We have had some "ah-ha" moments in the clinic lately when playing the game of test and retest so I wanted to share! When doing something different such as using a new appliance like a mouth guard, trying a new pair of shoes, or using a new office chair, we often wonder, "Is this right for me?" I get that question often and I love playing detective to see what the body shows us. How does it do this? There are key things to observe: range of motion, efficiency or CoreFirst strategy, quality of movement, and symptoms. I want to dive into these areas more with real-life examples to show you how amazing and adaptable our bodies are.
Range of motion is checking out how well different areas of the body move. We get range of motion not only from our muscles, tendons, and fascia but also from other systems such as the nervous system, dural system (fluid around the brain and spinal cord), and vascular system. Earlier this week, a patient and I tested her mouth guard. While wearing the mouth guard, she laid down in her usual sleeping position while I checked her knee extension and shoulder abduction (moving the arm like a snow angel) passive range of motion. Knee extension (straightening) tells us about hamstrings length but it's also a way to check the sciatic's nerve ability to slide and glide. Shoulder abduction similarly gives us a glimpse into the neural/dural system. We checked these two areas again with her mouth guard removed and bam! Everything moved further and with a springy end-feel. Those were immediate changes that told us the mouth guard wasn't helpful for her entire system. One theory as to why these immediate differences occur is because there is a change in the tensegrity of tissues in the body.
Checking efficiency or Corefirst strategy means seeing how the body reacts to perturbations. There are a few tests I used that are taught by the Institute of Physical Art (IPA). I may perform a Vertical Compression Test which is basically gravity accelerated with my hands on someone's shoulders or head. This is used to see if the body is stacked in a way that sends the force of gravity through their feet and into the ground instead of into their body. Another test is called the Lumbar Protective Mechanism where resistance is applied to different areas of the body to detect if the core automatically comes on, which occurs in an efficient state. Last week, we were wondering if insoles would be useful. With feet flat on the ground, the Vertical Compression Test caused the patient's pelvis to shear forwards with a collapse in his lumbar spine, which is an area where he feels pain. We placed some support under each arch and checked the test again. With support, he was solid as a rock and he and I felt my pressure going into his feet and into the floor. That confirmed that arch supports are the way to go for him.
When looking at quality of movement, we are looking at characteristics such as ease of mobility, stability such as single leg balance, and proximal stability (the trunk is stable) during distal mobility (moving appendages). In this category, often times the patient needs to put in some serious strengthening work. If an area is weak, I can assist this area with my hands while we test it but no amount of manual therapy can replace exercise. Sometimes mobilizing various areas of the body will immediately help the body stabilize or move better but the patient then has to go home and work on these areas! Most often, these areas haven't been firing well in a long time so exercises to specifically address them is paramount. Use it or lose it.
Monitoring for symptoms can be checked by using an intervention to see if it increases or decreases discomfort. This can be done by observing a movement that is painful, temporarily changing one area of the body actively or passively, and having the patient repeat that movement to see if it feels better or easier to do. That can give us the green light that addressing a particular area of the body will be helpful. One example is the upper ribs and neck pain. If a patient has pain turning their head towards the right, I may alter the position of some upper ribs and then have the movement repeated to see if they go further or have less discomfort. If nothing changes, then I search for other areas that may have more influence. Painful movements can also be tested with external objects such as adding or taking away a bag on someone's shoulder or adding a supportive belt to the pelvis.
Instead of wondering if something is the right support, fit, or general intervention for you, don't guess. Bring it in and let's use objective data to give us the answer. Just because someone swears by a particular brand or product doesn't mean it will work well for you. We don't want to guess; we want to know!
