The Movement Project - Part 1: Is Altered Movement Really the Underlying Mechanism for Mechanical Pain?

 If you rehabilitate movement you should know this

Do not take for granted that everyone can learn or benefit from cognitively altering or controlling movement

Background

There are several schools of thought which aim to cognitively alter and / or control movement patterns for the treatment of mechanical pain. The underlying premise linking this rehab concept to musculoskeletal symptoms is based on some simple concepts:

• The way that the central nervous system (CSN) coordinates movement can influence tissue loading
• The CNS has numerous motor control options when producing a movement
• End range movements are needed and required for normal function
• Frequent use of end range movements can increase tissue loading
• Some people habitually use their end range movements
• Subjects with low back pain (LBP) move their hips more than their lumbar spine during trunk flexion and extension, therefore loading tissues

These points provide the biological plausibility for the intervention but it does raise a more important question:

Why does the CNS chose to move the spine in a manner that will potentially increase tissue loading and harm the spine?

Therefore prescribing exercises to cognitively alter or control movement of the spine is analogous to empiric therapy. Clearly the underlying mechanism(s) are required and treatment should specifically target them. No other school of thought specifically targets the functional mechanism as to why the CNS chooses a potentially harmful movement pattern.

This question facilitated the Movement Project with the goals to:

• Identify and understand the functional mechanisms of altered movement. Since there may be genetic influences, the goal was to consider modifiable factors.
• Develop intervention strategies that specifically target the functional mechanisms
• Test these interventions clinically
• Predict who will respond to this type of intervention

We are happy to say that the Movement Project is completed. The projects that were completed to get here include:

• Narrative review and systematic review of mechanisms of altered trunk movement patterns
• Development and testing (laboratory and clinical) of an underlying hypothesis
• Development of a preliminary clinical prediction rule as to who will respond to this therapy
• Clinical trial on cognitively altering movement patterns
• Systematic review of interventions that cognitively alter movement patterns

This project brought about The Learning Project because we learned from the Movement Project that one of the functional mechanisms was related to learning difficulties and the neurodevelopmental process.

We know how to rule in and rule out who will respond to this therapy. Approximately 20% of people cannot learn these exercises. We have interventions for those who do not learn and targeted interventions for the functional mechanisms of altered movement. 

Sean GT Gibbons BSc (Hons) PT, MSc Ergonomics, PhD (c), MCPA