by Mitch Hauschildt, MA, ATC, CSCS
I tend to get patients who have no obvious reason for their pain. They have seen several different people and have plenty of diagnostic testing performed before they end up on my schedule. The advantage that I get in these situations is that I get to see all of the things that have been tried and failed, so I don’t go down those paths. The disadvantage is that I am put in the position of trying to fix the thing that no one else can seem to get figured out. I love the challenge, but get frustrated, just like anyone else does when things don’t get better as fast as I want to.
My best case scenario when I perform an evaluation is that there is something big that flashes in my face like a bright red stop light, telling me exactly what is wrong and where go to with my treatment. Those are the easy cases. But, what happens when you don’t get the red flashing light? That’s when your evaluation skills really come into play.
A lot of times, especially for athletes and active individuals, pain and dysfunction is a cumulative effect of a number of different factors. That’s when the “Little Bit” syndrome shows it’s ugly face.
What is the “Little Bit” syndrome?
It’s when a little bit of one thing and a little bit of something else and a little bit of another issue all add up to something significant. Sometimes a little bit of an ankle mobility restriction, combined with a little bit of a hip external rotation restriction, combined with with a little bit of a rotational stability restriction add up to some pretty bad posterior tibialis tendonopathy.
It can also be a little bit of a hip flexor mobility issue combined with a little bit of a core rotation motor control problem combined with a little bit of a running mechanical issue that can add up to a proximal hamstring problem. I can keep going with examples, but I think you get the idea.
Sometimes we aren’t always able to exactly define how and why the little bit syndrome causes the pain that it does, but if we take the approach of first identifying areas of dysfunction and then fixing that dysfunction, the pain and problem usually fixes itself.
When we optimize overall function in the body, we release one’s own healing mechanism.
People with the Little Bit Syndrome tend to be the people that no one can figure out. That’s because there isn’t anything that seems to make sense as to why they are having pain. In those instances, we chalk things up to being a cumulative effect of seemingly disconnected dysfunctions in seemingly unrelated areas restricting the body from healing itself.
How do we fix Little Bit Syndrome?
We fix it by finding all dysfunction (no matter how small it may be) and fix it, regardless of whether we can connect it to the problem or not. In order to do this and do it effectively, you have to perform a very comprehensive, total body evaluation. For this purpose, I prefer to use the Selective Functional Movement Assessment (SFMA). It does a great job of identifying dysfunction and is very comprehensive. But, as I always say, “I don’t care that you use my system. I just hope that you have a system.”
Your evaluation HAS to drive your treatment, not the diagnosis. This is something that frustrates a lot of people in my courses, because our educational system teaches us to treat injuries and not people. I ask people to treat dysfunction and forget about the diagnosis. that is the key. When you are struggling to find the cause of the issue, look for the little bitty issues and go after them. You will be surprised how well it works.