Structure and Function
The structure of the anatomy has often been a defining criterion of what function that particular aspect of anatomy provides. The idea being that by identifying the shape of a joint, or the structure of a nerve or anything other tissue will provide most of the information needed to detail the behaviors associated with it. There exists confounding examples that challenge this thought process however, and although that muddies the water, it also offers novel areas to explore.
Let’s start with a simple example, the knee joint. For most intents and purposes, it is a relatively simple joint with fewer degrees of freedom than many others. Most of us are probably familiar with the “knock knees” look of someone’s knees or even the “bow-legged” appearance that cowboys display. These examples are specific shapes of the legs, and the knees in particular, however those shapes do not necessarily indicate the functionality of the joints themselves. Those folks with knees like that may have no issues squatting, bending or straightening and as far as we can tell they can move like anybody else can. Those structures are not all-defining.
The spine is another example. Imaging studies like MRIs, may show someone has a herniated disc or scoliosis, however these findings do not provide sufficient evidence the person has difficulty moving. In fact, a number of patients with those findings may move no differently than the majority of people. They may be able to touch their toes, lift and carry without any noticeable deficits.
Identifying abnormalities when there is a problem may be useful in providing clients with strategies to improve in whatever capacity they would like. Noticing that a structural change has occurred could aid in determining a course of action for a clinician, but that clinician should also attend to the fact that it is not defining that person’s capabilities. We are incredibly adaptable, finding new ways to accomplish tasks despite an obstacle being placed in our path. As a physical therapist I often use obstacles as a means of creating a new adaptation. One that may provide the results a patient is looking for. Structure and function are not equal; they do not define what we can do or how we do things. Structure might provide evidence for a story that took place, and it can influence how we move forward, knowing all the while we can adapt to changes at any point in time.
Austin Ulrich, Physical Therapist
