Car or Driver
This morning, the driver in front of me was clearly texting. In fact, at times she seemed so distracted I thought she might have been blogging. I’m amazed at how much driving while texting influences attention and motor control. Swerving into oncoming traffic seemed to be her specialty, but missing stop lights ran a close second.
Imagine if an officer stopped this woman and began inspecting her car for defects. Her tires might be a bit out of alignment. That could explain the swerving. She didn’t stop at that light so her brakes might be a problem too. These are all possible reasons to explain her erratic driving behavior. But of course we all know better. The issue was not with the car, but the driver.
This had me thinking about how we assess and manage so-called aberrant movement patterns in the clinic or gym. A student physical therapist and I were watching a patient who was performing a standing squat. The student observed that the excessive internal rotation of the patient’s leg was due to a “weak hip abductor”, and subsequently began recommending strengthening exercises. After a brief discussion of motor control behavior, we took a different approach by simply showing the patient how to perform the movement without the internal rotation.
It was amazing how much “stronger” she became in 30 seconds! Not only did the squat look better after the instruction, the patient continued to do well despite an increase in load. Weak muscles should have gone the other way, with movement deteriorating under fatigue. The issue was not with the muscle, but the nervous system controlling them.
I thought this was a small but important example of where we often go wrong with our patient’s or athletes. We are much better prepared to address problems with the joints, muscles, and bones (the car) than deal with the integrated nervous system that runs the show (the driver).
Rotating the tires and keeping the brakes in shape are good ideas for a healthy car, but they don’t explain most automobile accidents. Similarly, keeping healthy muscles and joints is a great idea, but it rarely explains much of the movement we see from our patients or athletes.
Dig deeper and you’ll often find it’s more driver and less car.