Trog Blog #4: “it doesn’t matter until it does”

Yet another strange idiom from one of the owners of Elevate PT (can you guess which one?). We can cut straight to the point on this one—what is the clinical pearl here?

“It doesn’t matter until it does”. That’s it.

This actually piggy-backs very nicely on Trog Blog #2 & #3. I say it a lot to students when they start getting worried about “aberrant movement patterns”. At first glance a funky shoulder blade, a hitch in someone’s giddy-up, and that weird hiccup you see in someone’s shoulder could all be a problem. Key word: could.

Those things likely don’t matter. There are a number of papers suggesting that previously conceived notions–like scapular dyskinesia, spinal flexion during lifting, squat shifts, etc–really don’t matter. They are seen in asymptomatic populations. They are seen in people with high function & low disability.

But then, sometimes, they do matter. So what’s the deal?

Well, if you subscribe to the notions listed in Trog Blog #2 & #3–that human movement is emergent, redundant, and based on predictive processing–then you can start to let go of some of the minutiae you were taught in school. And recognize that a lot of things with human movement are contextual.

You realize that the winging shoulder blade might not be a problem at all. But it might limit their ability to transfer force during bench press, so it may warrant some direct strengthening of serratus anterior.

You realize that someone’s predictive processing is causing anticipatory postural

adjustments before they pick up grocery bags. You realize that you need to work on changing their internal modeling by having them do more (or less) lumbar flexion in a “safe” position before having them do kettlebell carries in your clinic.

That doesn’t mean we let go of evidence entirely. In fact, this concept should make you want to read more. To try to figure out when it matters & when it doesn’t.

Just don’t get all weird when things do or don’t matter…and don’t live in caves…