Anatomy is important.

Anatomy describes how one bit connects to another and what it’s called. It lays out the typical positions of the components of the body and, with physiology, tells us how it all works.

But anatomy does not say how you move. One could not look at a supine body and say with any certainty whether they had back pain, felt stiff in the mornings or found running difficult. Dissection and a pathological examination indicate areas where the soft tissues and skeleton have changed over time, but since almost 50% of the adult population have dysfunctional spinal discs, yet not all of them present with neurological symptoms, this would be only indicative that there might be a problem not a definite diagnosis. Even then, that does not describe where they would potentially experience that pain or how it would present clinically.

All of that must be discovered through the case history and observation. Observation in all senses, including what they’re not saying or doing, how they feel, how they respond to palpation and so forth. And, as we exist within a dynamic world, at least part of that assessment has to take place with the person moving in their normal position. It is impossible to see why a shoulder is hurting if it is not normally used lying down. A knee may only twinge when the patient walks down stairs and so on. Active and passive examination needs to be considered, and not rote.

Learning to observe, to see rather than just look is a vital skill that we need to learn over time, it is a root from which other elements grow. Without effective observation feeding the diagnostic sieve, we cannot know which tool in our set to apply most effectively.

Artists learn to observe by doing. They try to see the whole, consider how it fits together, the interlocking parts. Relaxed, open, non judgemental. As practitioners, our process flow often inhibits this gentle scanning. We have probably talked to the person, taken the case history, formulated ideas, theories, considered current models of diagnosis. And through that filter attempt to see the problem in front of us. But what if we turned it around? Asked what that person experiences, why they’re with you today and then, non-judgementally asked them to move? Once we’ve observed them, then you can start the therapeutic journey.

Step away from the anatomy, the collection of organs, muscles, nerves, fascia and bones that sits in front of you and look.