Thursday, September 10, 2015

Pathokinesiology instead of kinesiopathology

Pathokinesiology: Faulty movement patterns result from some process or problem going on within the organism, perhaps within its nervous system. Find out what the problem is, address the problem (which is usually only pain, but could be something else actually pathological), then watch to see if the faulty movement pattern disappears. Use movement output as a clue, a symptom only. Always see deeper than the surface. 

Kinesiopathology: The movement patterns themselves are the bad guys, to be corrected. If you move badly for long enough, you'll end up in pain, because.. muscle. Sarcomeres. Or something. Something to do with tissue. You the patient are the bad guy because of moving badly. You're ruining your body. Your pain is your own fault. Move differently and it will go away. Plus you won't destroy your body. Plus I can bill for treating a condition (a noun) instead of for interacting with a patient (a verb). 

I have John Ware on SomaSimple (post #48) to thank for clarifying and historically contextualizing the difference.

He says, 

"Actually it was Helen Hislop who came up with the term "pathokinesiology" waaaay back in 1975. Nothing really ever came of it because, in my opinion, modern healthcare systems aren't designed for- and won't pay clinicians to provide- interactive treatment. It's all about procedures, interventions, injections, operations, etc... We can thank Shirley Sahrmann for defining and popularizing the term kinesiopathology within the PT profession.... We should use a pathokinesiological perspective when treating patients with persistent pain problems. The movement disorder is persistent mechanical deformation; the essential diagnosis is abnormal neurodynamic."
... Which puts us squarely into the realm of the nervous system, some glitch in the software aspect of its function, some positive feedback loop thing, some sort of input that blew up into a pain problem coupled with motor output problem, maybe at entirely different times, maybe from different parts of the NS trying to solve a problem it couldn't handle with whatever hard drive it ended up with, so the "problem" moved more rostral.

Nothing is simple to work out, but for sure, the conceptual tools we were given in school were mostly blunt stone axes. I'm all for upgrading the conceptual tool kit, even in the face of opposition (which is out there. Lots of it. From corners you would never have anticipated.) 

I twittered this back to him, "I guess you would prefer we went back to this?" : 
Image by Sigurd Mikkelsen PT

Learning to use two eyes is way better than being equipped with only one:

Here is the thing: a therapist with no awareness of/ interest in/or desire to learn about all things brain and nervous system, has only one eye that has to see two things, at the same time, at different focal lengths; 1. a patient, and 2. the body attached to them, full of all sorts of lurking orthopaedic ailments. Now, *that's* dualism, right there.. 
You can treat people that way, but it's really clunky.
Clunky. And often very noceboic.

After one has developed a working knowledge of the afferent nervous system (not just the motor output system), and what the brain does with afferent input, it's like suddenly you have gained TWO eyes, binocular vision, stereoscopic vision. The best part is, you no longer have to drag fresh patients through that ghastly noceboic morass of all All Things Ortho That Are Wrong With Them, Completely Speculative, Based Entirely On Pain Presentation or Provocation Testing, Bad-looking Biomechanics, etc. Instead, you can explain pain to them, treat them kindly, wait and see.
If it's a tissue thing, it will show up.. later. 
(As long as the patient is reacting to a pain presentation, you can't ever know for sure.)

Besides, people live with all sorts of tissue stuff they never ever knew they had. When it comes to pain, correlation definitely does NOT equal causation.
So let's not focus on tissue so much.

It's like developing (cognitive) depth perception, finally, later in life, seeing depth and space in the world; it turns one's professional role from moving flat cardboard cutout images around, into real interaction, real therapy.
Dualism is replaced by (cognitive) binocular vision. Two cognitive "eyes" working together from two slightly different perspectives, does NOT equal "dualism". It equals depth perception.

When you teach binocular vision, this way of appreciating their brain, to patients, stress goes down and they stop being so bothered, worrying that they are going to fall apart.

So, this toothpaste (me) is never going back in the tube.