Tuesday 12 June 2018

Joint Insecurity?

Disclaimer: This is purely a personal opinion post, not an accepted fact or opinion of the medical community.

"Your shoulder is unstable."

We've heard this one before. I've used it before, myself. When speaking on the "stability" of a joint, we're referring to the muscles, passive structures (ligaments) and neural systems that surround the joint to maintain its structure and integrity.

Stability can become compromised for a number of reasons, with muscular weakness, lack of proprioception, and physical tissue damage among them. In many cases, the instability is real. A previously-dislocated shoulder pops out again very easily with very little force. A post-ACL reconstruction patient experiences buckling and failure of the supporting muscles. A rolled ankle that has a much easier time of rolling again after the first injury.

But what about when this severe lack of integrity isn't present. What about the person who simply has an achey shoulder? "Multi-angular instability!" The client with low back pain? "Core instability!" Neck pain? "...Neck instability?"

It may seem like a trivial thing, but words have a lot of power, especially when used on individuals who may be in pain and coming to professionals for help. Using terminology that instills more fear about one's own condition can increase pain expectation and potentiate avoidance habits. This is why many clinicians are being more selective of their language. We're not being hopeless optimists about a problem; we're simply preventing psychology from making it worse! If the back isn't at risk of dislocating, then why are we telling people that their cores are unstable?

That being said, when a joint isn't truly at risk of injury, especially when it comes to chronic pain clients and those who might not be in situations that put their joint in danger, then should "instability" be one of the terms that's vaulted and reserved for those truly-unstable situations that I spoke about above? Lately, I've found myself naturally gravitating to the word "insecurity". Yes, just like when we were awkward teenagers in high school.

It does make sense. A lot of times, in chronic pain, muscular tone is high and pain outputs are driven due to the conditioned state of the body to think that the joint is at risk and to respond as such in order to protect the area. My metaphor for clients, often, is that the muscles are angry and on strike, not allowing the joint to function as needed. To treat, we simply provide sensations to the tissue to get it to relax and exercise it to create a better sense of security, removing the reason for the body to think that those negative responses were necessary.

I'm open to discussion from clients and colleagues. In the meantime, I'll continue to play around with this word and see what kind of feedback and success I can garner.


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