I have been taught like a good British School of Osteopathy graduate to come up with a diagnosis.
I listen to your explanation of where the injury is located, what happened when the injury occured, what has happened since, the nature of the symptoms etc and then I examine you, looking for physical signs of injury or inflammation, or infection, or just musculoskeletal assymetry or altered movement patterns. All of this is to determine the tissue causing the symptoms.
Except there is rarely one tissue causing the symptoms. So I use the time-honoured format of including pre-disposing factors and maintaining factors in my diagnosis. The pre-disposing factors are those which are musculoskeletal and maintaining are others, such as lifestyle factors, poor mattress, stressful job etc.
Sometimes the list is extensive and it is like the song 'there was an old woman who swallowed a fly' with the problem getting bigger and bigger as insult piles upon injury, except that to make it more complicated you're often not quite sure in which order the injuries happened.
I only have to look to my own body for an example I have a flexed area between t5 and t8, I've had problems with my shoulders, painful ribs and also pain lower in my back at the TL and in the left sacroiliac joint...oh and tight hip flexors. How do I, or my osteopath, deal with all of that? We could either treat them as unconnected or try and find a plausible story to link them together. Why would that be useful?
It is useful to understand which problems are connected because one may have been caused by another and in turn may prevent the other from resolving fully unless it receives attention also, likewise if the initial insult isn't dealt with the newer problem may recur, even if it has been fully resolved, the pre-disposing factor hasn't been removed. It makes sense to me to prioritise the newest injury first, that way you are returning to a state you know the body was able to inhabit for a while, even it it may not be sustainable in the long-run. Removing the initial insult, if possible, would be to take the body to a new condition and may result in further compensations and new injuries.
So how does this apply to my body? I think there are 2 groups. I think the Sacroiliac Joint, hip flexors and TL are the newest group, dating back to an SIJ injury in Jan 2017. They are almost self-contained...except the TL dysfunction causes both twelfth ribs to, for want of a better word, get stuck and increase the tension in my rib cage related to the rib problems higher up
The T8 area relates to an injury about 5 years ago and actually appears to be one joint rotated left and another rotated right and both pulling in opposite directions
the T5 area injury is a joint that is stuck flexed (unknown timespan, at least 8 years) with associated ribs either side which sit are pushed proud of the bulk of the rib cage and cause tight intercostal muscles, and tipping forward of the shoulder blades, this in turn causes muscle pain from muscles which are permanently on stretch, I feel this most in the back part of the armpit where it joins the torso. The tipping forward of the shoulder blade also causes mechanical disadvantage to the shoulder and increases the chance of subacromial impingement and inflammation and also of muscle injury, particularly to the rotator cuff muscles and lo and behold I have had exactly those problems.
So where to start? Start with the newest problems, so the Sacroiliiac joint, hip flexors and TL, as a discrete set of problems they are quite manageable as a group for treatment and I am pleased to say have nearly fully resolved. The Problems around T8 next, they are very near to resolving also. Meanwhile work on the ribcage has been much more productive since the TL issue and the associated twelfth rib mediated tightness has gone, the 5th ribs are sitting a little flatter and the shoulderblades are less tipped. All this means the shoulders are starting to recover...but I'm well aware that this can't stop until the T5 issue is resolved, otherwise I will always be prone to bad shoulders and it may even be that the lack of movement through T5 area was a predisposing factor for the T8 TL or even the left SIJ injury.
So don't be surprised if you come to me with a bad shoulder and I'm interested in your pelvis. I may need to find the spider to remove the fly!