Unwinding the pattern of patterns

Let me put it to you of some recent (5-year) findings. Ninety plus percent of my clients

have an abdominal visceral contributor to their pain, MDs and SMCDs, and/or a

lymphatic contributor. I want it to be less. I suspect it is more. I want it not to be a case

of confirmation bias, which is why I’ve been following the system more diligently and

watching the evaluation findings. There’s a pattern that is influencing all or most of the

dysfunctional and/or painful patterns. If you’re like me, you’ll notice that most of our clients have multiple top tier patterns

that are dysfunctional, and that within each dysfunctional and/or painful patterns, there

are multiple mobility dysfunctions. And that if you’ve refined your local biomechanical

evaluation further, you’ll notice that the physiological mobility restrictions you

measured are associated with joint play MD’s, also known as arthrokinematic MD’s, or

accessory joint MD’s or active tissue palpation restrictions. It can be quite an extensive

picture for one person, can’t it?

What we commonly see are multiple patterns that are dysfunctional and/or painful, and

sometimes it’s for what we used to consider a par-for-the-course regional medical

problem. For example – “bung shoulder”, or “stuied knee”, or “tight back”, or “jammed

knee” or “dodgy ankle”. And we were trained in our undergraduate, or post-graduate

programs, or weekend courses, or profession-specific-advanced-specialty programs to

become specialists in how to treat these regional medical problems. My SFMA

Instructor colleague Rod Harris already wrote about the potential trap of specialising

before generalising (see below), but I want to describe it differently.

Multiple patterns dysfunctional.

Multiple breakouts dysfunctional.

Multiple MD’s:

At physiological movement and accessory movement level.

So many damned patterns!

I’ve noticed a pattern about these patterns. Before you notice a pattern of these patterns, you simply (well, it’s not simple is it?) had

a list of MD’s, SMCD’s and pains to address.

And you followed our recommendations about how to rank them. Here are some of our

recommendations:

· Go to the most dysfunctional first; or

· Go to the closest dysfunction to painful area; or

· Begin address those dysfunctions from proximal to distal; or

· Begin address those dysfunctions from cephalad to caudal; and

The one we actively do NOT advocate… whichever pattern leads you to an area that lets

you use your most recently learned technique. This is an addictive process leading to

Favourite Technique Syndrome. Remember, you don’t get to use your favourite

technique, “you get to apply a technique that is based on the findings of your evaluation,

all the way down to the direction of the arthrokinematics/accessory joint play

restriction, or active palpation restrictions.”

Step back a moment. Remember that in the SFMA we recommend you still include your

appropriate neuro/ortho screen, special tests and breathing screen, because, and wait

for it, remember that health before function before performance?

So, back to my notice of patterns about patterns. What if all those lists of patterns you

had to address were separate. What if regional interdependence of performance,

patterns and parts wasn’t a thing? Well, what would happen is you’d have long list of

things to work on. It would keep you busy for many treatment sessions and you could

count on your diary filling up with clients. You would put out a spot fire (MD) in one

session, then reinforce it and retrain it and recheck the breakouts and top tier. Then you

would plan on checking it next time, and add a treatment on another parts MD or

pattern. And you would be like a shepherd of cats, coordinating seemingly independent

patterns and parts that are, no doubt, impacted on by so many variables between last

visit and next, such as sleep, stress-response, nutrition, poor movement habits, inability

or unwillingness to avoid aggravating activities.

Back to the pattern around patterns.

When you step back from the page of all your notes, you can see a pattern.

Let me give you an example by summarising a common patient:

“One or multiple pains, multiple MD’s, some SMCDs underpinned by MDs and pain.” It is responsible to gain clarity around a medical diagnosis that might explain the type of

pain and how we should protect the client.

Then it’s responsible to begin changing the behaviour of the person around that medical

diagnosis.

So, multiple MD’s is what we consider.

A shoulder pain. Highly sensitive special tests but not specific. Unclear medical

diagnosis. Let’s move on. Pain with movement. Arthrokinematic MDs. Tissue palpation

clouded by pain. Step back a moment. Broaden the perspective. Create the negative

space of “ma”. Scapula kinematics indicate MD’s in multiple directions. Confirm that

the thorax has an extension/rotation MD bilaterally. Note that in the passive lumbar-

locked spine rotation test that the lower rib cage doesn’t rotate far, being a main

contributor to not achieving 50 degrees rotation. Step back further. Note that there are

multiple cervical movement MDs. And spine flexion MD, and FABER(E) and Modified

Thomas Test MDs, and hip IR and ER MD’s in both hips flexed and extended, and tibial

rotation MDs and ankle and subtalar MD’s and foot MD’s. Whoa. A lot of MD’s, all

possible causes, contributors or complicators of a shoulder pain, right?

Remember the breathing? How’s their diaphragmatic behaviour, as evidenced by

abdominal expansion in the anterior and lateral directions? Are they apical breathing?

How’s their stress levels (remember the patient-centred communication you’re trying to

be better in?)

Do you know what their hydration levels are for today’s visit? Or sleep levels?

Let me put it to you of some recent (5-year) findings. Ninety plus percent of my clients

have an abdominal visceral contributor to their pain, MDs and SMCDs, and/or a

lymphatic contributor. I want it to be less. I suspect it is more. I want it not to be a case

of confirmation bias, which is why I’ve been following the system more diligently and

watching the evaluation findings. There’s a pattern that is influencing all or most of the

dysfunctional and/or painful patterns.

Now, let’s learn about how to assess and treat those visceral and lymphatic

contributors together, to smash open the patterns above. Register your interest in attending a Lymphatic & Visceral Manual Therapy Course.