The Movement Project - Part 2: Understanding Movement Patterns

 If you rehabilitate movement you should know this

Background

I was asked by a novice to highlight a few points that can help when aiming to use retrospective clinical reasoning (putting all the information together after the subjective history and planning the physical assessment). It may also help the moderately experienced clinician as well.

As we know from our Neurology training, people move in patterns and there is a large variability in motor control to perform the same functional task. It is helpful to have some background about movement patterns and movement pattern control.

Specific Movement Pattern Control:

The tests of movement pattern control are based on exercises in which one joint (or region) is maintained in a neutral position with conscious control, either while an adjacent joint (or region) is independently moved, or while performing part of a functional movement, with normal breathing. The exercises require more sensory motor awareness and neurocognitive function to perform than general exercise. They are generally performed with slow, low force repetitive movements.

Tests of movement pattern control are conceptually quite simple. The adjacent region (above or below, cranial or caudal) is moved while the test area (area believed to be the source of tissue pain in mechanical pain. Note: we'll have another blog on this point) is maintained in a neutral position. As we know, rules can be broken so sometimes the region to be moved needs to be two or more regions away when it relates to function (e.g. shoulder flexion and lumbar extension or cervical flexion and mid thoracic flexion).

Functional or Non functional?

These types of exercises are non functional of course. The exercises have been criticized by many for this reason. It is abnormal to eliminate an aspect of the kinetic chain sequence during a functional movement. The point is, the movement patterns of those with low back are not actually normal. So rehab is to cognitively use an abnormally specific pattern and then integrate it into function using kinetic chain sequencing. There should be no debate after this.

Planning Which Test to Use:

There are numerous potential challenges you could assess. Sometimes this is overwhelming. There are a few pieces of knowledge which can help you in your clinical reasoning. One is knowing the general dysfunctional patterns of the body. Below is a list for the spine:

Lumbar Spine: Flexion or Extension

Thoraco-Lumbar Junction: Extension (flexion does occur less commonly)

Upper Thoracic Spine: Extension

Mid Thoracic Spine: Flexion

Mid Thoracic Spine: Rotation

Lower Cervical Spine: Flexion

Mid Cervical Spine: Flexion or Extension (occurs with a translation control deficit)

Upper Cervical Spine: Extension (Flexion can occur with a forced flexion injury)

Cervical Spine: Rotation (normally upper)

Note: Rotation can occur with any of the sagittal plane movement pattern control deficits. The mid thoracic spine and cervical spine are a little unique in that rotational symptoms frequently occur without sagittal plane pain. However there will be sagittal plane movement pattern control deficits.

Another is appreciating function. You need to match the aggravating factors from the history to a test. You should only need to do a few movement pattern control tests to get a diagnosis and start rehabilitation. For example, if the patient's symptoms occur during sitting, consider the tests relating to sitting. It can take a while to get used to this, but we have workshops to help you understand this.

Movement Patterns

This part is more advanced and is really only for those who understand primitive reflexes. Most primitive reflexes are whole body and not just localized to where the sensory stimulus is. These are involved in patterns of movement. For those patients with patterns of poor movement pattern control and kinetic chain sequencing in extension, you should consider the extension phases of the Symmetrical Tonic Neck Reflex and Moro Reflex as well as the Landau, Foot Tendon Guard and the Trunk Extension Reflex. 

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