Recent publications by Shirley Sahrmann and Thom Myers have introduced new ways to look at movement dysfunction and musculoskeletal pain. The former identifies what she calls a kinesiopathic model which identifies all components involved in a mechanical problem. The latter postulates a fascial link to chronic or recurrent body weakness, with connective tissue lines or meridians significantly effecting body movement patterns. Both authors challenge the prevailing orthodox view; that clinical diagnosis and treatment for mechanical pain should focus solely on the pain producing tissue; that there is little consideration and assessment to be afforded to the function of associated structures, deemed clinically unimportant; there is little value in a composite diagnosis, incorporating the primary diagnosis with its associated adaptative patterns.
To give an example, capsular shoulder injury is a common complaint often with a complex history, but little clearly defined causation to each recurrent event. This patient with chronic relapsing shoulder pain, may well have one of the rotator cuff muscles investigated and treated. No assessment on the associated cervico-dorsal vertebral function, latissimus dorsi, multifidus, the diaphragm or scalenes is undertaken to evaluate for signs of their irregular function. Nor is time afforded to examine the shoulder girdles' relationship with the pelvis or lower limb function, in this type of clinical problem.
These authors have contributed to the debate on how best to treat mechanical pain syndromes. They provide valuable insight into the complexity of faulty body mechanics, their theoretical treatment model's being both more holistic and complete than the prevalent orthodoxy. Joanne Elphinston's latest text, Stability, Sport and Performance Movement: Great technique without injury, should also be added to the same essential reading list by all who are interested in the assessment and treatment of patients with spinal and limb pain.
The first three chapters of her text cover a definition with its central constructs, of what constitutes stability in the human form. The author details the structures comprising the dynamic pillars that stabilise the human body. She also provides various conceptual theories useful in understanding why things go wrong with our musculoskeletal system. Elphinston proposes throughout that there should be a dynamic basis to understanding faulty function. In this regard she advocates the same approach to diagnosing faulty function as the aforementioned authors.
Her contribution to the science and art of movement dysfunction is to remind us of the concept of the Central Longitudinal Axis (CLA), which is a flexible reference point around which our bodies work when we get active. This concept has been reflected by a variety of other authors such as Moshe Feldenkrais and Serge Gracovetsky. They subscribe to the concept of dynamic and balanced equilibrium within the human form, and within which all templates are based. They propose a mechanical utopian form, if you like. The resultant diagnosis and treatment which centres on this approach, tries to assist the body to regain the internal balance which it has lost. Clearly this differs from the linear approach used by many therapists who have a more condensed mindset.
Chapter four looks at how to go about measuring functional change, with the remainder of the book illustrating the means of building better functional integrity within the body, including not only strength and stamina, but co-ordination and dynamic skills which all human movement patterns require to varying degrees.
The final three chapters cover some specific issues such as the use of weight training to increase stability, special issues relating to young athletes and stability training for children, and lastly sample programmes that are sports specific.
A wide variety of sports are used to illustrate the fundamentals within the Stability concept, everything from football, tennis and kayaking to water polo, karate and equestrian skills.
The author writes clearly about her subject, and the diagrams and illustrations included are excellent. The only possible improvement that perhaps could be considered for future editions would be a CD-Rom to help illustrate her concepts using a more fluid medium than two dimensional photographs, excellent though they are.
This book was only available for some inexplicable reason in Swedish, until Jon Hutchings of Lotus Publications came across it, and decided to make it available to an English readership. I defy anyone who works in mechanical pain management, sports injury prevention, or bodywork not to get something useful and of practical value from this work. This is a must read text and was a pleasure to review.
Donald Scott ND DO