What To Do If Your Patient’s Symptoms Don’t Fit In A Textbook Diagnosis

In the world of professional sport and private practice your patient’s symptoms will almost never be textbook and a diagnosis will never be black and white.

Today, I’ll show just how easy it can be to deal with a situation like this…

It Is Fine, Don’t Panic

It isn’t often that a patient’s symptoms look like a textbook example.

We know already that two people will react differently to pain. Just because two people have a pain experience with a pathology you have seen before doesn’t mean they will express pain in the same way.

What To Do?

Firstly understand, are there any other trip wires? Is the issue influenced by any other systems?

Very often what you’re going to see with a musculoskeletal assessment is the influence of other systems within the body. 

If someone’s respiratory system is sensitised, their heart rate is high and they’re in what we’d call fight or flight, the way they move is going to be very different to somebody who’s going back towards rest and digesting. 

In fact, if you get your patient back into rest and digest their movement will make a little more sense and their perception of the symptoms may ease.

So, it is incredibly important to consider the tripwires of the respiratory system, the neurological system and all of the chemicals being pumped around the body as a result of fight or flight, or as well call it sympathetic dominance.


As therapists and healthcare professionals we are obsessed with a diagnosis and labels.

Now, sometimes we won’t even have a diagnosis in the first or second session. As a therapist this can be quite scary because we assume the patient is immediately looking for their diagnosis.

After years of work in professional sport and private practice I can’t remember the last time a patient pressed me for a diagnosis. What the patient wants is to understand where they need to get to.



Final Thoughts

If your patient isn’t straight out of a textbook, don’t panic.

If the symptoms don’t make sense, look for trip wires, get them back into rest and digest and retest.

Finally, use your explanation. Make your patient understand what you believe the true stressor to be and where they need to get to. 

Click here for more on how we use information like this in private practice and the Go-To Therapist Method.

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