Our Professional “puzzle” …Structure or Function? – Superior Physical Therapy

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Our Professional “puzzle” …Structure or Function?

Our professional “puzzle”…Structure or Function?
Lenny Parracino, CMT, NTP, FAFS

How often are we faced with a puzzling client/patient? A puzzle is defined as cause to
feel confused because we cannot understand or make sense of something. In today’s
information age, it can get even more confusing – who do we believe? Our traditional
education and training can make us feel confident to simply follow a protocol for a
particular structural-symptom (ACL tear, meniscus tear, LBP, “itis”, weight-gain,
weakness, fatigue, depression, etc.)? However, following symptom-based protocols can
put you in a nasty cycle of “this-for-that” therapy or conditioning. What if the “part” or
symptom wasn’t the real problem, instead just an expression of global dysfunction, an
expression caused by the whole? As a child cries we don’t react by muffling the child,
we realize that there is a reason and we attempt to solve the puzzle. If our car has a
blinking red “check” light we don’t place a piece of black tape over the light and ignore
the warning. So why when we experience pain or discomfort do we often attack it,
muffle it, or tape it, as opposed to searching for causes? Simply imagine a quiet thief
(function) and a screaming victim (structural symptom). Both situations are important to
consider, you want to help the victim but catch the thief!
How often do we perform a technique or test because someone (often an authoritarian)
said to? We, at the Gray Institute, believe each clinician, trainer, or coach should be their
own authority and use their own intelligence to work with their clients/patients, thus
creating solutions based on the individual, not pre-designed protocols. I challenge us, as
professionals, to appreciate protocols as a guide, yet use our own intelligence to
creatively apply the various guides to the dynamics of the whole… the whole
INDIVIDUAL.
As a practitioner of over 20 years, having made many mistakes by getting caught up in
what I knew about a part, a structure, and even a test; and how I felt entitled that I could
“fix” the part/structure or better the test result without respecting how the complaining
part actually functioned, I urge you to consider a more holistic/functional view with every
part/structural puzzle you are faced with. It is easy to get caught up in the pathologic,
symptom-view, or even a test result, as it is often objectively “barking” at you and your
client/patient. However, in truth, function is very dynamic, interconnected, fluid and
always changing. Whether you’re rehabbing, training, or conditioning, we must be
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careful viewing the body as a machine, addressing isolated body parts or seemingly
isolated problems (i.e., stretch the hamstrings, strengthen the glutes, reduce knee
swelling, take an artificial drink for fatigue, a laxative for constipation, an antiinflammatory
for aches, etc., etc.). Instead, we must use our logic AND imagination to
unravel the complex whole. The following is a list of a reductionistic, symptom view
vs. a functional view…think – which would you prefer be applied to YOU
professionally?
Symptom View VS. Functional View
1. The body is viewed as a “machine” composed of
separate systems reduced into its constituent parts.
1. The body is viewed as a dynamic and complex
interconnected system of mind, body and
emotions.
2. Emphasis is placed on the identification of
disease or pathological tissue change.
2. Emphasis is placed on identification of areas of
imbalance or dysfunction in normal physiology.
3. Assessment/testing is extremely specialized and,
therefore, narrow in scope.
3. Assessment/testing integrates data from many
different systems and methods.
4. Strategy is based on reducing
symptoms/complaints.
4. Strategy is based on addressing underlying cause
of complaint.
5. Major focus is spent on how the client is doing
based on numbers, charts, statistics and test results,
etc., that are measured against a statistical “normal
population”.
5. Major focus is spent on both subjective and
objective information gathering based on a concept
of optimal physiological function.
6. Relies on later stage development of symptom
as a marker.
6. Allows for early prediction of dysfunction.
7. Health is measured as an absence of symptoms.
As long as you do not have a symptom, you are
considered healthy.
7. Health (optimal function) is measured along a
functional continuum, which is a spectrum moving
from dysfunction to optimal function. Intervention
can be made at every stage of the spectrum to
restore and/or improve health/wellness-function.
There is a movement (no pun intended) today in the world of medicine/health care to
appreciate an integration of structural complaints with a systems approach. In this
paradigm shift, the relationship between the part and the whole is more symmetrical.
While the properties of the parts certainly contribute to our understanding of the whole, at
the same time the properties of the parts can only be fully understood through the
dynamics of the whole. The whole is primary, and once you understand the dynamics of
the whole, you can then derive, at least in principle, the properties and patterns of
interactions of the parts. Although this can be viewed as a paradigm shift relative to the
way many of us are taught in school, the concept isn’t new. As the founder of
osteopathic medicine Dr. Andrew Taylor Still (1828-1917) believed in the following
principles:
1. The human body functions as a total biologic unit
2. The body possesses self-healing and self-regulating
mechanisms
3. Structure and function are interrelated
4. Abnormal pressure in one part of the body produces
abnormal pressures and strains upon other parts of
the body
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So, yes, it’s a puzzle and all needs to be respected. Just like when we were little kids
putting a puzzle together, we often didn’t start with just centerpieces. Instead, we looked
first at the whole picture on the box, opened the box, then sorted out all the pieces face up
to then find corners, straight edges progressing to linking them to form patterns. In the
end, all pieces were treated equally to form the whole picture. For us, as practitioners, it
behooves us to respect and assess the individual as whole, with an appreciation for the
parts. Imagine a day where practitioners treat Bobby with weakness vs. leg weakness on
Bobby; or Mary with breast cancer vs. treatment for breast cancer; or Johnny who has
trouble lunging vs. judging why Johnny can’t perform a lunge he has never performed
before. So, I challenge us to ask the next time we test/assess… Are we testing the
individual or are we testing the test?
We, at the Gray Institute, believe, first and foremost, in the whole uniqueness of each
INDIVIDUAL. We, then, anchor to the application of the physical, biological, and
behavior sciences – not a separation, but an integration. This model allows the
client/patient to dictate the pathway, as opposed to using a memorized structural-protocol
or a pre-made test. We also believe that every one of our colleagues, like you, exude the
intelligence to be creative and design your own pathway to help those with whom you
work. We share this through a process of Applied Functional Science™ anchored by
natures principles, not a rigid series of rules.
In conclusion, the next time you are faced with a client/patient “puzzle”, ask yourself…
how is the WHOLE being affected by the part? What can I do with the whole to support
the known part disruption? Is the part dysfunction primary to the functional
compensation? What can I do today to create an environment to support the part? This
thought process will shift us, as trainers, coaches, and therapists, from a mastermechanical-
technician to a creative-humble-facilitator.
We hope to share more with you soon!

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