Remember when your hip ached for no apparent reason and then it just went away a few weeks later? Or when you woke up with a stiff neck and after a day of moving around it got significantly better? I find most orthopedic aches and pains stem from joints not moving well. It’s easy for joints to get disturbed (especially given we tend to move them predominantly only in a few ways), but these problems often cause only minor complaints which do self resolve. Just continuing to move, possibly with a little rest, usually allows the joint tweak to work itself out.
In contrast to what most orthopedic clinicians believe, I don’t think that neuromuscular reeducation, strengthening, or passive modalities like laser are usually required. If they were so essential, I don’t think we’d see so many aches and pains resolve without them.
People that seek medical care, people that I treat, typically have these joint issues, too - they just haven’t gotten better on their own. What I find is that while most of these people do need movement, certain movements are better than others. Often we have to minimize the movement that seems to be perpetuating the issue as well. I typically have patients do just one movement at a time. Of course I do find some people have tendon, muscle, or nerve problems - and they get treated differently. However, I find around 80% of patients’ complaints stem from joints. In the McKenzie method we call them joint derangements. Mulligan calls them positional faults of the joint. -- Laura
Even small, very-fixable problems can cause a lot of pain (or other symptoms). And very often that pain is magnified or compounded by fear - fear of more pain; fear of not being able to move, to work, to return to exercise; fear of the need for invasive treatment. If people had a basic understanding of how the musculoskeletal system worked, they would be better equipped to fix their problems themselves. More importantly, though, they would not have to be so afraid and anxious as they would know that almost all problems are fixable with movement.
I severely burned my hand once. Despite immediately submerging my hand into an ice bath, the pain was intense. As I cried, I repeated aloud to myself: it’s just pain, it’s just pain, it’s just pain. I intrinsically knew it wasn’t something that was going to cause any real problem and I wanted to assure myself that I had nothing to fear. In essence I wanted my cognitive brain to override my emotional center and let the facts win. I simply had to minimize the pain as much as I could, get through it, and I would be fine. People often know this when it comes to cuts, bruises, burns, and the like. They know that despite pain, they don’t have much to fear. This needs to translate to musculoskeletal problems as well. -- Laura
Let’s say I am helping someone fix her shoulder derangement. If I have the correct diagnosis, I expect significant improvement quickly with an exercise in a specific direction - and eventual 100% return to normal. Let’s say we figure out that direction (often it’s extension or functional internal rotation). By finding that positive response to that direction of movement, we confirm our diagnosis and therefore establish a reasonable prognosis.
Now, here are other factors that could affect the ability to get the problem 100% resolved: patient’s shoulder position at work, at play, while sleeping; patient’s compliance with the home program; patient’s performance of the exercise; stress level; diet; lifestyle factors (eg smoking); other health issues; environment; genetics; patient’s belief system/expectations; how the problem affects the patient’s life; and other people’s input/opinions.
For this reason, I often use the words “should,” “likely,” and “in most cases.” Yes, there are many problems that, in my head, I think are 100% fixable; but I know that, until something is 100% fixed, it’s not a given. There are numerous factors when it comes to addressing problems with the human body and mind. As a clinician, I set expectations based on interpreting all the available data. -- Laura
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