Vail health column: Injuries vs. ailments
May 30, 2017
The majority of my sessions get off to a similar start. When I ask someone to tell me about their injuries, the response includes something along the lines of "I have arthritis, a herniated disc, a torn rotator cuff, a labral repair and a joint that needs replacing." Are these injuries or ailments? There's a big difference.
I suppose it comes from years of filling out medical forms. They want us to list where we hurt and how would we rate the pain (1-10). Next to that is a space for us to list our surgeries. That's what we learn to equate with a medical history. Where it hurts and what's compromised. That's not a history, it's a snapshot. We look at the bits that are hurt and broken, but what about the back story? There's a story behind the pain — the injury.
When I ask a patient to tell me about their hip injury, it goes something like this: "I Googled it, and talked to my friends and we think I have a labral tear." My response, "I'd be surprised if you didn't."
Research shows that 69 percent of people with zero hip pain have labral tears of the hip. (Am J Sports Med. 2012 Dec.). In this case, the labral tear is the ailment. The imaging may show something is amiss in the hip, but it doesn't explain why. It's the injury I want to know about.
At some point in your life you were pain free, with perfect anatomy. And then something happened. You broke a toe, sprained an ankle, jammed a hip or fell on your tailbone. These are the injuries. These are the back story to the pain. They cause a cascade of events. An injury to the big toe changes the options available to the rear-foot, which impacts the mechanics at the knee, which alters the possibilities at the hip and so on up the chain. The labrum in the hip got torn (ailment) because the mechanics down-stream rendered the hip incapable of proper function.
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This person may have experienced pains in their ankle, knee, hip and back. They likely had each ailment treated in isolation. Nobody addressed the back story (injury). Follow the crumbs back to the beginning. The body can only use the options available to it. If that jammed toe never gets addressed, then with every single step, the body will continue to not do what it can't do. It's not a matter of being weak, tight or broken, it has lost options.
Restoring function is about restoring lost options. I use anatomy in motion. This looks at every joint from the big toe to the skull and what each does in 3-D during every phase of gait. The injury history helps guide me to the root of the problem.
An old ankle sprain may leave a person unable to "land" on that foot. Or a hit to the hip may render a person unable to shift to that side. We do a full body interview to look for what's missing. By using wedges and 3-D movements, we restore lost options.
We're an intricate constellation of moving parts. A change in one part impacts the whole system. Rather than chasing the pains, we want to figure the back story. By backtracking and addressing the injuries, we address the source of the pain. By restoring options to the source, the body is given a chain reaction of possibilities.
Julie Peterson, MPT, owner of Concierge Physical Therapy, has a strong background in manual therapy and functional movement. She can be contacted by email at info@conciergePTcolorado.com or by phone at 970-306-3006.
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