My approach
I could bore you and tell you the techniques I use to treat people, however, I do not think that is the best way to describe my approach to neuro-musculoskeletal issues. I think an obvious challenge when departing from school is that the protective membrane that the institution provides is gone. I am currently spending a lot of brainpower trying to understand what I think a good practice looks like and what would excite me to go to work daily. I can tell you for free it was not case report writing. The goal of this blog will be to elaborate on my Instagram posts. I can not stand those really long wordy IG captions, so this is the solution. A blog written by a poor writer, enjoy!
Anyway here is where I am at:
Most injuries that I have seen in practice have no real mechanism of injury. For example, Jimmothy does not typically come into the clinic to tell you that he was hit by a car and his knee was driven medially. *Unfortunate shout out to Nick Chubb and RIP my fantasy team* The history describes a clear potential mechanism that will then guide the physical examination. In Jimmothy’s case, he may have some torn ligaments and require a surgical consult along with pre-hab and rehab.
More often I see something like — Jimmothy comes into the clinic and tells you his knee hurts. Orthopedic tests are unremarkable, he feels some tenderness on the inside of his knee. His pain is usually felt after long bouts of standing and the day after running. The diagnosis is as murky as the physical findings, let us just call it a meniscus irritation. Easy peasy, throw a laser on it and you’re done, thanks for reading. Just kidding this is not Star Wars. Ok let’s rub the knee to make the boo-boo feel better, that may work, but that does not work for me.
What I think we should consider is - how can we optimize movement to dissipate forces. To simplify that statement we could look back to our pal Jimmothy — we can postulate that there is an increased concentration of load causing the tissue of the medial knee to at the very least sensitize. How can we use soft tissue therapies, joint manipulation, and exercise to change the way force is distributed in the body? This is a good time for a shout-out, Dr. Wishloff offered me the opportunity of mentorship. I was able to spend 3 months watching how she was able to treat both the symptoms and the system. For a new practitioner, this was revolutionary and puzzling simultaneously. The inspiration leads you down a path where you want to understand and ask questions like yes their knee hurts but — how is the spine moving? How about the foot? Did you look at the hips? Additional considerations are — does the joint have that range of motion? Is the range of motion full but they can not control the full range? Can they control the full range but lose control at a certain load? To summarize how my approach has rapidly changed over the last few months. The issues I tend to see are chronic mechanical issues, therefore, we may take a mechanical approach via movement-based therapy which can yield a great deal of patient autonomy and also keeps me percolating.
There will be more to follow. Oh, and for you folks who just love strengthening things. Yes, mobility is not always the answer, however, if a tissue is being overloaded- is it not a reasonable first step to try and redistribute the load?
