The SIMPLE movements were derived from my observation that many patients in my practice suffered from disordered movement patterns that result from and contribute to lumbar spinal stenosis.
The interesting thing that I noticed after I had started to gather the data was that many patients who had not (yet) developed radiographic evidence of stenosis, nevertheless, displayed many of the same impairments in strength and range of motion as those patients who had a medical diagnosis of spinal stenosis from their physician.
Low back pain is an endpoint and lumbar spinal stenosis is the last step in the degenerative cascade that originates with disordered movements in our earliest years.
Patients present to many practitioners at points along the way to their penultimate point and it is my hope that SIMPLE can be used to describe the physical dimension of those points.
In my naiveté I persist in believing that if we can describe a physical process then we can change it.
SIMPLE Bias
At this point I should acknowledge an obvious bias in the SIMPLE system: an exercise bias.
SIMPLE is designed to provide the physical therapist with goals and interventions that are amenable to therapeutic exercise and (to a lesser extent) manual therapy.
This bias is not accidental.
The physical therapy profession is well positioned to lead the public in modern exercise attitudes and in movement awareness. Exercise is very nearly synonymous with the phrase ‘physical therapy’.
The connection between exercise and physical therapy exists, not because of advertising and marketing, but because of a real need and a demand for skilled exercise services.
The connection between exercise and physical therapy is not complete since the association with exercise is ‘flavored’ by athletic trainers, personal trainers, exercise physiologists, aerobics instructors, coaches and fitness gurus.
To control the domain of exercise then physical therapists need to measure movement.
If a physical therapist can tell their patient the exact amount and quality of their existing movement impairment then the physical therapist can prescribe exercise precisely to correct the impairment.
To measure movement physical therapists need simple and precise tools that determine the extent of their patient’s involvement and that can help decide the proper intervention.
In Outpatient Physical Therapy for Musculoskeletal Conditions, Stephanie Carter, PT, PhD says the following:
“It is not known how many people with musculoskeletal conditions actually need physical therapy services, and no criteria exist for making this determination”8
SIMPLE is predicated upon the following assumption:
The presence of impairments (with or without pain) should be the criteria for determining those people who need skilled exercise intervention.
The role of SIMPLE is to help physical therapists measure the presence or the absence of impairments that affect physical function and thereby become better decision-makers and better diagnosticians.
To physical therapists, physical therapy is much more than just exercise.
To physical therapists’ patients, however, physical therapy is just what physical therapists do.
The patient doesn’t know the difference and the patient doesn’t care.
The patient just wants to get better.
Tim
