Another year, another trip to the optometrist. This familiar ritual consists of various tests and devices designed to periodically reassess my vision enhancement needs. Foremost among these are a series of ‘which is better, A or B’ questions.
Choice is Key to Establishing Preference
In this assessment, I look through a progression of adjustable lenses at a line of highlighted letters. With each change of lens, I am asked to judge which of the two choices presented seemed clearest, or ‘best’. Through some mysterious process of back to back comparisons and trial and error experimentation, my optometrist makes a recommendation about either riding out another year with my current prescription or upgrading to stronger lenses.
His job is to provide the choices and make sense of the responses. My job is to perceive differences between choices and to come to a decision about what amount/type of vision correction is best for me. This is a cooperative venture where he suggests, based on preponderance of evidence—and I decide, based on subjective criteria of preference.
Analogous to Rehab Scenarios
This same division of labor template of professional choice presentation and patient preference decision is (or should be) present with a variety of musculoskeletal complaints. Not all of them, to be sure—and not so much post-surgical or traumatic injury recovery where range of motion and strength of the injured part is primary:
- Total knee/hip.
- Proximal humeral fracture.
- Inversion ankle sprain.
- With these kinds of rehab scenarios, the injury creates the movement dysfunction.
- With these kinds of scenarios, we are not seeking to change historic motor behavior but to restore it.
On the other hand, repetitive stress injuries/degenerative condition are created by dysfunctional or sub-optimal movement/postural patterns.
- Lumbar and cervical degeneration.
- Hip and shoulder impingements.
- Patellar irritation and tennis elbow.
- In these scenarios, the movement dysfunction creates the injury/tissue irritation.
- And, in these scenarios, we are seeking to change motor behavior in order to reduce repetitive/habitual movement.
Lead the Horse to Water…
But, of course, we can’t change someone else’s motor behavior. We can only bring their attention to the negative consequences to that behavior and suggest better options. In this respect, we and optometrists share a common task. We present the choices and encourage our charges to proprioceptively examine their options. They compare what they have been doing (what we have determined to be their ‘pattern at fault’) to our carefully crafted solution (what we have estimated to be their ‘corrective pattern’), then make an informed decision about their ‘pattern of preference’ or our provisional target. Clinical examples of contrasting choices might include:
- Coming up from bending with a hip extensor emphasis, contrasting to a lumbar extensor emphasis.
- Looking along with horizon with thoracic integration/support, compared with localized cervical movement.
- Climbing stairs with the knee falling into valgus or with the knee aligned over the foot.
- Anchoring the arm to the neck vs anchoring to the back.
Goldilocks & the Three Choices
This is a ‘Goldilocksian’ strategy—intentionally setting up the conditions that encourage our students to compare and contrast (2-3) competing movement or postural choices. Once a preference has been identified and embraced, it then needs to be naturalized or embodied. We do this by prescribing an individually tailored movement practice, along with advice about how/when to apply lessons learned in exercise into daily activity.
- Recognize the error their ways.
- Learn the new/improved pattern.
- Identify it as superior.
- Practice it to hone it.
- Use it to habitualize and naturalize it.
- All of which require a willingness on the part of your student to pay attention and make changes.
I must confess to a certain degree of envy when I compare his job to mine/ours. He sees someone maybe once a year—we see folks once or twice a week. The only behavioral changes he asks for are to put on a different pair of glasses—we ask our folks in these scenarios to make fundamental changes to long-standing habitual movement or postural patterns. He works with our #1 sensation (vision)—while we labor in relative obscurity working with our #6 sensation (proprioception).
But being easy isn’t as important to me as being fulfilling, challenging, rewarding and interesting—I like the career choice I have made.