If the diagnosis is a structural problem, then the location of pain is almost always where the structural lesion is. Structural lesions with bones, muscles, tendons, ligaments, discs, cartilage, and menisci create local symptoms. The main exception is when structural lesions occur with nerves, in which case symptoms can travel along the nerve. So if what you suppose is a problem in a structure changes location, it’s more likely that instead of there being a problem with the structure, there’s a problem with how things are functioning - which is the majority of problems. With functional problems (that is, something is not working well instead of a structure actually being broken), it's common for pain to change location. Muscle strain, tear, pull pain doesn't move. It's where the strain, tear, pull is. -- Laura
Simply put, therapy makes something that isn’t working, work again. Performance, on the other hand, makes something that already works, work better. There is overlap between the two realms, but it’s not as large as many seem to think. If you understand how to fix a torn muscle, you likely have a basic understanding of how to maximize performance of a normal muscle. Likewise, if you understand how to make a normal heart become more efficient, you’ll have modest knowledge of what happens when something goes wrong.
Having been a relatively high-level athlete myself, I am comfortable in the world of performance (fitness and sport performance). However, that is not my expertise. As I value expertise, I advise people within my area of expertise (orthopedic therapy) and refer people to other professionals for guidance in other fields.
Do you run a 9-minute mile and want to run a 6-minute mile in 3 months? Do you want to improve your vertical leap by 25% before next season? My role in these situations is to ensure no orthopedic problem is stopping you (which is an important step!). That it, things work well, they are just not conditioned for that higher level of performance. While I could certainly help in the performance realm, if you want the best, most efficient training plan, I am not your person.
Overlap most concretely occurs when a high-performing patient is nearing the end of therapy. My job is to restore a patient’s body to the patient’s individual normal. If her normal is playing professional soccer and I can get her only 75% of the way there (at which point her body is way above universal norms), that is the time for a performance specialist to take the lead to get her to 100%. -- Laura
It is not uncommon to hear “My left leg is just not as stable as my right” or “I lack control placing my right foot on runs” or “My balance is much better on one side.” I haven’t encountered people voicing this about their arms, but it could certainly manifest in the upper body as well. I won’t say it’s always, but it seems like in all cases when patients have complaints about a lack of stability in one leg (not a specific joint, but the entire limb), it’s a spine issue.
Again, if we think of the spine as the fuse box, it makes sense that an irritated spine could create these somewhat vague complaints in the limb. While “instability” is usually a good, appropriate descriptor, it’s also often a lack of control, responsiveness, and/or balance. What I’ve seen people call “dead leg syndrome” on blogs is most likely an example of this too.
Don’t make the mistake I made. Years ago I noticed a marked difference in the stability between my right and left lower extremities. Leaning against the wall in the hospital one day with my legs about a foot from the wall, I could balance fine on my left leg when it was placed under my left hip socket, but failed miserably to do so on my right side. I spent close to a year doing relatively fruitless single leg strengthening and balance/coordination exercises. It got better, but not by much. Some time after that (having given up on making progress and having gotten into MDT), I remedied the issue with directional preference movements of my low back. -- Laura
When discussing athletic performance, we think of coaches, strength and conditioning specialists, trainers, and so on, but my role comprises the foundation. Power, balance, and mobility are certainly trainable, but if your body is not fully normal to begin with, training will only get you so far. If performance prowess is your goal, you need normal nerve conduction, nerve extensibility, strength, mobility, biomechanics, etc. first. (Having no symptoms doesn’t mean everything is functioning normally.)
Consider jumping. If there’s even a slight derangement (painful or not) in the lumbosacral spine, the electricity supplying necessary muscles can be impeded. Tiny malalignments in the foot, ankle, knee, hip, or spine joints can affect strength, mobility, balance, and movement patterns with jumping. Abnormalities with muscles or tendons themselves (rare) will also impact jumping.
My expertise is in ensuring people have normal physiology before they go train to make it exceptional. (There are, of course, some allowances.) Perhaps most importantly, I teach people how to self-assess and self-treat so they can always perform with optimized physiology. It takes only minutes. I believe that many “off” days are due to minor, transient joint malalignments - which can easily be self-detected and corrected if you learn how. --Laura
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