Interpreting the Reviews
Preparing for a backpacking trip into Canyonlands National Park last year, I started looking into getting a new pair of sandals. My beloved Chacos had finally completely fallen apart, and I wanted a style of sandal with a closed toe box for river crossings. Doing research and reading the reviews for a number of different sandal brands, I narrowed it down to a couple different options.
Trying on my various choices, I really liked the Keen Newport H2. They have good arch support and good sole traction, the straps are smooth and comfortable, my delicate toes are protected from stubbing and, most importantly, they are aesthetically pleasing! However, when reading the customer reviews, I started having second thoughts.
Most of the reviews were four and five stars—these people loved and raved about them. Very few reviews were middling, but the red flags popped up when I saw several one stars, accompanied by some truly scathing comments. The common complaint was that the stitching for the heel strap would tear out, sometimes within just a couple months. I agonized over the decision for a minute or two, but they were so comfy (and so handsome) that I threw caution to the wind and brought them home.
Figuring Out What Went Wrong
After a couple days of wearing them, I figured out why the heel stitching was problematic for some people. Taking a movement short-cut, I found myself kicking out of them by stabilizing the heel with the opposite foot and just pulling my foot out. I noticed how the heel strap kind of ‘stuck’ to my heel and was pulled straight up and away from the foot bed when doing it this way.
Aha! Stress noted—now for a new strategy. I needed to devise a different solution for taking the sandal off that didn’t pull the stitches in a ‘non-physiological’ direction. Bend over. Loosen the straps. Pull the heel strap down and over the heel so the stitches weren’t stressed. No brainer—as long as you can make the correlation between movement stress and ‘tissue breakdown’.
Application to Practice
And this is a perfect analogy for how we can think about repetitive stress injuries and degenerative conditions.
- Help your client to recognize the stress—not just intellectually but proprioceptively.
- Explain how the movement and postural stresses lead to tissue breakdown and resultant pain.
- Propose movement and postural based solutions that control stresses on the relevant tissues.
- Prescribe exercises or design a movement practice that reinforces desirable movement patterns and optimal muscle synergy combinations.
- Provide examples of when these proposed solutions should be utilized in daily activities—and encourage your charge to look for related examples or situations.
Movement Model of Musculoskeletal Pain
This is a ‘movement model’ of musculoskeletal pain in a nutshell—and is very different from the traditional ‘medical model’ that our beloved profession tends to follow. With our emphasis on differential diagnoses, we have historically stressed identification of the ‘tissues at fault’. But while helpful, knowing the location or origin of pain in the context of repetitive stress or degenerative conditions is much less valuable than recognizing (and being able to control) the ‘patterns at fault’.
Controlling stresses requires recognition of stresses—which is a matter of paying attention. This is the difference between having a one star or a five star experience of your body.