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What is the most common problem I see?

It gets noisy when I think...apologies...

FAQ: What is the most common problem I see?

In answering this question, it is so tempting to name a body area or structure as the most common - disc bulge, shoulder impingement, acute wry neck, tennis elbow, ACL injury etc etc. Statistically, a "diagnoses" like this could be counted and a "most seen" winner could be found. But that would go against my philosophy! I am after the root cause of problems, not the symptoms!

A refresher...

In a post about our philosophy - you can read it here -, I mentioned the Integrated Systems Model by Diane Lee and Linda-Joy Lee (no relation!).

To summarise what I look for, the key areas I assess you in are:

Clinical Puzzle from the Integrated Systems Model by Diane Lee and LJ Lee (2010)

1. Who you are - Your Story, what has Meaning for you, how you perceive your Virtual Body, what Emotions you may have about your problems, and what your Goals of Treatment are.

2. Your different systems - Articular, Neural, Myofascial and Visceral - for each area of the body that may be part of the problem...I have been known to assess people's neck and jaw chasing down a foot/ankle problem!

3. The way you "do" the things you do in life - rest, lie, stand, sit, walk, run, exercise, work, housework, etc etc.

As you can see from the picture, it is like a 3 layered onion. The beauty of this model is that each layer can affect the other layers.

How do the 3 layers interact?

You might have a fear of bushwalking because you have sprained you ankle before (story, meaning, emotions) - this can cause you to tense up your muscles (myofascial and neural systems) which then affects the way you walk (your strategy for performance and function).

Or you may have a broken foot bone (articular), which makes you limp (strategy for performance and function) and affects how much you think about the foot (virtual body), your story and the emotions and meaning you place on the whole problem.

Or...you have learned to do a manual task a certain way because "that's how it is always done" (Strategy for performance and function), which leads to certain motor patterns developing (neural) and, depending on who taught you, you may be REALLY committed to doing a task a certain way (meaning, story, emotions) and don't want to change for some reason or another, even if it is straining your body (neural, articular, myofascial and visceral).

Bending over incorrectly is a coordination problem!

So what is the most common problem I see?

I would have to say that problems coordinating and controlling your joints are the most common problems I see. Some examples...

  • Bending from the back instead of from the hips leading to excessive strain of the muscles, joints and discs of your back eventually leading to pain, arthritis and other associated problems
  • Not being able to keep your hip "centered" in the socket leading to labral (cartilage) linjuries and eventually a hip replacement
  • This guy looks ok...but are his shoulders ok?

    Not centering the shoulder joint

  • Not keeping your back still during a lift/exercise
  • Your ribs twisting when they should stay still
  • Knees coming in together during a squat
  • Feet rolling in/out during exercises in an inappropriate manner

Looking back at the Clinical Puzzle picture, all of the above can be due to any of the 3 different layers being the main problem. However, I find the neural problem is the most common one I come across.

The Neural Piece of the Puzzle
Basically this piece of the puzzle is where nerves and your coordination are involved. Whilst you can have stiff joints, cartilage damage,  tight muscles, pinched nerves, a funny way of doing something or a psychological reason for your problem, I find myself STILL having to retrain coordination patterns.

How do you know if you have a coordination problem?

Here are some simple ways to tell if you need an assessment or treatment for a coordination issue:

  1. You keep getting injuries or the same injury doesn't heal
  2. You can get past a certain performance point - can't lift more weights, can't do more, can't progress, etc
  3. Sometimes it hurts to do something and other times it doesn't, without any good reason for being different
  4. You are diagnosed with tendon or muscle tears without a serious accident like a fall or hearing it pop/tear
  5. You have cartilage issues/degeneration/tears without an accident or incident
  6. You are told you need to have you knee/hip.shoulder cleaned out
  7. You have muscle spasms that don't go even after a massage - or they come back a couple of days after the massage
  8. You have flexible joints and you ache all over
  9. You feel like you have to stretch all the time

Comment below and tell me some of your symptoms and let's see if it is a coordination problem or not...

9 Responses

  1. Great article. It shows the value of getting the right person to look at problems and then getting the right course of treatment.

    I’ve been to so many physios that just massage your ‘sore spot’ so you feel better for a day or two, only to have the same problem come back.

  2. Pingback : How to Ruin a Champion’s Knees – Why Brandon Roy Retired Early « The Physio Detective

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  4. Harley Sroka

    Nice post. I used to be checking continuously this blog and I am inspired! Extremely useful information specifically the remaining phase 🙂 I deal with such information much. I was looking for this certain info for a very long time. Thanks and best of luck.

  5. Sean

    I am constantly feeling like I have pain for no reason! I thought it was just because I am active and that active people have to deal with aches and pains. I have pretty sore knees most of the time, and lately I’ve been dealing with achilles pain and I don’t know why. My lower back hurts sometimes as well. But mostly it is my lower leg that gives me the most trouble. So, where do recommend I go to get some assessment/ treatment? Thanks for your site by the way, it is a lot of really good information.

    1. Thanks Sean. I suggest you find a specialist Physio or titled musculoskeletal Physio if you are in Australia. Perhaps if you let me know where you live, I might know someone there.

      It does sounds like you have a coordination issue straining varying structures in your body.

      Let me know how you go.

      1. Sean

        Thanks, yea, I live in California- Sacramento area- so not even close. In fact, I’ve never even heard of a Physio before until I came upon your site. But I’m seeing a sports medicine doctor this week about the achilles pain. I will look into seeing a Physio, though. Maybe theres one in my area and I just don’t know it. Im just worried because Im a young guy, 22, and Im having all these pains already. It makes me nervous.

        1. Hey Sean. no problems. Being young is on your side mate 🙂 Why not try emailing Diane Lee or LJ Lee at info@discoverphysio.ca – they can possibly recommend someone near you. There would be plenty of Physical Therapists around near you…just have to find a good one! Keep in touch and let us know how you are going. If worst comes to worst, travel to San Francisco to see Kelly Starrett himself!

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