What is this movement based therapy?
Its 2020, we all are partly or completely urbanized and clearly we all need some guidance on how to move. Now thats where physio’s can play a crucial part apart from various other exercise science experts.
Let me tell you how!!
There are a lot of physio’s who can help solve your aches and pains by just advising the correct movements. like i said its 2020! Have you heard of therapies to solve your problems purely based on movement corrections. we at physiocure practice few of them.
Being into sports physio, I try to follow a mix of these various movement therapies to help all my clients with their injuries like Lowback pain, Headaches, neck pains shoulder impingements, knee pains, faulty postures etc
These are based on functional movement screenings for example to check how are you moving in the 7 basic movements of human life.
This therapy is not just restricted to treating your aches and pains. we as physiotherapists can also guide you and teach you correct way to do gym exercises by just examining once as to How do you move?
Its called Functional movement screening. its very effective for active people as well as athletes.
For clients who are experiencing lower back pain or neck pain, I usually follow a therapy based on Dr Shirley sahrmanns Movement Impairments Syndromes. It has been so far very effective in treating more than 10,000 clients at the clinic for various spine problems in the past decade.
What is Movement Impairment syndrome (MIS) ?
In 2000, Shirley Sahrmann, a renowned physiotherapist along with her colleagues introduced a new school of thought which uses examination of movements and identifying impairments which eventually help physiotherapists design treatment programs to treat musculoskeletal conditons like low back pain, neck pain, shoulder pain and many more. The basic concepts of MIS are based on the following points.
- Musculoskeletal pain syndromes are the result of cumulative micro-trauma from accumulation of tissue stress and irritation resulting from sustained alignments or repeated movements in a specific direction(s) associated with daily activities.
- the reason certain musculoskeletal pains develop because there has been minute trauma/stress on that tissue occurring for over years or a long time due to faulty adopted positions for your work or leisure.
- The joint(s) that is moving too readily in a specific direction is the site of pain generation.
As a result, the affected area will move excessively in a particular direction, for example a person who has been using a computer with a wrong ergonomic setup and adopting wrong postures for years will be able to poke his chin out much more than an individual who has just started and complain of occasional neck pain.
- The readiness of a joint to move in a specific direction, i.e., the micro-instability, combined with relative stiffness, the neuromuscular activation pattern and motor learning contribute to development and persistence of the path of least resistance.
- The reason a joint can be moved excessively in one direction is the structures supporting it tend to stretch out and cannot be restored to normal length, the muscles surrounding that joint learn to function in a faulty manner and it ends up becoming the new normal position for that joint.
- Treatment is based on correcting the impaired alignments and movements contributing to tissue irritation as well as correcting the tissue adaptations, such as relative stiffness, muscle weakness, and neuromuscular activation patterns.
- Once your physio is able to identify this impairment, the treatment is as simple as correcting that impairment via corrective exercises and allowing the surrounding muscles and tissues to adapt to a better normal position.
- Training to correct impaired alignments and movements instead of training “isolated muscles” will induce appropriate neural and musculoskeletal adaptations.
- In summary, using this concept, the faulty movement is tested and corrected than typical physiotherapy/orthopaedic treatment and indirectly /directly the ailment is resolved with appropriate and simple measures.
The following example illustrates how correcting the impaired alignments and movements address the cause of the pain, which is not achieved by identifying the pathoanatomical source of the symptoms.
- A patient is referred to physical therapy with the diagnosis of Supraspinatus Tendinopathy.
- Tendinopathy is the pathoanatomic source of pain.
- After assessing the patient’s scapular and humeral alignments and movements and associated symptom behaviour the physical therapist makes a diagnosis of insufficient scapular upward rotation with hume
ral anterior glide- basically the physio concludes that the shoulder blade is the reason of his pain and its inefficient work needs to be corrected.
- The other components of the examination identify the contributing factors that include (1) relative stiffness, (2) muscle strength, and (3) neuromuscular activation patterns.
- The idea behind the KPM is that classifying the patient according to impaired alignments and movements (i.e., Scapular Insufficient Upward Rotation, Humeral Anterior glide) is more useful to guide physical therapy treatment than identifying a pathoanatomical problem because these are the impairments to be corrected
check out this advanced shoulder blade exercise we recommend to our clients
TREATMENT PRINCIPALS:-
- Treatment is based on correcting the impaired alignment and movement patterns as well as correcting the tissue adaptations associated with the impaired alignment and movement patterns.
- Treatment includes patient education, analysis and correction of daily activities and prescription of specific exercises.1, 2, 79, 80, 81
- Patient education refers to educating the patient about how the repetition of impaired movements and sustained alignments in a specific direction may be related to his musculoskeletal condition and how to correct the impairments during all of his daily activities, particularly those that cause symptoms.
For example, patients with Scapular Depression Syndrome may be taught to keep their scapula elevated by supporting their arms while working at a computer. The goal of the support is to reduce the sustained load on the cervical spine and the muscles that elevate the scapulae
- The specific exercises and activities are performed during the treatment sessions and also are part of the home program.
- Each patient receives pictures or figures of the specific exercises and daily activities with written instructions. Videos also can be used to teach the patient how to perform the exercises and activities.
For example- a patient referred to the clinic with low back pain required to be tested for single leg stance as a part of the examination. The following instructions were given to conduct the test and when one the impairments was identified, that movement was corrected using the same movement as an exercise with specific instructions
The patient had 2 impairments:- the hip of the stance leg dropped and the knee moved inwards, suggesting a particular impairment which was corrected using cues.
CONCLUSION:-
The MSI based classification and treatment allows physical therapists to diagnosis and treat musculoskeletal conditions based on principles of the KPM where impaired alignments and movements are proposed to induce pain and pathology.
MSI syndromes and treatment have been described for all body regions. The reliability and validity of the system for some anatomical regions have been partially described.8, 52, 56, 57, 58, 59, 60, 62, 71, 72, 73, 75, 76, 77, 78
Several case reports describing MSI examination and treatment of different musculoskeletal conditions have been published79, 80, 81, 86, 87, 88, 89, 90 although efficacy of treatment has not been tested in randomized controlled trials, except in people with chronic low back pain.84
REFERENCES:-
Diagnosis and treatment of movement system impairment syndromes
Shirley Sahrmann, Daniel C. Azevedo, and Linda Van Dillen
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693453/#