Personal Care That Treats Your Pain

Experience having your complaints heard and a physical examination that localizes the pain.

Dr. Ravin’s Practice

Ligamentous laxity and tendinosis are common reasons for musculoskeletal pain complaints. Diagnosing ligamentous laxity requires an understanding of functional anatomy or knowing how the ligaments, tendons, muscles, and bones work to create coordinated and graceful movements across joints. These diagnoses are the result of a careful physical examination that assesses each of these elements.

Figure 1

Figure 1

The concept of referred pain is also important in the diagnosis of musculoskeletal problems. Referred pain is an error in patient perception that is attributable to the organization of the pain fibers in the spinal cord that are “hard wired.” All structures in the body have a characteristic pattern of referred pain. An example is pain from the ligaments and tendons of the lower back that radiates to the buttocks and down the leg. Hip ligaments refer pain that is most intense over the midbuttocks and that also radiates down the leg. (See Figure 1) Note that the referred pain patterns of the ligaments and tendons of the lower back and hip overlap in many ways. These images highlight the importance of understanding all the potential causes of lower back pain from the lumbar discs, nerves, or facet joints to the hip as well as the joints, muscles, ligaments, and tendons of the lower extremities. A comprehensive physical examination is the only way to diagnose which structure is causing the pain.

After the diagnosis, Dr. Ravin discusses with the patient whether the pain is likely to improve with the therapies he uses. Prolotherapy is used to treat ligament laxity. Injections with a local anesthetic are used to treat tendinosis and painful scaring; the latter procedure is called neural therapy.