You’ve woken up and you have pain across the back of your hips and gluteal area with some discomfort out into your hamstring. You go visit your therapist or chiro who pushes on your vertebrae to tell you that L5-S1 is not moving well (they can’t actually feel it move). They may then ask you to do a squat, and you shift away from the side that’s bothering you. It makes perfect sense that you move away given it hurts on the opposite side. You sit back down on the table and get your muscle strength checked, glute med/min and ankles are weak and it’s causing your hips to be off balance.
While nothing is unsafe (priority number 1), it is inherently short-sighted to assume anything about this all-too-common assessment provides insight beyond an inability to control movement and a lack of strength in areas where you’d expect it to be weak. Not to mention manual muscle testing is a very unreliable “quantified” way of measuring strength.
(In my opinion, the grading scale makes sense only for gross movements not fine, where a 0 means nothing, a 3 is held on your own, and a 5 is where you can hold against some kind of resistance. Trying to specify and say it’s a 3+ or 4- is way too subjective to be used reliably.)
In this example (or any movement screen), a squat screen where you aren’t moving well only tells me you can’t squat, and nothing beyond that where you leap being told you have hip dysfunction or weakness.
This may be a motor control problem that is dependent on neurological mechanisms such as speed and activation. If these neurological mechanisms have good incoming and outgoing information flow between the joints, muscles, and connective tissues; motor learning can occur.
A lack of balance here manifests as altered movement.
Muscle strength is useful clinically when we look at potential neuropathic-related problems like radiculopathy, but outside of that context, being told you have weakness is an unreliable cause. Your pain may inhibit firing but remember that pain may not be coming from the area of discomfort rather your brain sending a signal that something is not right.
Like a smoke detector, it only tells you there’s an increase in heat or smoke not that there’s a fire. Pain is the smoke detector, something’s not right and we need to investigate WHY.
Find a therapist who looks at the why instead of what.
When I ponder about that statement, it means going beyond the superficial explanations of if this is “out of balance” and you need to strengthen muscles to pull it back.
Simply treating the symptoms or focusing on strengthening specific muscles may not be enough to address the root cause of the problem. Sometimes, the pain may temporarily decrease due to accidental problem-solving by the therapist, but the underlying issue may persist. In such cases, the pain is likely to resurface once you resume your activities. This happens when the therapist focuses on WHAT instead of WHY.
So what is the why behind your pain? No one can say, but to fit it into a neat box where it’s an “If this, do that” approach is not going to cut it for the majority of more complex problems that people get.
This I suppose, is the point of this article, when a treatment is based on an assessment that only looks at one subsystem (which is a part of a complex multi-systems entity like a human) it will fall short when it isn’t a muscular system problem.