I get all sorts of folks coming into the clinic from surgeons to soccer studs, cops to Crossfitters, Pro Wrestlers to Pro Basketball Players, and everything else in between. Even though all have different injuries and conditions, all have a common question that they want answered - “Can you help me?”
I’d personally like to say - HECK YEAH to all of them, but I’d definitely be lying if did. Some folks need to be co-managed, while others just need to be referred out. Those that I’m blessed enough to team up with for treatment typically fall into one or more of these categories:
Architecture problems
Soft tissue issues
Nervous system deconditioned
When I mention these three categories to folks, they typically look at me with a baffled look. That’s perfect! I have their attention, and now their curiosity (hopefully like yours right now). So let’s break these 3 categories down so it makes more sense, shall we?
When I say “architecture,” I’m referring to joints, and the bones that are involved with those joints. I can say nerdy words to the patients like arthokinematics (local joint motions) or osteokinematics (global bone motions) but I’m not trying to throw too many concepts over their heads. The word “architecture” usually makes people think of the design of a building and the materials that create its backbone - its foundational shape. Similarly, what gives shape to our bodies are our skeletal system including the joints that connect them. One of the first things as a health care detective is to determine whether or not there is an architectural problem.
It’s these architectural problems that can cause passive limitations to someone’s performance. If the freedom in your joint can only go from 0-90 degrees, that’s it. That joint’s happy place can only function within that parameter; over that, and injures occurs. Incomplete use of the full range of motion is usually attributed to soft tissues mechanically persuading it, or the deconditioned nervous system unaware of accessing the joints potential.
When I say “soft tissue,” I’m talking about the things that make up the rest of the body that’s not joint or bone. This would include muscles, ligaments, tendons, and fascia (what I like to call the “spiderwebs” throughout your body). Now, I know that there’s other soft tissues like internal organs, nerves, and blood vessels that can be players, but all that would’ve been ruled in/out already during the history and evaluation processes. As alluded to earlier, soft tissue issues typically go hand-in-hand with architectural problems. It’s typically these soft tissue issues that cause active limitations to someone’s performance.
The last of three categories is a deconditioned nervous system. I totally made this up (chuckling to myself), but people get it. Just saying the word “deconditioned,” people immediately get an impression of weakness, out of shape, or just not as healthy as it could be. That’s exactly what I want folks to realize - their nervous system needs to buff up and whip back into shape!
How does that happen? Well that’s where we get on their nerves and play “brain games.” This is where we focus on sharpening movements by consciously being intentional about the task at hand. Most folks have movement amnesia where they basically suck at being aware of their bodies. As a result they aren’t able to access and control their bodies efficiently and effectively, resulting in suboptimal movement and eventual injury. Their body’s inability to move well is due to their body’s circuitry going haywire, resulting in the deconditioned nervous system. It’s this fogginess in the nervous system can cause both active and passive limitations to performance.
So there you have it, the three categories that folks typically fall into when their bodies break down. Keeping it simple, sweet, and understandable so the patient gets it is an ongoing communication skill that continuously evolves. Until then, this sturdy tripod of architectural problems, soft tissue issues, and the nervous system being deconditioned is what I’m running with!
Change your mindset … Change your perspective … life is much better when you have an outlook that creates opportunity.
Thanks for being curious and taking the time to read this! Hope it added value to your life and equips you to become better than you were yesterday!
Dr. Joe Jaime, DC, DACBSP®, ATC, CSCS®, FRC®ms, CES
Credit: Pictures taken Unsplash