1. Actual inflammatory disorders, like rheumatoid arthritis and other ‘collagen-     vasular diseases’.
  2. Nerve damage/injury—stroke, severed or damaged nerve fibers following accident or surgery, or an actual neuropathy.  Some numbness and tingling in hands and feet is incorrectly diagnosed as ‘neuropathy’ when it is in fact arising from stretch-induced nerve damage in ligaments and tendons.  The nature and distribution of these ‘referred symptoms’ are easy to differentiate from an actual ‘neuropathy’ in the office.
  3. True ‘sciatica’, which is quite rare and which generally puts people in bed and on narcotics.  The nature and distribution pattern of these symptoms can easily distinguish ‘true’ sciatica from referred connective tissue damage symptoms.
  4. Actual spinal stenosis.  Actual spinal stenosis causes problems holding urine or feces, and causes numbness in a ‘stocking’ or ‘pantyhose’ distribution in the lower extremities (the entire foot, or the entire leg, instead of in part of the lower leg and foot, for instance), weakness that causes people to have trouble walking without falling, and muscle atrophy.  If the problem is simply pain in the back and scattered symptoms down the leg or legs, then there may well be a connective tissue problem causing ALL of these symptoms.
  5. Joint damage so severe that, not just the cartilage, but the bones of the joint surface are badly damaged.  This is an indication for a joint replacement.