I rarely give patients pathoanatomical diagnosis anymore, but rather I give them a Physical Therapy diagnosis. For example, I do not tell my patients they have a rotator cuff tear. Instead I choose to say they have scapular downward rotation syndrome. This diagnostic approach focuses on a movement based problem and not a single tissue. When looking at movement dysfunction, I choose to focus my attention on the joint level first. Many times I tell my patients they have a joint dysfunction that is limiting their movement. However, unless the patient has had some advanced anatomy course, I have to explain to the patient what joint dysfunction means. More importantly I need to teach them why the joint is affecting their movement dysfunction. In this post I am going to breakdown the definition of a joint dysfunction and the different causes of a joint dysfunction.
All synovial joints have involuntary movement known as joint play. Generally, the amount of joint play is minimal (<1/8 inch). While this movement is minimal, the joint cannot move normally unless the joint play is normal. If joint play is lost, a joint dysfunction is the result. Since the muscles cannot correct a joint dysfunction, restoring the joint play through mobility based interventions is essential.
Why do joint dysfunctions occur?
The 4 common causes of joint dysfunction are trauma, immobilization, sustained postures, and following a serious pathology. These 4 causes should seem reasonable. If a patient has a traumatic injury, swelling occurs in the joint altering the normal arthrokinematics. If a patient is immobilized after an injury OR performs sustained postures for several hours at a time, synovial fluid exchange is altered and the joint becomes stiff. Finally if the patient has a more serious pathology, such as a heart attack, their body becomes deconditioned and less mobile.
When one finds a hypomobile joint dysfunction, perform joint mobilizations or manipulation. One's manual therapy skills can drastically assist in returning normal joint play. Following manual techniques, perform a corrective exercise to sustain the changes of the manual techniques. For the patient's home program, give them a similar mobility based exercise so the changes are not lost within session. For example, if a patient presents with scapular downward rotation syndrome. I would assess the thoracic spine and CT junction joint play. Assuming it is hypomobile, I would manipulate these regions. Next, I would perform a thoracic mobility exercise (such as cat/camel or quadruped thoracic extension rotation). Finally, I would give the patient this same exercise at home to sustain the changes gained in the clinic.
Let me know if you have other questions regarding joint dysfunctions.
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