I’ve always loved this quote by author and psychiatrist Dr Gordon Livingston. It’s a short but challenging sentence I’ve used to great effect mentoring new physios.
“If the map doesn’t agree with the ground,
the map is wrong”
It encourages you to think outside the box. Really look and understand what you see in front of you.
Whether you realise it or not, you have been taught to follow maps you’re entire life. As a child your parents provide you with a mental map to follow. They show you right from wrong, provide you with values...gave you a direction to abide by.
University is no different!
It teaches you the theory. Provides you with a thought process to follow. A path to adhere by. But what happens when the problem does not stick to the rules?
Everyday we see patients with injuries that don’t fit the mould.
In fact…
Less than 30% of patients fit exactly ‘what the textbook says’
Many physios and chiros fall into the trap of pigeon holing problems based on what they learnt at uni. They stick to and ‘trust’ the process.
Question is,
What if your injury or tightness does not follow the rules
Have you suffered other injuries that might be involved
What if your body is different?
At what point do you stop, realise you're lost and recalibrate?
Create a new guide based on what you actually see
I can tell you this…
If the theory applied does not match your body exactly, you won’t get better!
80% of the Time There Will Be a Curveball
You will have symptoms which don’t respond to traditional thinking and treatment.
One of the patients I looked after the other week is a perfect example. He had been suffering Achilles tendonitis for close to 6 months. He had tried every textbook approach
Physio and treatment
Had an injection
Stretched,
Rested
There was no change!
As is often the case…
In taking a more detailed history it turned out he had broken his femur causing the hamstring to stop working properly. This affected the tibia, changed how the ankle worked and put stress on the achilles.
Unless the hamstring starts working the achilles will take the load and the tendonitis won’t go away.
Bottom line is this…
If It’s Not Getting Better...You Are Looking At The Wrong Map
You need to find the right one!
You should have some change after about 3 visits. If you’re not starting to see positive changes or progressing as you should you need to be able to quickly change direction. No point continuing the wrong way right!
If the plan isn’t working, you don’t stick to it just because. You alter the approach based on what you see.
I’ve seen Achilles problems stem from a spinal issue, a shoulder problem, a neck problem, an opposite side ankle problem. It’s simply because everyone will compensate in their own way.
Remember the quote,
If the map doesn’t match the land then the map is wrong. The theory needs to fit the patient, not the other way around.
This approach works.
It’s a big reason why we get the results you’re after.