Now when I ask the WHY, I don't expect to hear answers like "arthritis, bad ankles or old injury". These are not the "WHY", they are simply contributing factors. I'm looking for "whys"! You USED to be active. You USED to be pain free. You USED to be able to touch your toes. You USED to be able to roll over with minimal effort. Now? Not so much, yeah? I know what I'm capable of doing and have a good understanding why, but then again thats my job. Do you know why you can't touch your toes? I'll be willing to bet it can be isolated to 3 possibilities: Tissue, Joint or Motor control!
In the Selective Functional Movement assessment there are 3 possible explanations (aside from anatomical variations, congenital or acquired) and they are as follows: 1. Stability Motor Control Dysfunction (SMCD). 2. Joint Mobility Dysfunction (JMD). 3. Tissue Extensibility Dysfunction (TED). With any dysfunction, usually indicated by the presence of pain, there will be either a stability or mobility dysfunction and in some cases both can be present. So what are these 3 categories, allow me to explain.
The Stability motor control is the neurological side of things where the brain has forgotten how stabilize a joint during active motion while in a weight bearing position. In the scenario where a patient can't touch the toes while standing but can do it while sitting on the ground, it tells me there is something wrong the brains understanding of stability somewhere in the posterior chain. At which point we would issue motor control exercises to rewire the connection (so to speak) for the brain and retest for improved stability.
The Joint mobility Dysfunction (JMD) is much simpler in nature. It is very simply what it sounds like. It's what we use to label a joint that cannot physically move, active or passsively, with in the normal anatomically accepted ranges of motion. At this point the joint is "stuck" or "subluxated" and is in need of mobilization or chiropractic adjustment to reintroduce the proper motion in the joint. A good example would be when a patient is unable to touch their chin to their chest in either a vertical or horizontal position, actively or passively.
The Tissue Extensibility Dysfunction (TED) is similar to the JMD in that they are both mobility issues. Obviously they differ in the nature of the mobility restriction, but they can be equally troublesome. In this case the active/passive ranges of motion in weight bearing and non weight bearing are are restricted. The difference is noted in the passive range of motion when the end point of the joint is a soft "bouncy" feel to it, while theJMD has a "hard" stop to the motion that is finite in nature. For the patient, the TED illicits a "stretch" in the hamstrings (back of the leg) when touching the toes and the JMD would be pain in a joint when being pushed to end range.
If you are in pain, annoying or debilitating, you have dysfunction and all the aspirin, advil, TENS units, copper wraps, kiniesiotape, pain pills etc. are gonna fix it! The only way to fix it is proper assessment, diagnosis and treatment will get you started in the right direction. after that its up top you to put in the work. Improving dysfunction is not a passive activity. You can't just sit there while the doctor or physio does they're magic to make you whole again, we all saw how well that worked for Humpty Dumpty!! As a responsible physician I can only tell you what is wrong and provide a little guidance, but you have to put in the effort to make it work!! So let's get you feeling better together and see where it takes us!! look forward to seeing you in the office!