When thinking about movement dysfunction, it’s useful to classify pain and injury in 3 categories; which I have arranged in most commonly seen in the clinic:
98 % of all dysfunction we see in the outpatient clinical setting:
Connective tissue imbalances (fascial tensional torsions creating massive compressive forces on the human frame)
I regularly see patients who lack significant mobility. However, it’s not just that they are stiff, it HURTS, and it HURTS in several places. In fact, when we start the evaluation and assessment portion of the treatment, we always find areas of restriction that the patient didn’t even mention in their subjective portion, but somehow it has severe tenderness and poor tolerance to touch, mobility and high irritability. These patients have had diagnostic images and structural integrity is seen, but their pain and sensitivity are that of something that is wrong. We look at posture (in standing and in supine), we put hands on them and feel the tensional loads that are unsymmetrical. We find, shoulder levels that are not even at rest, a forward head posture, unbalance pelvis, leg length difference, etc… and even though they have structural integrity, they are internally dealing with a roto scoliosis that is twisting them from unbalanced connective tissue forces. This is by far, the most overwhelming impairment in the clinical setting I have observed over the last 11 years of PT practice. It is not particular to gender, age, socio-economic status, education, activity level or fitness, I have treated 6-year-old to 90-year-old that show the similar dysfunctions, and we have corrected those dysfunctions with specialized manual interventions identified as Myofascial Release that is coupled with other forms of therapy interventions.
2 % of movement dysfunction in the outpatient clinical setting:
Pathology (something anatomically, cellular, endocrine, or neural has gone serious wrong in your human frame)
This category is in the realm of traditional medicine, and any good clinician is think on the level during the assessment and evaluation: “by what you’re saying your symptoms are, it sounds like the back pain you’re experiencing has characteristic of a kidney infection” OR; “I don’t think you are working out to much or pushing it too hard. By the sight of the of that bright red ring of that suspicious bite on your arm, you may need to get check out for Lyme disease”. Therefore Differential Diagnosis is a CRITICAL portion of any skilled clinician (I am currently an associate professor at Loma Linda University school of PT, where I give a lecture and lab on Differential Diagnosis) will ask about changes in bowl and bladder function, unaccounted for weight loss or gain, night sweats, dizziness, fever, nausea, or vomiting—just to make sure that “low back pain” isn’t “colon cancer”. Pathology is dealt with through traditional medicine and honestly accounts for a big ol 1 % or less of the total outpatient clinical visits.
Catastrophic injury (Great force was transmitted into your human frame by accident and caused structural failure, the other 1%)
This category includes getting hit by a car, falling off a bike, stepping into a manhole, having a 300 lb. lineman role into your knee, or slipping on slippery surface backwards. This is where modern sports medicine excels. Bad things are going to happen to good people every day. Reconstruction and injury management capabilities are at an all-time high. Fortunately, this category also falls into the 1 percent bucket.
In summary, even there is an endless categorical placement for all my patients, these three are the fundamentals and allow me to decide what type of intervention is best for my patient in the correct time frame. However, even in the minority group of pathology and catastrophe, the end result after healing and medical management is delivered is still…... connective tissue imbalances that come from a surgical intervention, prolonged bed rest, decreased weight bearing, poor body mechanics, changes in gross mobility and health.
My goal is to educate my patient on their pain, pain is informative and knowing where it’s origin and what to do with it is just as powerful as the intervention.
Be well.
Visit us at RendonPT.org, call us at 909-796-4342 or come in and visit us at 394 Commercial Rd, San Bernardino, CA 92408.