether you should consider surgery. In this situation, a second opinion may be valuable. You may also discover information that you had not considered or was not offered to you.

Patients often expect an explanation for musculoskeletal pain to be based on damaged structure and believe that these structures need to be fixed (biomechanical understanding).

Providing explanations for pain, based on faulty pathology and anatomy can be challenging as modern research has shown that the relationship to pain, disability and treatment is not direct. Research does not show that more damage means more pain.


For example, X-rays for low back pain are not recommended in clinical guidelines to doctors, as the results of the X-ray do not indicate the intensity of the patient’s pain and furthermore give no direction to treatment. X-rays may show severe degenerative changes and disc bulges, but this not correlate well with how much pain is felt.

X-rays are recommended more to exclude serious pathology of if there is deterioration in the patient’s clinical condition. Explanations for the onset of low back pain are better understood by looking at broader based, causal factors such as mechanisms of pain, lack of movement, poor fitness, lifestyle, beliefs about pain and injury, and other psychosocial factors.

This understanding can be important for acute injuries but becomes particularly relevant in understanding persistent pain.

Research has shown that understanding pain from a biopsychosocial framework and offering treatment to modify these factors has a direct impact on reducing pain.

If surgery has been recommended or you feel that you are not progressing with your present treatment, you may find that this second opinion service will be beneficial to you.

This service may be a one-off consultation and may help in your decision-making for ongoing treatment.

Please ensure that when making appointments for this service, you inform the clinic, so adequate time can be assigned.

Contact David Fidler at Active Physiotherapy for further information or to make an appointment.

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