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Mel you have emphasised what I have maintained in very many years of practice. We tend, particularly in the past 10 plus years, to have created pseudo scientific models in physiotherapy of biomechanical models of ergonomic behaviour that are too academic. What some practitioners do not seem able to perceive is that when dealing with movements of the spine and trying to ascertain what movements causes what ailments one has to set very rigid, frigid and physical restricting parameters to isolate the causitive activity (and remember what a lot of us preach has no relevance to day to day living in patient's lives). The bottom line, to the detriment of new treatment technique development, seems to be the recognition and appreciation of the treatment techniques that has effective results. Deon. ----- Original Message ----- From: <[log in to unmask]> To: <[log in to unmask]> Sent: Friday, May 17, 2002 11:23 PM Subject: Normality? Someone on another list asked if any chiropractor has ever seen a "normal" spine. The entire issue of normality is and always will be a contentious and highly relative one in medicine and health, as was implied eons ago by the sage who stated that "One man's meat is another man's poison". This fact is recognised by anatomical authorities who point out that everyone may not even have the same muscles, the same sites of attachment or the same skeletal structure. Idiosyncrasies and individualities are rife in the structure and function of the human body. One may refer to normality of structure and normality of function, but "normal" structure does not necessarily imply "normality", efficiency and safety of function - nor does normality of function necessarily imply "normality and health of the underlying structure. Normality in the human body cannot be equated with the fine tolerances that are needed in engines, computer components, machines, aircraft and other technological devices - as I wrote in my earlier PP132, the body is an efficient cybernetic biosystem which monitors, corrects and repairs many deviations from what some might refer to as "norms". In other discussions, we have addressed the issue that the body is not precisely homeostatic, but allows a significant degree of deviation (or a large "safety factor") to permit it to function effectively and efficiently over a wide range of conditions. The concept of the "neutral spine" is based upon this very fact - the spinal structures do not align themselves in a precise manner to 10 significant decimal places, but function within a certain fuzzy or gray "neutral zone". So, if one relies on X-rays and various other structural diagnostic tests of musculoskeletal integrity, does an absence of observed "abnormalities" imply that the person will exhibit efficiency in all stabilising and mobilising tasks? On the other hand, do "functional" tests which give the "all clear" mean that the person will not suffer from some definite structural "imbalance" or pathology? Then, does a static X-ray, CAT scan or MRI give us much information about structural integrity and behaviour during the more dynamic demands of daily life and sport? Can we extrapolate accurately from static tests to dynamic motor activities? Similarly, how much information do the currently popular muscle function tests really provide about how one actually functions in the far more dynamic situation of sport? Certainly, it is often a good idea to apply any relevant tests and diagnostic procedures, but a great deal more circumspection is necessary if one attempts to relate relatively mild "imbalances" or "abnormalities" to impaired performance, pain and injury. It would appear that far too many therapists in certain fields are relying on scare mongering and jargon-ridden, alarmist, marketing strategies to attract more clients. It is of interest that research has shown that perceptions of one's structure and function (as well as fear of pain or fear of injury) can markedly affect one's performance, so that we might conclude that these money-making alarmist therapists may be increasing the likelihood of dysfunction and pain. For this reason alone, they may not be the harmless or helpful care-givers that they claim to be. We have heard the idiom, "As you think, so shall you be" (related to the self-fulfilling prophecy) - let us protect ourselves from anyone who shifts our minds in a direction in which fear, injury and inefficiency become more likely. Maybe this is why many of those unbalanced, unusual or permanently injured athletes who do their "best to prove the experts wrong" very often do exactly that! If one is really concerned about spinal problems, then it probably is a good idea to see several independent specialists in different musculoskeletal and neurological disciplines and never to rely on a single chiropractic or orthopaedic examination as the main reason for undergoing any therapy or surgery. Normality is as normality does. Therapy is what therapy does. We can end with several questions to resolve this issue: 1. Isn't all normality relatively abnormal? 2. Isn't all abnormality relatively normal? 3. Isn't all normality relatively normal? 4. Isn't all abnormality relatively abnormal? 5. Are none of the above true? 6. Are all of the above true? Dr Mel C Siff Denver, USA http://groups.yahoo.com/group/Supertraining/