Do non specific labels help or harm? 🤷‍♂️ (12/1/26)

This new systematic review in JOSPT on diagnostic labels has got me thinking about the whole specific vs non specific argument!

"The Effect of Diagnostic Labels on Treatment Preferences and Beliefs in People With Musculoskeletal Pain. A Systematic Review of Randomized Trials"

Here are some thoughts on the paper’s key points!

Firstly, “non specific” labels are likely not the best use of terminology, that’s a separate discussion, but conceptually it’s not a choice, it’s the reality!

Mechanical clinical tests just are not able to differentiate between different structures in the back, whether you like it or not. That’s the reality.

Movements at the spine, let’s take flexion for example, will load the disc, facet, ligaments, muscles, and pain from flexion might be because any of these structures are being loaded. It’s also important to remember these are a source of nociception/pain and not a cause of why the source maybe painful.

Should everybody get an MRI or diagnostic block to find the source of pain?

Some would say yes! But we also have research that says these diagnostic investigations can lead to harms such as more invasive procedures and influencing recovery expectations.

“Specific diagnostic labels may increase demand for invasive care and foster more negative recovery expectations” – JOSPT 2026

In fact, we know that one of the most important prognostic factors is expectations of recovery! So, you may satisfy the patients desire for one thing, but does that also effect the outcome later down the line!?

One thing to also consider is, even if you have a specific diagnostic label, do you have a specific conservative treatment? Just like the clinical tests previously discussed, using mechanical interventions such as manual therapy or exercise, are not able to apply forces independently to structures in the back either.

An exercise will load or move the disc, facet, ligaments, muscles, just like the tests!

We know manual therapy is pretty non-specific too. Both in the application of force, or the need to even be that region specific to get a change in pain.

Even a specific diagnosis such as radicular pain/sciatica don’t have clear specific interventions, multiple interventions and exercise types seem to have similar outcomes. Diagnostic labels are a lot like MRI’s! People want them! That’s really clear from current research. And just like MRI’s they likely need more than just the label.

“Non-specific labels may encourage non-invasive management but can contribute to patient dissatisfaction” - JOSPT 2026

 It’s the narrative that matters!

This applies to both specific and non-specific labels BTW

Helping people understand more about THEIR painful problem is really important, that should go beyond a structural label.

We actually know more about non-specific back pain than any other diagnosis in the MSK world but people act like we have no idea what’s going on : )

We can still address specific concerns and worries, specific lifestyle factors, specific education about natural history and things that might help.

Maybe it’s being specific to the person rather than the structure!