Inferring a mechanical fault or tissue-based rationale for pain and suffering can result in thoughts of being broken and fragile. Blaming a patients’ pain experience to a biomechanical fault, tissue health or delayed muscle activation negates the complexity of pain and the human experience. Humans are not cars or household appliances, they are complex biological organisms with unique experiences, feelings, beliefs, history and learned behaviours. With a few decades of research to support the concept that pathoanatomical rationale is not a good indicator for pain, it is no longer acceptable to prioritize this outdated reasoning when trying to help patients suffer less and function better. Where is the evidence for these pathoanatomical tissue-based concepts? Is this the result of some faulty research or misinterpretation of findings? The words and stories we tell our patients matter, a lot! Therapists need to be aware the impact our explanations can have on patients. Most of these exercises are easy to perform and may help people with hip, buttock, or lumbosacral pain, but the narrative is at best incomplete, and at worst, it is completely incorrect. However, the premise is not backed by current research. Here is a wonderful looking e-book with exercises and protocols for treating gluteal amnesia. This process involves following the research evidence and incorporating our personal clinical experiences. Overcomplicating the clinical encounter where the therapist assesses for faults or dysfunctions that must be fixed in order to alleviate pain and restore optimum functioning takes the healthcare provider away from what their primary objective which should be, which is to support, encourage, and help to rehabilitate to a level of function and well-being that the patient desires. Canadian massage therapists can check out pages 15, 17, 19 of this document. This is stated in educational and competency documents for all MSK professionals. Health care providers have an ethical obligation to understand and use current, relevant and quality research evidence to inform their practice decisions. Hint, the research for specific core exercises are no better than general exercises in long term outcomes. Findings from a few research papers may be misconstrued and then wild extrapolations are made, ie Paul Hodges research on motor control and the ensuing explosion of treatments and ideas on core exercises for lumbopelvic pain. Often the rehabilitation and fitness world jumps onto fads that have little to no research to support them. The multitude of reasons why someone is in pain or suffering can seldom be reduced to a single factor like ‘lazy muscles.’ Although certain body parts may be stronger or weaker than others, the human system is great at finding ways to function and move in spite of this. We are rarely symmetrical in build or movement. Humans are complex biological organisms that adapt, and change based on a variety of inputs and outputs. Basing a treatment plan on conjecture without any shred of biological plausibility or supporting science is not healthcare. To achieve desired rehabilitation goals clinicians first need to understand what the client/patient expects and wants, and then they can work together to develop a plan. When treating people with pain and/or developing treatment plans, clinicians must be making recommendations informed by the science. This reasoning is outdated and unhelpful. Despite widespread acceptance by many in the rehabilitation and fitness professions, the human body is not equivalent to a mechanical device. This explanation seems simple and could be plausible IF the human body worked that way.
The rationale is that neuromuscular functionality has been forgotten from prolonged sitting, periods of inactivity, or compensation from injury. This concept is based on the belief that the gluteal muscles not ‘working’ or ‘firing’ properly. Or why they present with a perceived excessive anterior pelvic tilt, ‘tight’ hamstrings, or difficulty performing certain physical tasks. These are some common terms used to explain to clients why they are experiencing pain in their low back, sacral, hip or buttock area. Gluteal Amnesia, Sleepy Glutes, Lazy Butt Syndrome
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