By Brett Windsor, PT
An excellent and thought provoking article by Shirley Sahrmann in the latest issue of the PT Journal. It was about the future of physical therapy and our attempts to transform into a true profession by adopting a unique body of knowledge based on owning ‘movement’ as a science. I’ve reproduced below a diagram from the article that I think is a great little representation of where we are going. No more silo’s between ortho and neuro and cardio…There’s just a clean acceptance of the patient as a whole person with movement problems.
Given that I work in a DPT program…I see this coming. The incorporation of the ICF into the curriculum and the inexorable move away patho-anatomical diagnosis towards more systemic movement based diagnosis are two signs. Things are changing…
The question for NAIOMT is…where do we fit in with this paradigm? Are we truly equipped to participate in this move towards a lifespan preventative approach to physical therapy? Where do we need to change? What do we need to question?
There are many, many questions to answer. I’d love to hear your thoughts. I’ve provided a link to the paper below. You’ll need to be an APTA member to access it…
Brett
naiomt.me 
I definitely am for branding ourselves as the movement specialists and would appreciate movement based diagnosis system. Do you think though that we should still seek to understand what tissue may be at fault that was caused by or resulted in a movement dysfunction. I think that’s a strong point of NAIOMT – know how to reason through a scan and then specific manual assessment to find what’s the dysfunction and to use pattern recognition as key aspect too. This clinical reasoned exam can lead to both the movement dysfunction and a patho-anatomical diagnosis, right? Maybe I don’t understand if the two are mutually exclusive because I don’t think they have to be.
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Thanks Clay. From a personal perspective, I think the tissue fault is important. The first question of corse has to be ‘What is the movement dysfunction?’, but just as important is to know the reason for the dysfunction, whether it be a surgery, pharmacology, medical pathology, and/or tissue-based pathology. Lifestyle factors also play a very important part. I think an understanding of how all of these factors contribute to a movement dysfunction is critical to effective management and prognosis. there’s a way to strike a balance. How close are we? Brett
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Thanks for the post … this is a great step forward. During the development of movement system nosology, let us also be wary of classic pitfalls. No explanatory hypothesis, like a diagnosis, is free from error … rather we labor endlessly to limit the error. We can avoid making another “spinal subluxation” mistake via rigorous attempts at disconfirming what seems intuitive. Still, this is awesome stuff… a much needed expression of our expertise.
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I think the patho-anatomical model is worthwhile seeking unless it is absolutely impossible to find a pain generator. I’ll give you an example of how I think weighing the evidence too much in exchange of giving up reasoning can be a dicey situation. Say someone comes into our office with a script for lumbago and they report a twisting type injury with lifting. They have painful movement in all directions and a pain empty end feel with rotational stress testing at L4-5. Yet the fit the CPR for lumbar spine manipulation by Flynn and those guys. I’m thinking in my head, this could be an annular tear and a non specific, non locked technique incorporating rotation could be really deleterious to the patient even though the CPR says my positive likelihood ratio is through the roof. We can’t weigh how we treat patients simply by plugging and chugging into a CPR or classification based approach and leave our brain that we spent so much money on sitting at our desk. In my book, sound clinical reasoning is king and we ought to fall back on classification systems and CPRs when our patho-anatomical model fails us
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