The thing that I’ve always loved about my career as a physical therapist is that often I get to play the role of a detective. I’ll give you an example: a CrossFit athlete comes in and reports knee pain with running and squatting after years of working out at the local CrossFit box. Standard medical practice says we should take x-rays of the knee to rule out anything serious and then likely put the athlete on some type of anti-inflammatory medication to decrease the athlete’s symptoms. I’m not saying this course of action is inappropriate, but I think if these are the only interventions, we’re missing the mark. I like that my career allows and even encourages me to think more globally about a patient’s symptoms. As a PT, I want to watch this athlete squat. I want to watch this athlete run. I want to examine the hips, the spine, and the ankles of this athlete and see if this is purely a knee issue, or if there are other movement restrictions that are over-stressing the knee and resulting in the athlete’s pain. This is unique to physical therapy. This is not standard medical practice.
At HPT, we recently studied a research article from The Journal of Orthopedic Physical Therapy Practice entitled “Treatment of Shoulder Impingement Syndrome Using Non-thrust Mobilizations to the Thoracic Spine and Ribs: A Case Report” . In this report, therapists treated an overhead lifting athlete’s shoulder pain using the theory of regional interdependence- the idea that pain, or, in this patient’s case shoulder impingement syndrome, may be caused by a restriction or dysfunction in another area. In this report, therapists treated the patient’s shoulder impingement symptoms by focusing on improving mobility in the patient’s thoracic spine (the area of the spine where the ribs reside). The patient had been given a cortisone injection and some exercises by his doctor, which proved ineffective prior to the onset of PT. After 6 visits of PT and some home exercises, the patient was back to doing his workouts without pain.
Now I’m not trying to say that all shoulder pain is correctable by treating the spine, and I’m also not promising that we get everyone better in 6 visits. What I’m trying to say is that most dysfunctions are not isolated issues, but they’re regional issues . If we only treat shoulder pain by treating the shoulder, we normally miss the mark. I encourage you to find a healthcare provider who thinks outside of the proverbial healthcare box and watches your body move, assessing your symptoms in lieu of the surrounding tissues. Think outside of the box, so you can be more successful and pain-free in the box!