SPMLs & EtOH

SPMLIHGROwSEPFD Exasperating, but always what is asked of us (especially by surgeons) is ‘What is an SPML?’ and ‘Why do it that way and not the standard (aka proper) way?” Did you spot the conceptual error? Actually two. 1. ‘do it’ There is no “it”. SPML has half of the process name missing from the abbreviation. The only letter in ‘ SPML’ that is essential is the “S”. Selective . Selective isn’t a list of those muscles that have tissue contracture. It is selective of what functional abnormalities are to be dealt with – and – in more than one way, not just by cutting. Contracture is not a THING, singular. It is a salad of things only part of which is tissue contracture. That brings up another part of the ‘S’. The reactive contracture caused by high gain spreading reflexes is not there at all while under anesthesia. Anesthesia methods must be selected so as to not blind us to the abnormal reflexive abnormalities which we have found are worse in functional loss than obvious tissue contracture. Range of motion should NEVER be the measure of outcome. More is NOT better. Power loss and inability to control wide range are sources of treatment failure, failure to improve function. With treatment we want to: Still be able to do whatever functional things existed, as before, but longer. Do them better. Be able to do a more functional but different thing instead. Do it several ways depending on the situation – situational capability. Remove joint damaging muscular patterns & thus head off joint damage. Detect structure risks before x-ray visualized damage occurs.