The Key Lesion - Speece, Crow & Simmons

I've posted this definition of Key Lesion, which appears in the text "Ligamentous Articular Strain" by Speece, Crow & Simmons, to be used as fodder for discussions in other message boards.

The Key Lesion
The Key lesion is the primary or most important dysfunction in the body and may well be the injury that prevented to patient's natural healing mechanism from effectively dealing with any ensuing injuries. This dysfunction acts like a beaver's dam across a stream. If the dam is removed, the water will flow downstream unimpeded. Likewise, if the key lesion can be removed, the rest of the body's dysfunctions may resolve themselves or be easily handled by the physician. There are many different methods you can use locating the key lesion. When looking for motion or lack of motion, try not to focus directly on the patient; instead, keep the patient in your peripheral vision, which utilises more rods and cones for stock rods are better at detecting motion. This will assist you in locating the areas that are not moving-these are the areas of dysfunction. One of these areas will be the key lesion.

Searching for the key lesion
Before we describe the four methods of finding the key lesion, it should be noted that we primarily use methods two through four, described below, to determine where we are going to start their treatment. This we do as part of our standard osteopathic exam.

Method 1
Do a systematic search through the body, and treat all the dysfunctions you encounter until you locate and treat the key lesion. It is usually the oldest and most significant dysfunction and prevents the other dysfunctions from resolving. This is a solid but very time-consuming method. You may you might have to treat a patient for one or two hours before you find the key lesion.

Method 2
Observe the patient walking towards and away from you to locate the areas that are not moving. These will be like axles: everything else will be moving around them, but they will remain motionless. One of these dysfunctional areas will most likely be the key lesion. When looking for these motions, whether the patient is walking or standing still, try not to focus directly on the patient for the reasons mentioned above. This will help you pick up the motion. Once you have located the key lesion, try to attack its first because it will probably take the longest to treat but will produce the most benefit. You would hate to see it emerge last!

Method 3
Pull gently on one leg to determine if there is an area of restriction further up in the body. This is done while standing at the foot of the table. (The feeling is that of pulling on the corner of a tablecloth to determine where a nail has been driven through it, anchoring it to the table.) Now, pull on the other leg and see if it gives you the same information. The most restricted area will most likely be the key lesion. This method is also discussed in other text.

Method 4
Observe the patient getting up from a chair and getting onto the treatment table. This may reveal additional restrictions of motion that you could not find while watching the patient walk. For example, watch a patient push on his thighs when rising from a chair would indicate a psoas muscle spasm. If the patient bends to one side, the psoas muscle spasm is located only on that side, but if the patient ends straightforward, the problem is bilateral.

Summary
The parts that do not move are relatively hard while those that do move are soft. You do not have to toss the parts around and do a lot of range of motion tests. Feel the body. The parts that are hard are the problem, and the soft parts are normal. Likewise, any part of the body that does not move has a problem.

The purpose of the treatments discussed in this book is too soften what is hard. It does not really matter how you accomplish this. What is important is that you do the techniques until the area softens and starts to move. This is a change that happens very quickly, in a split second. If you stop one second before the change occurs, you have done nothing, absolutely nothing! You have not affected the tissue in the slightest. For example, while it is unusual, it may take 10 minutes for a change to occur. In this case, if you only held the tension for nine minutes and 59 seconds, nothing would happen and there patient would gain no benefit. If you had held it for one more second, the change would have occurred. Of course, most treatments do not take 10 minutes, but the point is that if you stop before the change has occurred, you have accomplished nothing.