Back when I was a student, anatomy was just origin, insertion, and its actions, while physiology was alien to me since I didn't have any biology background. In computer science sense, anatomy = hardware, physiology = software of the human body. Subsequently, I learned about clinical conditions and diagnostic tests to ascertain pathological conditions and went into a orthopedic test/clinical pattern fetish mode, reading up on all sorts of conditions and tests. Having all these knowledge I happily head for my clinical placement and I started to see a flaw.
Some patients fit in the clinical pattern nicely, while others fall into the gray zone and some don't even have a "pathological/clinical condition" per se, they just have movement impairments syndromes or certain dysfunction going on in their body.
As I graduate and look at my juniors taking a case, they start to become very lost when they can't recall any clinical pattern that resembles the patient's presentation.
There's like numerous and uncountable clinical patterns around and its really impossible for students or new clinicians to keep mugging and churning them into their brains.
The solution? - stick back to basics (anatomy, physiological processes, psychology) which are essentially the 3 aspects that revolve around the human body.
First of all, it is important to understand that the 3Ps have intimate relationships with one another.
Life is all about movement and it requires the 3Ps to be in optimal condition for movement to occur without any problems.
In the physical/anatomical aspect,
Joints need to have optimal stability and mobility(full range of motion)
In order to achieve that, joints need to have
- Optimal Alignment (absence of positional fault)
- In order to have optimal Joint Congruence
- Which allows optimal Joint Biomechanics (roll&glide + joint specific biomechanics laws mediated by Muscles & Nerves) to achieve full range of motion with ease
- As well as extensible joint capsules and nice, clean joint surfaces which allow joints to move freely and easily
Muscles need to be able to provide adequate amount of joint stability and contract to move the joints.
In order to achieve that, muscles need to have
- Nice and clean sliding surfaces among the fibers and myofascia
- Good length tension relationship to produce sufficient force
- Good length and flexibility to provide mobility
- Adequate and correct information from Nerve Impulses
Nerves need to be able to convey information from the sensory receptors(skin, fat pads, ligaments, subchondral bone, etc) to the brain and from brain to the muscles
In order to achieve that, nerves need to be able to
- glide along its neural sheath
- Have flexibility to stretch along with the body
- Transmit the correct information
In the physiological aspect,
Blood vessels need to be able to provide nutrients and flush away metabolic wastes to ensure the health of the physical components of the human body. (Healing =/> Breaking down)
Along with other organs which help to maintain homeostasis of the body.
In the psychological aspects,
our beliefs, culture, emotions and our learning shapes our behavior and attitudes in life. Movements and gait are often learned via trial and error +/- observational learning. Any movement which defies the law of our body's biomechanics can lead to damage and maladaptation errors, leading to compensations through the kinetic chain, ultimately leading to undesirable dysfunction such as stiffness/pain.
Psychological stimulus such as stress can affect our body's physical and physiological functions as well:
The mind is a powerful tool. What we perceive essentially shapes our reality. Beliefs and our perception of the state of our body/pain/movement patterns can eventually shape our reality.
Mental practice can be helpful to learn movement patterns.
Pain beliefs can sensitize/desensitize the brain, sometimes even thinking about the pain can cause the pain.
Negative beliefs revolving around the state of our body can also lead to fear avoidance behavior and if you don't use it(joint/muscle/nerve), you lose it(atrophy, etc).
Mental practice can be helpful to learn movement patterns.
Pain beliefs can sensitize/desensitize the brain, sometimes even thinking about the pain can cause the pain.
Negative beliefs revolving around the state of our body can also lead to fear avoidance behavior and if you don't use it(joint/muscle/nerve), you lose it(atrophy, etc).
So now let's put dysfunction into the picture.
When the joint if out of place either by poor repetitive movement patterns or traumatic events, joint congruence is compromised. Ligaments might be stretched/broken, joint surfaces maybe worn out, inflammation may come into fill up the joint space, intra-capsular pressures may increase, closing down blood vessels, compromising with healing. With all these additional signals to be conveyed to the brain, the nerves start to get busy and easily agitated with so much workload and subsequently the muscles receive the information, some of which might be trash information with such a busy neural network. Muscles might be instructed to tighten up too much(spasm) or loosen up (neural/arthogenic inhibition) in extreme cases or they may just continue to function at a compromised efficiency(altered length tension) given the bone they are attached to is out of whack. With compromised stability, other muscles might come in to help out by multitasking and motor control is compromised along with movement.
Of course, this cycle of event is just a theoretical example and it can be of any origin. End of the day, as long as you are able just link back to the layers of anatomy, think about what happened and how all the structures are affected and how they cope with it (For every action there will always be a reaction), painting the clinical picture won't be a major problem.
