When recommending evaluation at other medical institutions

Most musculoskeletal pain cases can be initially directed through history taking and physical examination. However, for some symptoms, we recommend emergency tests, imaging studies, or evaluation by other departments to confirm the exact condition.

Guiding a referral is not a process of giving up treatment, but a judgment made for patient safety and appropriate treatment sequence.

If you experience a sudden loss of strength in your arms or legs, gradual weakening, dragging of the foot, or unstable walking, you must check for nerve compression and other neurological disorders.

Changes in bowel and bladder control and decreased perineal sensation are representative symptoms requiring prompt emergency evaluation.

For new pain in individuals with traffic accidents, falls from heights, or osteoporosis, as well as joint deformity and inability to bear weight, it is necessary to first confirm whether a fracture is present.

Before confirmation of fracture, strong correction and stretching are not performed.

If you have high fever and chills, severe heat sensation and swelling in the joints, immunosuppression, or recent surgery or infection history, we will check for possible infection. A history of cancer and unexplained weight loss, as well as pain that worsens even with rest, may also require further evaluation.

Sudden severe headache with changes in speech or vision, and paralysis of one arm or leg requires confirmation of a neurological emergency. Chest pain with difficulty breathing, back or shoulder pain accompanied by cold sweats, and sudden leg swelling with difficulty breathing also require prompt assessment.

Once emergency status and possible contraindications have been assessed, Chuna manual therapy, acupuncture, pharmacopuncture and exercise may be considered alongside relevant care if musculoskeletal function needs attention.

Sharing the examination results, treatment details, and current medications will help in creating a safe plan.

For major trauma and bone tenderness, assessment at a facility able to perform imaging may be recommended; for progressive weakness, a neurological or spinal specialist assessment may be recommended; and for high fever and rapid swelling, assessment at a facility able to test for infection may be recommended. Chest pain and shortness of breath, sudden paralysis and changes in speech require the use of an emergency medical system.

If you are unsure which department to choose, you can describe your current symptoms and warning signs and ask for guidance.

We will organize the time when pain began, whether there was trauma, changes in muscle strength and sensation, urinary and bowel symptoms, and systemic symptoms, as well as current medications. If available, also bring previous X-ray or MRI images and reports, surgical records and information about recent injection treatments.

It is more important to inform about when a test was performed and how the symptoms changed afterward, rather than simply stating that the test results are normal.

After fracture, infection and severe nerve compression have been ruled out, or necessary treatment has been provided, care for musculoskeletal movement and function may still be needed. At that point, check the treating healthcare team’s precautions and any surgical or procedure sites, then reassess whether Chuna manual therapy, acupuncture, pharmacopuncture and exercise are appropriate.

Collaborative care and treatment at a Korean medicine clinic are not competing alternatives to be chosen between, but rather a process of determining the sequence and dividing roles based on the patient's condition.

Even if the condition initially appeared to be a general musculoskeletal pain, during treatment, muscle strength may decrease, sensory loss may spread, or new symptoms such as high fever, rapid swelling, and night pain may appear. At this time, we do not repeat the previous treatment as is; instead, we re-evaluate.

It is important not to overlook neurological and systemic symptoms simply because the pain has decreased.

It is important to note changes such as worsening pain, rapid decline in muscle strength and sensation, and alterations in bowel/bladder function, consciousness, speech, and breathing. Even if pain has decreased with analgesics, rapid evaluation is necessary if such changes occur.

Even if no serious abnormalities are confirmed in the emergency examination, pain and functional limitations may not have actually disappeared. After ruling out dangerous conditions, joint and muscle function can be reassessed through history taking and physical examination to determine the suitability of Chuna manual therapy, acupuncture, pharmacopuncture, and exercise. If a new risk signal arises, we will conduct a joint consultation again.

In a Korean medicine clinic visit, if fractures, infection, progressing neurological abnormalities, or other organ diseases are suspected, imaging examinations and emergency or specialist consultations may be recommended. This does not mean giving up Chuna manual therapy; it is a process to first identify any current issues that are most dangerous or could change the treatment decision.

If pain and restricted movement persist even after ruling out an emergency condition during examination, the suitability of Chuna manual therapy, acupuncture, pharmacopuncture (pharmacopuncture), and exercise can be reassessed based on the examination results. Sharing information on symptom progression, examination results, prescribed medications, and treatment responses between medical institutions can help reduce unnecessary duplication.

Referral to another medical institution is not a failure of treatment at the Korean medicine clinic, but a safe sequence that first identifies dangerous conditions and issues requiring a change in treatment decisions. If pain and functional limitations persist even after ruling out an emergency condition during examination, you can share the results to reassess the suitability of Chuna manual therapy, acupuncture, pharmacopuncture, and exercise.

After consultation, it is preferable to confirm not only the test names but also which dangerous conditions have been ruled out, activity restrictions, medications to take, and criteria for follow-up. When using multiple medical institutions, share test results and treatment responses to avoid unnecessary repetition of the same examinations.