Before treating dysfunction there are many pertinent questions which need answering such as:
- Which muscle groups have shortened and contracted?
- Is the evident restriction in a specific soft tissue structure or joint related to neuromuscular influence (which could be recorded on an EMG reading of the muscle) or tightness due to connective tissue fibrosis (which would not show on an EMG reading). or both?
- Which muscles have become significantly weaker, and is this through inhibition or through atrophy?
- What 'chain reactions' of functional imbalance have occurred as one muscle group (because of its excessive hypertonicity) has inhibited and weakened its antagonists?
- What joint restrictions are associated with these soft tissue changes - either as a result or as a cause of these?
- Is a restriction primarily of soft issue or of joint origin, or a mixture of both?
- How does the obvious dysfunction relate to the nervous system and the rest of the musculoskeletal system of this patient?
- What patterns of compensating postural stress have such changes produced (or have produced them) and how is this further stressing the body as a whole, affecting its energy levels and function?
- Within particular muscle areas which are stressed what local soft tissue changes (fascia etc) have occurred leading, for example, to myofascial trigger point development?
- What symptoms, whether of pain or other forms of dysfunction, are the result of reflexogenic activity such as trigger points ?
In other words what palpable, measurable, identifiable evidence is there which connects what we can observe, test and palpate to the symptoms (pain, restriction, fatigue etc) of this patient?
- And what, if anything, can be done to remedy or modify the situation, safely and effectively?
- Is this a self-limiting condition which treatment can make more tolerable as it normalises?
- Is this a condition which can be helped towards normalisation by therapeutic intervention?
- Is this a condition which can not normalise but which can be modified to some extent, so making function easier or reducing pain?
- What mobilisation, relaxation and/or strengthening strategies are most likely to be of assistance, and how can this patient learn to use themselves less stressfully following this?
- To what degree can the patient participate in the process of recovery, normalisation, rehabilitation?
Fortunately, as a part of such therapeutic intervention well structured assessment protocols exist as do a vast range of Muscle Energy Techniques (MET), Positional Release methods (Strain/counterstrain - SCS) and Neuromuscular techniques (NMT) exist as means of achieving normality.