Other parts can be found here.
This part will deal primarily with the philosophy behind the book’s approach. I’m going to be rattling off quotes, along with commentary.
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“The breakthrough came with the realisation that some compensation strategies are normal adaptive coping mechanisms and do not demonstrate uncontrolled movement, while others are maladaptive compensation strategies that present with uncontrolled movement.”
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“Similarly, there is little recognition that painful conditions can be treated by correcting the movement rather than resorting to symptom-relieving modalities, drugs or surgery.”
The second quote above is from Shirley Sahrmann’s foreword. I’d add to the end of her quote, “icing, stim, massage, inversion tables, kinesio tape, etc.” One of my own goals is to minimize the amount of all this stuff, especially the amount of orthopedic procedures performed every year. Eventually, I’m going to write a series detailing the highly suspect value of orthopedic surgery.
I like to think of it this way: If you sprain your knee, you really twisted it, you don’t go, “Alright, time for surgery” in order to minimize symptoms. You go, “Ok, we don’t want to do that movement again.” And you slowly work some gentle, non-twisting movements, back into the mix. Chronic pain is typically similar. The movement might not be as extreme -your knee might not move in one direction as much- but the treatment is still the same: Find the movement causing issues, get rid of it; work on movements that don’t cause issues; often in a slow, gentle, mindful manner.
Sure, sometimes you’re missing an entire ligament, or something is torn, and surgery seems to make sense. Like ACL surgery or a partial menisectomy. Even then it’s not so clear surgery is worth it.
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“Normal or ideal movement is difficult to define. There is no one correct way to move.”
Very true! I wrote about this recently.
The authors mention you can still, for the most part, put people into classifications. But this quote gives the always there caveat of, “Well, you’re different.”
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“Disability is individual and what one person considers disability another person might consider exceptional function. For example, an elite athlete’s disability may be a function that most people do not have the ability to do, do not want to do or need to do.”
What’s poignant about this quote is how often everyday people still try to train like they’re athletes. Not only should an average person not do this, there is no need. You can look and feel great without training like a madman. Most professional athletes aren’t that healthy anyways.
“Clinical decision making should start from the patient’s perspective and interventions should be primarily aimed at those aspects of impairment that have a direct bearing on disability and/or functional limitations.”
I especially like the latter half of this quote. It makes no sense if you have issues with sitting in a chair, reaching into a cabinet, doing these simple daily things, to not be working on things which directly help these day to day movements.
An athlete’s training is, or at least should be, directly applicable to their sport. Often, this gets even more nuanced when you differentiate between positions. Pitchers train differently than shortstops. Quarterbacks differently than linebackers. Yet people who work at computer for eight hours a day are trying to train like “athletes?” Athletes don’t even train like athletes! Pitchers don’t train like an athlete, this vague notion of what exercising is, they train like a pitcher. They get much more specific.
If you have trouble getting up and down out of a chair, you don’t need some crazy program of heavy squatting, deadlifting, lunging, whatever. You need to work on how you get up and down out of a chair. 12 different glute exercises aren’t necessary. Often, you can get away with one exercise. That getting up and down out of a chair one.
This may be most true with the shoulder. Person has trouble reaching into a cabinet, yet the standard protocol seems to be do a bunch of pulling on therabands. Why not start with how this person raises their arm? You know, the thing they’d like to be able to do?
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The next few posts will still be dealing with philosophies behind the book, but I’m going to break a few points off into their own posts.
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Posted on March 25, 2015