KNOSIS as Body Dia-gnosis
At the core of a KNOSIS Physical Therapy Assessment or Body Discovery is diagnosing the pattern.
Known for our assessments and getting to the source, KNOSIS is a place to come to take care of your body. We focus on whole body health. From reactive to proactive we are changing the paradigm of going to a physical therapist when only in pain. Could we have prevented the pain if we had only looked for the patterns? What are these patterns and how can we understand them better to live in a body free of pain.
In this blog post we are going share how KNOSIS physical therapists diagnose the body and why forming this diagnosis is at the core of eliminating and preventing pain. We will highlight how diagnosis gives our clients a framework to conceptually understand their body patterns and then feel their way back to vibrant health.
Knowledge is healing power
KNOSIS means experiential knowledge. In Greek, the word is gnosis. At the core of Knosis is dia-gnosis, the body knowledge that leads to healing. When we identify patterns of inefficient movement, our clients can let them go, to restore balance and alignment to the body. At KNOSIS we help our clients cultivate this deep awareness of the body. Our wholistic approach to physiotherapy is designed to restore embodied knowledge.
To rekindle this vibrant inner awareness, we guide clients to shift from thinking about the problem to feeling its solution in the body. Working from within, you will cultivate and hone your own body knowledge to restore your ability to recognize unhealthy patterns and make proactive decisions about your health that get out of and go beyond addressing pain.
When the body gives us pain:
Experiencing pain in the body can be scary. Questions immediately arise: Where is it coming from? When will it go away? Why do I have this pain? Did I do something to cause it? Our expert physical therapists can help. We perform a comprehensive whole-body assessment to give you answers. We also consider how thoughts and beliefs can influence pain. In our Physical Therapy Assessment, we identify 3 important diagnoses:
1. The Patho-anatomical Diagnosis:
identifies the source of the pain. The source is the structure in the physical body that is sensitized and sending messages to the brain. Common sources of pain are muscles trigger points, fascia, ligaments, tendons, joints, spinal discs, and nerves. All these structures are innervated by our nervous system and when they are inflamed, compressed, or damaged they can send signals to the brain to alert us of danger. The pathoanatomical diagnosis is made through a detailed subjective and objective assessment. Our physical therapist will first listen to your story collecting information on past medical history and details about how the pain began and what makes it better and worse. Through a clinical reasoning process, they will hypothesize a pathoanatomical diagnosis and then test it in a physical assessment that includes palpation, functional and relevant movements, strength, and reproduction of symptoms. Our physical therapists work very closely with physiatrists, orthopedists, pain management physicians, and other MD to collectively agree on a pathoanatomical diagnosis. Imaging by X ray, MRI and ultrasound can be very helpful in identifying this diagnosis.
2. The Pain Diagnosis:
is the “type” of pain that one is experiencing. We must realize that not all pain is the same. What is pain? How do we understand it and what is it telling us? Pain is a process for how our brain and nervous system protects itself and the body. Ultimately the brain decides the level of pain based on how dangerous the situation is perceived to be. Fast onset pain like an ankle sprain has a completely different mechanism than chronic and persistent low back pain. As clinicians we must identify what kind of pain processing is present to change and eliminate it. There are 3 primary pain mechanisms.
a. Peripheral Nociceptive :
is pain localized to an anatomical structure, mechanical factors increase and decrease pain, pain behavior matches the movement behavior. Gets better overtime and responds with medications like anti-inflammatories. Management includes unloading the provocative mechanism and using ice, and other anti-inflammatories, modalities and education. This is the pain most patients are familiar with and good at treating. Mechanical pain should get better within 6-8 weeks and techniques should help within a day or 2.
b. Peripheral Neurogenic Sensitization :
is pain that goes beyond just a sensitive structure and includes sensory, motor and autonomic involvement. History can be unremarkable, there is recurrent insidious onset and the pain is frequently labeled as postural pain of static holding pain. The sensory changes associated with neurogenic pain include hyperalgesia, secondary allodynia, referred and or radicular pain on functional movement or sustained postures. Autonomic changes associated with neurogenic pain include vaso-constriction and perspiration. Motor changes associated with neurogenic pain include loss of muscle functional length, deep muscle inefficiency due to inhibition of normal proprioceptive responses and low threshold motor control, muscle imbalances btw stabilizer and mobilizer synergists, local twitch responses or “jump sign” to mechanical loading or provocation (MTP), and thickened tendinous attachments (adaption to increased load). 2 examples of Peripheral Neurogenic Pain are: Myofascial Trigger Point Pain and Neurodynamic Sensitivity like what one might experience with sciatica.
c. Central Sensitization:
The is the most difficult kind of pain. When pain has been present for a long time, the nervous system adapts and gets better at producing pain. The nervous system is on high alert and is overly sensitive. Messages of danger from a structure in the periphery can be significantly amplified. This pain can be occurring without anything wrong in the body tissues. Pain is easy to flare up. Simple movements or ever light touch can cause pain. Central Sensitization pain will respond to central inhibitors like alcohol, low dose anti-depressants, low dose anti-convulsants, and low dose muscle relaxers. This kind of pain will take a long time to get better because there is a problem with the wiring. In the management of these patients, we look for new ways of monitoring progress as we use gentle movements to regain control. We work away from the painful area at first. We use vibroacoustic therapy in the body to decrease the sensitivity of the nervous system and begin shifting the patient from danger to safety.
3. The Movement Diagnosis
is the dysfunctional pattern of restriction and/or excessive movement that is often at the root cause of pain. By identifying the movement diagnosis we not only can help to reduce stress on pain source, but we can prevent it from coming back. When movement choices shrink, it leads to strain on tissues of the body. The more movement options you have the more RESILENCY! The more choices you have the better your movement health.
A good example of dysfunctional movement is an ankle sprain in your 20s. You lose dorsiflexion motion in your talocrual joint and over time your foot starts turning outward as a compensation. This loss of motion translates up to the superior tibia- fibula joint reducing the tibia’s motion into internal rotation. Over the years, this loss of motion causes excessive compensatory movement between the femur and tibia. This rubbing is the impetus for progressive knee osteoarthritis. When the body loses motion at one site, it is common that it compensates with excessive motion at another site. If we could have only picked up this pattern, released the restrictions, distributed the movement evenly, we could have preserved our cartilage and tissues as we age. As part of our Physical Therapy Assessment and our Body Discovery Assessment our physical therapists diagnosis movement by identifying:
a. Restriction: Area where joint or myofascial tissue is not moving
b. Uncontrolled Movement: Joint that is moving too much often in one direction leading to ‘wear and tear’ on cartilage and soft tissues like ligaments, meniscus, cervical and lumbar discs and nerves.
Summary. At KNOSIS we look for patterns to help our clients to understand their bodies. With this knowledge a bodywork and exercise plan can be specifically designed. If in pain, there is a 3-step diagnosis. Whether in pain or not we want to know “where is our body restricted” and “where the compensation and moving too much? Visit one of our expert physical therapists for a body diagnosis. Let us help you take care of your body, by understanding and optimizing how you move.
KNOSIS IS DIA- GNOSIS
Our physiotherapists identify a BODY DIA-GNOSIS through bio - mechanics and movement analysis. We then develop personalized sessions of “body work” to release restrictions and “movement sessions’ to align the body and restore efficient movement to keep you performing at your best.
