Our brains like clean and simple solutions to complex problems. We like linear ways of thinking in the sense that A + B = C, or A before B before C. Hence why we as humans have developed endless algorithms to help us not only in day to day life, but in how to make decisions.
Now most of these algorithms are very important. For instance, if you walk into a hospital at 3AM and the overnight staff is present, you want to make sure you are treated the same way and go through the same process as if you were working with the day crew coming in at 10AM. These sorts of algorithms are needed for the cooperation and order of most of the systems we rely on every day.
When we try to apply these rules to things that do not follow order we end up with chaos. The human body is a perfect example. As healthcare professionals we all try to find the best system, algorithm or thought process to care for each and every patient, but with so many to choose from, each promising success, how do we know what is right? The answer is they all are, and none of them are.
Following our clean thought processes we like to think as the brain as a computer and the body as machine. The computer stores countless amounts of information and patterns to help us execute movement. Much like a machine we also like to think that we all need the same parts, and for those parts to be working together in order to produce movement. What if this was not the case?
We liken our brains to computers well because computers are the highest form of technology. 100 years ago we would have said our brains are like a steam engines. They do not “store” patterns, and they do not really operate like computers when push comes to shove. Classically trained as mechanics we also think that the body is like a machine and the whole is greater then the sum of the parts, but how do I know you have the same muscles as me, arranged in the same way? Furthermore what if your bones have adaptations such as torsions or length differences based on your environment and previous experiences – this will take specific assessments to rule in or out, and ultimately mean you should look and move differently then me to be safe. So before you go trying to bend in yoga like everyone else, do what feels comfortable first. If we all do not look the same, act the same, or “feel” the same why do we expect everyone to move and be treated the same?
Movement is something that should be felt, not expected, or forced into a particular linear way of thinking. We know that most, if not all, of the systems and treatments out there “work“, to some degree or another, but how we decide to implement them is what is important. All too often we forget that we have the best tool right in front of us to decide. The patient.
Imagine we were working out. Say doing bicep curls with our right arm. We work up the next day and our left foot was killing us. We would not think that was “normal”. The same goes for squatting. If you squat, say your back hurts, you clearly are not squatting correctly. Let’s apply this to patients. Most patients will come in with a particular complaint during a certain movement or movements. So why not assess their chief complaint and see if we can guide them into “feeling the right thing”. We often talk about movement and our external environment. This cue will try to lead the patient to understanding their internal environment.
Let’s go back to our squat assessment. A lot of athletes we work with complain of back pain during a squat. So I will ask them to simply lift the bar/kettelbell/etc and ask one question even before they move: “Where do you FEEL this?” In most instances they already report increased pressure into the area in pain. So if even before they move they are loading that particular area of their bodies, why would we expect the load to go anywhere else? The next step is simply: “Can you move your body/change position to NOT FEEL the load there.” This will often lead the client on a bit of an exploration (aka play?) to take the load out of their painful area.
Now here is where it gets fun, by asking them what they needed to do we can start to make decisions on treatment. For instance if they shifted their weight to the right, we may need to strengthen the right leg/hip, if they drew their ribs down, squeezed their shoulder blades we can direct treatment to the trunk. Once we ask them to now maintain their new position and move they will often feel weaker, but most times we will see a reduction or complete elimination of pain. Now they need stability in their new position.
This strategy is not without limitations, it also requires the patient to have a bit of humility. Changing your form or how you have always “moved” (or squatted) may mean you cannot do as much load or as many reps, but what is the goal? If the goal is to work out for today, then this might not be a good strategy, but if it is to work out for more tomorrows then I will take consistency and over intensity every time.