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Understanding Your Movement Could Be The Key to Understanding and Eliminating Your Pain

When you have an injury, your nervous system redistributes activity within and between muscles and and modifies  bio-mechanical behavior in order to “protect” the tissues from additional or threatened pain/injury.

http://www.ncbi.nlm.nih.gov/pubmed/21306915

An acute injury that initiates the inflammatory/healing  process is generally self-limiting, provided one doesn’t block the process with self-care measures such as the overuse of ice, NSAIDs or through repetitive use.

A chronic injury affects motor control, i.e. Compensatory patterns occur that act as a safeguard against further injury.

Motor adaptation after an injury generally involves the facilitation (shortening) of muscles along with concomitant inhibition (weakness) of other muscles,  and associated joint dysfunction.

Motor changes resulting in compensatory muscle reactions can lead practitioners on a  wild goose chase where the focus is  on the “symptoms” rather than the “dysfunction” or cause.

For example, a patient has chronic pain between their shoulder blades. Despite having chiropractic and massage on the painful area, the pain recurs.

A functional evaluation of this patient reveals:

  • Forward head carriage
  • Rounded shoulders
  • Weak/inhibited neck flexors and lower trapezius muscles
  • Overactive/Facilitated pectoralis, latissimus dorsi and upper trapezius muscles
  • Joint dysfunction in the cervical and thoracic spine

 

The above pattern was successfully addressed using:

  • Inhibitory techniques (e.g. dry needling and soft tissue manipulation) to the Overactive/Facilitated pectoralis, latissimus dorsi and upper trapezius muscles
  • Activation techniques (e.g. muscle energy work) to the weak/inhibited neck flexors and lower trapezius muscles
  • Joint mobilization
  • Corrective exercises

Is your pain due to a motor control issue?

If you have chronic pain, there is likely a motor control component. This can be easily demonstrated using a functional movement screen, followed by range of motion and manual muscle testing.

A movement screen evaluates  function at the five major joints, or Kinetic Chain checkpoints:

  1. Foot/Ankle  
  2. Knee  
  3. Lumbo-Pelvic-Hip Complex  
  4. Shoulder
  5. Cervical Spine

How to perform a movement screen at home using the Overhead Squat Assessment

  • Perform the squat in bare feet and shorts
  • Compensations (motor control issues) can be seen from the front, side and back (for the back and side, you will need someone else to observe)
  • Perform a series of squats 5 times per view  
  • Squat to the depth of an average chair height with your feet shoulder width apart and pointing straight ahead

 

What to look for

Anterior View

Kinematic checkpoints  

  • Feet  Should be straight ahead, 2nd metatarsal (toe) of each foot should be parallel to one another. Look for: ○ feet turning out
  • Knees should be straight ahead. Look for: ○ knees moving  inward or outward

Lateral View (Side)

Kinematic Checkpoints  

  • Lumbo-pelvic-hip complex. Look for:  ○ Excessive forward Lean ○ Back Rounds ○ Back Arches
  • Upper body. Look for:  ○ Arms fall forward

Posterior View

Kinematic Checkpoints

  • Feet. Look for: ○ Flatten ○ Heels Rise
  • Lumbo-pelvic-hip complex. Look for:  ○ Asymmetrical weight shift

 

Some of these compensations can also be seen during pushing or pulling activities as well as walking.

A  movement screen helps identify a region or regions where the body has compensated and has become Relatively Flexible.

The screen can be selectively broken down at each of the checkpoints by further evaluating muscle length through range of motion testing and muscle strength through manual muscle testing.

This breakdown can show the regional interdependence of proximal and/or distal areas and ultimately where a problem may be originating from.

e.g. A patient with knee pain and clicking demonstrates a forward lean during the Overhead Squat Assessment. When broken down through regional range of motion and manual muscle testing, the calfs are shown to be overactive and hamstrings under active. During therapy, the calfs were released, resulting in activation of the hamstrings and no knee clicking. This was reinforced with corrective exercises.

Key Points

  • Chronic pain is estimated to affect 1 million Americans
  • The conventional model is symptoms based
  • Chronic Pain Has Created ‘Silent Epidemic’ – More Focus is Needed on Non-Drug Approaches
  • Taking a “Functional” vs “Symptomatic” approach to musculoskeletal pain  through movement screening can help patients and clinicians identify the root cause of their pain and help to provide long-term efficacious solutions that do not have harmful side effects

http://www.apta.org/PTinMotion/News/2015/1/14/ChronicPainNIH/
Understanding Your Movement Could Be The Key to Understanding and Eliminating Your Pain

Other References

Clark, M., & Lucett, S. (Eds.). (2010). NASM essentials of corrective exercise training. Lippincott Williams & Wilkins.Clark, M., & Lucett, S. (Eds.). (2010). NASM essentials of corrective exercise training. Lippincott Williams & Wilkins.

Cook, G. (2010). Movement: Functional movement systems: Screening, assessment, corrective strategies. On Target Publications.
BONUS:

Interesting study on the effects of slouching: A slouched body posture decreases arm mobility and changes muscle recruitment in the neck and shoulder region.

http://www.ncbi.nlm.nih.gov/pubmed/26429723?dopt=Abstract

 

About the Author

Dr. Geoff LecovinNaturopathic Physician/Chiropractor/Acupuncturist/Certified Strength and Conditioning Specialist/Corrective Exercise Specialist/Performance Enhancement Specialist/Certified Sports Nutritionist/View all posts by Dr. Geoff Lecovin