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Treating The Cause vs. The Symptoms

Parts vs. Patterns

One thing that sets me apart from others in my profession is my approach to diagnosis and treatment of musculoskeletal conditions. For example, many therapists often become overly focused on the site or location of pain and neglect to view and treat the body as a whole. Just because the pain is located in the anterior deltoid does not mean we need to spend every treatment session working on the anterior deltoid. I think everyone can agree that the body moves and functions as a three dimensional, synergistic system. What I mean by this is that the shoulder is not isolated from the body so it is only logical to assume it is affected by other areas of the body. For example, poor control or stability of the trunk and scapula will create overloading and excessive wear and tear on the tissues of the shoulder. If the body moves as a unit you must treat the body as a unit.

Local Pain vs. Global Dysfunction

Although you may be experiencing sharp pain in the front of your shoulder that was initially brought on by doing overhead pressing or pushups, that is simply the area of injured/overused tissue, NOT the cause. So what is the actual cause? It depends, but more often than not a lack of mobility or poor stabilization elsewhere along the kinetic chain is what's causing that pain. One example is poor stability of the trunk and scapula that is creating improper movement which results in excessive overloading of the tissues. Simply treating the site of pain in this scenario will only provide temporary relief which is very likely to return. Without addressing the biomechanical dysfunction you are only treating the symptoms, not the cause.

Static vs. Dynamic

Many therapists examine your area of pain by checking range of motion and performing a series of orthopedic tests which are designed to help narrow the diagnosis to what "structure" is damaged. Although this may be helpful in figuring out what tissue is injured, it does very little or nothing to show you the root cause. In order to identify the underlying cause, I perform a movement screen and focus on the non-painful dysfunction. This provides me with not only what tissue is injured, but more importantly what (biomechanically) is not working the way it is supposed to. Once this movement dysfunction is identified, we can proceed with an accurate diagnosis and treatment of the true cause of pain.

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