“Find it, fix it, leave it alone” may be more accurate if someone added “repeat ad infinitum”. Addressing joint restrictions without addressing the biomechanical fault that likely created the problem is like beginning fire restoration before the fire is out.
A key to successful long-term improvement is identifying the weak link in the kinetic chain and employing appropriate rehabilitation to decrease the chance of future pain syndromes. A structural diagnosis is not sufficient to decide on treatment. Analysis of functional pathology is necessary. For example, alleviating anterior impingement of the shoulder without correcting underlying scapular dyskinesis may result in recurrence. Deficits in hip stability leading to low back pain or temporomandibular disorders perpetuating headaches or improper breathing patterns that overwork and destabilize the spine are other common examples of overlooked primary contributors. Evaluation of the locomotor system can be achieved through the movement screens developed by Vladamir Janda, Pavel Kolar, Grey Cook, Gary Gray, etc.
When stability deficits are present, D.C’s must teach new neural patterns that will enhance not only our patient’s confidence (self-efficacy), but also their motor control. Exercises may start on the floor to “groove” a pattern such as the plank. Care should then progress to more functional movements. The work of Stuart McGill has been pivotal in identifying exercises and movement strategies to reduce spinal load. Exercises should always target the weak link and not necessarily the painful muscle, ligament, or joint.
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