Do you know what you're specifically treating? Probably not...
“You have a huge knot in your hip flexors! Let’s release it.”
“For sure it’s your T5; it isn’t moving.”
“We need to activate your tibialis posterior or it will be a big problem for you on your runs.”
You’ve all heard these things from various practitioners and to us, they are going about physical rehabilitation the WRONG WAY.
For physical rehabilitation practitioners (RMT’s, physiotherapists, chiropractors, etc.), a part of their clinical reasoning relies on the interpretation of their palpation, the process of using their hands to identify injury of the body or area of pain. It is used to evaluate dysfunctions and aid in their determination of clinical reasoning.
The concern with this approach, in isolation, is that the reliability and validity of palpation for diagnostic purposes does not provide strong evidence for its use. From all manual therapy professions and all levels of experience, there is poor inter-rater reliability and validity when it comes to palpation of the spine, muscles, fascia, as well as general anatomical landmarking. There is too much variation from person to person to provide any true certainty to the exact joint or tissue we are assessing.
"We need to get away from talking about specific parts and muscles because as it turns out, we are very good at being right about it."
So what do we need to change?
It’s about the explanation of the problem ACTUALLY is. It’s not a knot in your hip flexors, it’s that we need to improve your hip extension; it's not that your T5 isn't moving, it’s that we need to restore thoracic mobility; it’s not specifically addressing the tibialis posterior, it’s to establish adequate ankle dorsiflexion needed to minimize injury risk when you run. This is one of the major reasons we created our courses: we need to update the language practitioners use in the clinic on what the most recent scientific studies show us.
Ultimately, there are many areas of the narrative physical rehabilitation practitioners predominantly use that need to change, and this post is highlighting just one. We need to get away from talking about specific parts and muscles because as it turns out, we are very good at being right about it. The focus needs to shift to things we KNOW we can change: range of motion, pain modulation, and quality of life. Learn these concepts at our Palpation and Foundations courses.