Patients speak to me before they say a word. The way someone favors one leg walking into the exam room. The way they tense up as they reach for a chair. I learned to read those signals years before I became a physician, because I was a physical therapist.
That training shaped how I think about pain today. Physical therapy is built on functional movement, how one joint compensates for another, or how a limp from hip pain can strain the lower back. I still think that way in an exam room, and it shows up daily in how I practice interventional pain medicine. When I read an image or consider a new in-office procedure, I ask a functional question first: how does this diagnosis affect the way the patient moves and interacts with their environment.
That question shaped how our practice built its approach to care. Whether the diagnosis is stenosis or scoliosis, the plan starts with the person in the chair, not the image on the screen.
Patients are more than their imaging
The exam begins the moment a patient walks into the room. I analyze how they walk or how they sit on a chair, because it tells me important information patients do not divulge in their history. Once we’re talking, I’m listening for how they’ve been living around the pain rather than through it. Those accommodations can often signal symptoms that are causing the greatest impairment.
From there, I ask about what remedies they have already attempted and review any related imaging. Imaging matters, but not the way people assume. An MRI is a snapshot of anatomy, but it doesn’t explain how a patient sleeps, works, walks or manages the routines that matter most to them. This is where a physical therapy background becomes an asset. When I read an image, I can identify the problem, trace the axis of pain, and determine which downstream structures have started compensating. A disc problem at L4-5 can present as hip pain, or as a limp that has nothing to do with the disc itself once the body has spent months working around it.
Considering patient history, visual cues and previous treatments alongside medical imaging gives me the full story. Take two patients with similar L5-S1 disc herniations. One can barely cross a room because radicular pain has taken over daily function. The other has mild, manageable discomfort that responds to targeted exercise. Treating them the same because their scans look alike ignores the one factor that decides the plan: how the condition is affecting each person’s life.
Does the treatment plan fit the person sitting in front of me? That’s the standard I hold for all treatment plans.
Getting people back to their lives, not baseline function
“Functional” is a clinical word, and it can flatten what matters to a patient. For one person, success looks like getting out of bed without help. For another, it means getting back on the pickleball court by spring. Both are legitimate goals, and they call for different plans even when the underlying diagnosis looks identical on paper.
At Florida Spine Associates, the goal isn’t moving a number on the pain scale. It’s calming an inflamed nerve root enough that a patient can fully participate in physical therapy again, and restoring the motion that chronic pain has slowly taken away.
My background in physical therapy shapes how I evaluate a patient and allows me to better collaborate with their team of providers. When I can understand how a certain care plan will affect their mobility, I can offer better advice to physical therapists on rehabilitation or create a customized post-operative plan with our surgical partners. Collaboration is the point. Leaving any of those off the table because a diagnosis fits neatly into one specialty is how patients end up cycling through providers instead of getting better.
A shift toward prevention, not resolution
The future of spine care looks more individualized than it does today, not less. As imaging and diagnostic tools keep improving, the harder and more valuable work still comes down to one question: what does this mean for how this particular person functions, not just for their anatomy. That’s the question I learned to ask as a physical therapist, long before a lot of this technology existed.
Spine care, like much of medicine, is moving away from a model built around fixing problems only once they’ve become severe enough to need a solution. We’re experiencing a paradigm shift, one that moves our industry toward a model that measures success by how a patient lives. That shift aligns with what patient-centered care has always required: understanding what matters most to each patient and helping them return to the activities they enjoy, rather than focusing solely on what shows up in their chart.
Dr. Burrough is a board-certified anesthesiologist with subspecialty certification in pain medicine, and a founding partner of Boca Raton-based Florida Spine Associates
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