I believe that they will find small fiber nerve damage in these structures for several reasons:  1.)  it explains the tenderness; 2.) It explains the pain; 3.) it explains the associated muscle malfunctions; 4.) it explains the potential for creating ‘distant’ referred sensations; 5.) it explains the potential for creating distant ‘autonomic nervous system’ symptoms, like migraines and voiding dysfunction; 6.) it explains why all of these go away when tensile strength is added back to the structure; 7.) it explains why these symptoms go hand-in-hand with situation where there is obvious ‘stretching’ in the ligament structure around joints, with physical evidence that includes damaged discs (due to abnormal mechanical forces on the disc due to abnormal motion of the bones), cartilage loss (due to abnormal abrasive forces at the joint surface due to ligaments which are not holding the bones in correct alignment), meniscus and labrum tears (which also reflect the humerus or femur moving abnormally and damaging supporting structures in the joint);  8.) it explains why the ‘pain associated with this or that seen on imaging studies’ can go away, while the things seen on these imaging studies do not change at all.  My back probably still has several degenerated, bulging, ruptured discs, foraminal narrowing, spondylolisthesis, bone spurs and bony changes commonly referred to as ‘arthritic’.  But, since my back has not hurt for the last ten years, do I care what these structures look like on my film?  No, i do not.  Do people with thinned cartilage in their knee, but no knee pain, care how thick their cartilage is?  Particularly if the ligament laxity that allowed their knee to be damaged is tightened, and the structure is no longer being damaged by use?

There are a number of scientific studies which call into question the ability of MRI’s to ‘diagnose’ back pain correctly, so my skepticism about the role of those studies is not unique.  But I also have a high degree of confidence in the ability of a physical examination to offer just such correct diagnosis in the back, and in every other joint and area of the body.  How do I know that I can successfully find ‘the actual’ source of symptoms, and ALL of the symptom-causing structures?  Because my treatment solutions all have a numbing medication.  I am numbing, as well as treating, each structure.  If I can make the patient’s symptoms resolve using the numbing medication in the structures that i treat, what would this tell you about WHERE THESE SYMPTOMS WERE COMING FROM?  And, if I can find such symptomatic damage, I can also effectively treat this damage with a high degree of success. Welcome to the world of Prolotherapy.  And now you understand, at least conceptually, WHY I believe such a palpatory examination can be so useful.