Co-morbid disease will be used here to refer to two different scenarios.  In the first, the patient has a pre-existing disease/pathologic state that effects the approach to functional movement treatment and/or fitness.  In the second a non-musculoskeletal condition can present as a musculoskeletal condition or vice versa.    These are among the reasons why treatment needs to be PCP centric.  This approach is no different than cardiology or neurology, which have cardiac surgery and neurosurgery respectively.  The current approach has surgeons, orthopedics surgeons, but not a corresponding internal medicine branch.

Pre-existing Dise
ase/Pathologic State:  The list of disorders patients can have which need to be accounted for with functional training and/or fitness could fill numerous textbooks.  These include:

-Cardiovascular disease (ex: angina and hypertension)

-Pulmonary disease (ex: asthma)

-Neurologic disease (ex: imbalance, spasticity)

-Nutrition (ex: dehydration, B12 deficiency)

-Rheumatologic disease in remission (ex: rheumatoid arthritis)

-Endocrinology (ex: diabetes)

In the picture to the left, is the women’s left arm pain due to a heart attack, a pinched nerve in her neck, angina, a biceps muscle tear, neck nerve compression, or another pathology?

Non-Musculoskeletal and Musculoskeletal Diseases Resembling Each Other:  Examples where the two are difficult to differentiate include:

-Anterior groin pain (ex: femoral neck fracture versus ectopic pregnancy)

-Fatigue (ex: dehydration versus polymyalgia rheumatica versus overtraining versus peripheral vascular disease)

-Middle of back/interscapular pain (ex: muscular fatigue versus aortic dissection)

-Hip pain (ex: bursitis versus tumor), stress fracture (ex: overuse versus osteoporosis)

Does the women in the image to the right have groin pain from a femoral neck fracture, ectopic pregnancy, abductor muscle strain, inguinal hernia, kidney stone, or some other pathology?  These cases illustrate why we feel the approach needs to be PCP centric.

“In general we are not treating young ‘heathy’ elite athletes in our patient population.  For this reason, the approach in these patients needs to be PCP centric for more effective treatment of patients, improved fitness programs, reduced risks of bad outcomes, and liability risk reduction.”

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