When your next patient walks into the clinic and you think they need to just get stronger to resolve their pain, consider this: is their emergency brake on?
Have you ever driven your car a few blocks and something does not seem right? When you let off the gas, your car stops short. To move forward, you seem to have to push the gas harder than normal. All of a sudden it hits you! The emergency brake was still on! You could still drive, but it was wearing out your brake. You were burning more gas and there was an abnormal resistance to moving forward.
When your body has a mobility issue, you may be able to move seemingly alright. You may even measure motion and appear to be normal. When you really break it down, if you really feel for the resistance to motion during passive testing, there just seems to be something a little extra there. There’s a lack of smoothness. Maybe you need more force to push the body part through the motion. This is the emergency brake. If you have a tight antagonist (opposing muscle) to the muscle or area experiencing pain, then you are operating with the emergency brake on. This is going to result in the painful area to test “weak”, and the typical response is that we need to strengthen it! Avoid making that assumption without checking into it more.
Last week we discussed overhead athletes and their propensity to show a reduction in internal rotation ROM. Another area where athletes and non-athletes alike show a mobility restriction to raising the arm overhead is with the lats and teres major.
To fix this, I address soft tissue through a variety of techniques, one of which is a patient-directed release:
This is not to say that strength and motor control are not important! Pressing the gas in your car is the only way to move forward. But if your emergency brake is on, pressing the gas comes after taking the emergency brake off.
Ari Kaplan, PT, DPT, SCS, CSCS, Cert MDT is the Co-Founder of the Association of Clinical Excellence (ACE), an education company focused on building the physical therapy community and developing the complete professional. ACE has three primary areas of developmental focus: Leadership, Clinical Skills, and Personal Mastery. He co-published his first book, Modern Day Management: A Short Guide to Successful Meetings in March of 2015.
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