People don’t come in (caveat: yes, I suppose some do!) complaining about their asymmetry. They come in complaining about a pain during some activity or another. (Check my post on Knee OA and pain.)
We listen to that pain complaint… and go right to some abnormality, some objective finding in the area of the subjective complaint. If we find a structure in the area of the complaint: BOOM! success, PT of the year, let me fix that for you. (ex. c/o SIJ area pain, PT notices slight inominate rotation, does muscle energy technique)
This is well and good when the objective finding is similar to a nail in the foot. You remove the nail the pain should go on home as well. The patient came in with pain. We send them out with a level collar bone / a de-rotated T6 vertebrae / an orthosis that holds up that pesky navicular bone. Did we do what we were supposed to do?
Sure, if it’s a car. We want a fix to that noise, the mechanic replaces a belt, presto-chango the problem is solved.
When the patient gets better, was it because of placebo or fixing the structure? Or both? Research can tell us a lot about how connected these things are. Causality.
I am at a point of cognitive dissonance here. (I am hoping more clinical experience will deliver me some more answers) Should I look for physical impairments that can be reproduced on exam? And should I try to connect them to the pain? Yes, I know I should and I will. I am looking for the physical cause of that pain complaint, but knowing that the pain is not a clear representation of the tissues is a lot for me to handle. The physical cause is also a neurophysiological cause! All feeling occurs in the brain. ( More on the sensation of pain here. ) Until I get a handle on it all I plan to treat, reflect, question and interpret. Pain can be right and pain can be wrong. Asymmetries and abnormalities can right and can be wrong. It is our job as skilled professional to find what is meaningful in both areas: the body and the brain.
– Matt D