MUSCULOSKELETAL MEDICINE

DIAGNOSING DYSFUNCTION

1. Structural Diagnosing is the black and white way of thinking about illness, it is based on anatomical pictures, physiology books, and biomechanical principles. For example, a patient is having pain in their left shoulder, doctor takes an MRI of the left shoulder, the doctor diagnoses a left rotator cuff tear, the doctor performs surgery to "repair" the torn muscle, the patient presents to a physical therapist to rehabilitate their left shoulder. This is considered the Old School type of medicine, and is the standard type of care in America because it's easier, quicker, and "cheaper" to diagnose through clinical tests and imaging. But, one could argue that a lot of healthcare dollars and bodily suffering is being wasted on unnecessary surgeries due to convenience.

2. Functional Diagnosing is based on the overall ability of a structure or physiological system to perform it's job within a multifaceted human system. For example, a patient presents to a doctor for left shoulder pain, the doctor refers them to a neuromusculoskeletal expert (a Physical Therapist) for functional diagnosing. Upon initial examination the physical therapist assesses the individual's overall ability to function and move, all while documenting flaws within their movement patterns that could be causing their current complaints. Is the left shoulder pain caused by scapular dyskinesia, clavicular malformation, thoracic mobility, cervical nerve root irritation, or much more. The human movement system is complex, therefore the diagnosing should be precise and multifactorial. Through specific palpation, mobilization, and tools physical therapists can determine why there is dysfunction in the movement system and what is causing tissue damage to the individual in the first place. This allows the therapist and the patient to come up with specific goals for bettering overall function, rather than just assuming that the patient needs new parts (ie surgery). This type of medicine is a lot less invasive, more personable, and allows for healing on multiple levels. Although this type of medicine is more difficult to diagnose, it allows the patient to be treated as a whole and not broken into parts for treatment. This is considered a New School of medicine.

Injuries & Movement

Pathokinesiology (aka Injured Movement) refers to the idea that moving after an injury will lead to dysfunctional movement patterns. Those dysfunctional movement patterns will further lead to a functional disability if not corrected. Making it difficult to perform every day tasks, and causes pain and suffering. In simpler terms, first came the injury then came the dysfuction.

Kinesiopathology (aka Movement Injury) refers to the idea that repetitive dysfunctional movements will lead to impaired bodily structures and impaired functional recruitment. Too much of this will cause repetitive microtraumas to happen (like sprains and strains). Major dysfunctional movement can cause major injury aka macrotraumas (like a fully ruptured vertebral disc or a fully torn ACL). These types of injuries can disable a person and seriously affect quality of life. In simpler terms, your dysfunctional movements caused you to become injured.

Movement Precision

Variety and Variability are best for motor development, motor control, and motor learning. Our bodies were meant to move in three planes (Sagittal, Frontal, and Transverse) therefore we should train them for that. Training in this manner will allow supporting tissues to retain optimal kinesiologic behavior. Don't wait to accidentally find out that you were lacking neuromuscular control in a certain plane of motion, be proactive.

The Joint By Joint Approach

The human body can be thought of like a stack of joints, one piled on top of the other. Each joint serves a specific purpose within the human body. This chart describes the primary needs of some of the major joints in our bodies. Notice that from the ground up, the purpose of every joint alternates from mobile to stable. When one of those joints is not performing its primary role within the movement system, the adjacent joint has to pick up the slack, this often leads to injury. Therefore, it becomes crucial to assess neighboring joints after and before injury. This will ensure optimal movement and performance.

Common Muscular Dysfunction

This list represents common muscular imbalances in the human body and is a good start for movement evaluation. Tonic muscles tend to have a lowered irritability threshold, are readily available with all movements, and often lead to impaired movement systems, dysfunction, and decreased mobility.