I routinely get asked by clinicians and other professionals alike the following question- “Why do you say that you hate to restrict movement unless you have to?” This question is usually followed up with something along the lines of, “What if the person is in pain, won’t increased movement irritate the issue?”
To me these are both great questions and questions that really should not need to be asked, but yes of course, they get asked. Let’s take a few moments to break down these two questions:
“Why do you say that you hate to restrict movement unless you have to?”
My initial response to this question is pretty simple. We were meant to move- If I restrict movement in one place, the body is going to compensate elsewhere and we will get the chain reaction we do NOT want. Take the philosophy of Regional Interdependence for example, which means, impairments in seemingly unrelated parts of the body in fact have direct relationships to the dysfunctional movement. Example- A restricted distal tib-fib joint at the ankle leading to decreased dorsiflexion can and will ultimately cause gait abnormalities which will lead to LBP or some other issue.
Let’s break down Regional Interdependence into two categories- Joint and Fascia. Take the Joint-by-Joint approach which states that each joint in the body is either more mobile or more stable and that each joint must be surrounded by the opposite type of joint. Mobile-Stable-Mobile-Stable, etc. Now let’s look at fascia- Specifically, the Anatomy Trains. Take the Superficial Front Line as an example- there is a continuous line of tissue going from the foot and travels all the way to the forehead. Everything is connected to everything and anything can cause anything.
The basic jist here is that if I limit someone from moving their shoulder I will in fact create dysfunction in the t-spine, or the elbow or the c-spine or even the hips. The body is mean to move globally and if we limit locally, we’ll start to develop poor movement patterns. In a lot of cases we’ll actually put poor movement patterns on top of other poor movement patterns.
Now, here is an example of when I WILL limit movement. Take the patient that comes into therapy and is 2 weeks post-op Bankhart Repair. Am I going to crank their arm into 90/90? Absolutely not! For those of you who don’t know what a Bankhart repair is, just go take a look at http://en.wikipedia.org/wiki/Bankart_repair. The key here is that when you Externally Rotate and Abduct the shoulder, the humeral head will stress out the anterior capsule and anterior labrum. That would not be good in this case. Thus I will limit motion (for as little time as possible). One this person is past their restrictive phases, I am going to regain their motion as fast and as safe as possible. Some of you are probably asking yourself, “What are some strategies that I can use to help me in the long term, while protecting the repair?” This is a GREAT question with a simple answer- while they are in their sling, work on their hip mobility, work on their t-spine mobility and work on everything you possibly can, without affecting their glenohumeral joint.
In other words, get CREATIVE and have FUN!
“What if the person is in pain, won’t increased movement irritate the issue?”
Chances are this person is in pain because their movement, well, sucks. If you don’t fix their movement dysfunction the chances are pretty good that they will not get better. This is where your ASSESSMENTS come into play and will drive your treatment direction. Personally I extensively use the Selective Functional Movement Assessment (SFMA) to show me exactly where and why there is dysfunction. Is it mobility? Is it stability? Is it motor control?
We were created to move and we need to tailor our rehab philosophies and our training philosophies to fit this model. The body knows movements and the brain knows movement patterns. Develop proper movement patterns by allowing the body to move and you will begin to unleash potential you thought would never be impossible. Remember this- everything is attached to everything and anything can cause anything and you’ll do just fine. That and you’ll have happy patients and clients!
-Rick Daigle, PT, DPT- Founder and President of MMIM