I agree absolutely. It is axiomatic that any diagnosis, particularly with vaguely defined symptoms, be illuminated by careful clinical assessment. However to aim to do an "all-encompassing assessment" on every patient is neither practical nor productive. On the principle that common things occur commonly the most likely diagnosis should be considerd as a hypothesis to be confirmmed by a limited but focussed assessment. This could include a "theraputic trial" of standard physiotherapy modalities, or something like trying a walking stick, as suggested. At the end of the day the search is for a benefit, not a diagnosis. If something works it doesn't matter how or why it works (at least for that patient - questioning the mechansm of how therapy works is most useful in appraising potential management of subsequent patients) JP Driver-Jowitt