Article Rundown

• Availability and time matter more than fancy tools or facilities
• Most chronic back pain cases fail because real assessments aren’t done
• Mechanical patterns, not MRI buzzwords, drive accurate diagnoses
• Individualized, time-intensive care is what restores function and confidence

Availability Supersedes Ability — and Why Time Matters More Than Tools

One of the most important lessons I’ve learned over the years is simple: availability supersedes ability.

You can have the best equipment, the most advanced facility, and every new recovery gadget imaginable. None of that matters if the people using it don’t know how to properly assess an injured athlete or chronic pain patient and build a plan that actually creates relief.

That’s where most systems fall short. Not because of bad intentions, but because they’re not structured to allow for depth, time, or true investigation.

Why Most PT Systems Aren’t Built for Complex Back Pain

Physical therapy education has to cover a lot of ground. The problem is that when knowledge gets wide, it often can’t get deep. And nowhere does that matter more than the lumbar spine.

A real back assessment isn’t something you squeeze into a short appointment. It requires time, pattern recognition, and an understanding of how mechanical stress actually drives pain. Most clinicians aren’t given the opportunity to develop that depth inside traditional systems.

That doesn’t mean great PTs don’t exist. It means the system often doesn’t allow them to practice at the level complex cases require.

We Don’t See the Easy Cases

Most of the people who come to us aren’t fresh injuries. They’re not the ones who got better with a few weeks of basic rehab.

We see the people the system failed.

They’ve been in pain for years. Sometimes decades. Many have had multiple failed surgeries, injections, and treatment plans that never addressed the real driver of their pain. These aren’t simple cases, and they can’t be treated like they are.

Complex problems demand a different approach.

What a Real Multi-Hour Assessment Actually Looks Like

Everything starts with the interview. A real one.

We spend serious time learning who the person is, what they’ve tried, what aggravates their symptoms, and what their life actually demands of their body. Job requirements, family responsibilities, and personal goals all matter when you’re building a solution.

From there, we move into a detailed mechanical assessment. We test flexion, extension, rotation, compression, shear, and nerve root involvement. We look for consistent patterns — what provokes pain and what creates reprieve.

Once you understand the pattern, you can stop guessing.

Why Imaging Without Context Misses the Mark

I review MRIs differently from most. I usually look at the imaging before reading the radiology report, because vague language like “minimal” or “unremarkable” doesn’t help the person who’s hurting.

Pain is often dynamic. A disc bulge that looks small on a static image can become a major issue under load. I’m looking for a direct match between mechanical findings and what shows up on imaging — not isolated observations taken out of context.

Most importantly, I show the client their MRI and explain it. When people understand why they hurt, their confidence and compliance change immediately.

From Reprieve to Resilience: Making It Practical

Once we establish reprieve, the next step is building resilience. That’s where things get individualized.

An athlete, a welder, and a desk worker all need different solutions. The goal is always the same: get them back to work, back to family life, and back to functioning without fear.

Day two of the assessment is about progressions, coaching, and adapting strategies to real-world demands. Nothing generic. Nothing random. Everything tied back to what that person actually needs to do.

Why the System Feels Broken

A big issue is communication. Imaging specialists, physicians, surgeons, PTs, and pain management providers often work in silos. When no one connects the dots, the patient pays the price.

If systems allowed more time and better collaboration, most people wouldn’t need a multi-hour assessment just to be heard. But until that changes, complex cases require a different model.

Time isn’t a luxury for these patients — it’s the treatment.

BRIAN DOES ONLINE AND IN-PERSON COACHING!

Back Injured Average Mary or Joe who wants their life back

Back Injured Athlete Wanting to Return to Sport

Lift and exercise coaching & cueing to troubleshoot form

Program adherence & accountability coaching