Movement Dysfunction

Introduction

Coordinated movement

A good understanding of the control processes used to maintain functional movement stability is critical for physical therapists treating or managing musculoskeletal pain problems. Motor dysfunction is usually related to the person’s inability to control the stabilizing muscles within the muscle system. Most cases of chronic pain are due to failure of the stabilizers of the motor system. To effectively address this issue, it is necessary to look outside the isolated area to assess the function of the entire motor system [1]. As we humans develop our locomotor system genetically Dysfunction of predetermined neurodevelopmental processes in the motor system occurs in predictable patterns [2].

Movement System Impairment Syndromes

Sahrmann and colleagues developed a syndrome-based diagnosis and treatment of motor system injury (MSI) to guide physical therapy. The conceptual framework underlying the proposed MSI syndrome is the kinetopathology model (KPM), the repetitive Movement and continued alignment can induce pathology. The MSI syndrome is thought to be the result of repetitive use of alignment and motion, which over time is thought to become impaired and eventually lead to pathoanatomical changes in tissue and joint architecture. [3] [4]

The classification and treatment of motor system injury syndromes of all body regions is described.

Classification involves interpreting data from standardized tests of alignment and movement.

Treatment is based on correcting impaired alignment and movement patterns and correcting tissue adaptations associated with impaired alignment and movement patterns. Reasons for these pattern changes include:

• Risk factors: Sustained postural and repetitive motion, including intrinsic factors (eg, personal characteristics) and extrinsic factors (eg, job fitness) that may contribute to the degree of tissue change.
• Injury development and persistence: a combination of microscopic instability versus stiffness, neuromuscular activation patterns, and motor learning.

Assessment: KPM uses clinical testing to identify impaired movement in the kinetic chain and optimize interventions for this dysfunction.

Treatment: Correcting the impaired alignment and movement that lead to tissue dysfunction by addressing the presenting stiffness and weakness and neuromuscular activation patterns is a proposed treatment approach for MSI [5].

Steps in MSI

The following steps are used to evaluate and treat MSI:

1. Determine the syndrome
2. Identify the contributing factors
3. Determine the corrective exercises
4. Identify alignments and movements to correct during daily activities
5. Educate patients about factors that contribute to musculoskeletal conditions by practicing corrections during activities

Functional Muscle Classification

When performing an exercise, there are prime movers (mobilizers) and stabilizers. The stabilizer muscles are tasked with stabilizing the body and extremities in multiple planes of motion, while the primary movers are the muscles that do most of the work.

1. Primary movers, also known as agonists, are the muscles that do most of the work in lifts.
2. Stabilizer muscles are not directly involved in moving loads, they are working to keep certain body parts stable and stable so the primary movers can perform the exercise efficiently and safely. They are thought to have a postural role and control excessive joint movement. a muscle It retracts as it acts as a stabilizer, but doesn’t lengthen or shorten as dramatically as a prime mover. The table below provides more information on the main movers and stabilizers, based on the work of Comerford and Mottram[1].

Table 1. Characteristics of stabilizer and mobilizer muscles [1] Maximum volume surface stabilizers have wide aponeurotic insertions allowing them to distribute forces/loads Leverage mechanics encourage speed/range of motion

Table 2. Characteristics of local and global muscles. [1] Local muscles Global muscles Local muscles come from the deepest layer and have segmental origin/insertion Global muscles come from superficial/outer layers and they have no segmental vertebral insertion These muscles control/maintain Neutral spine These muscles insert/originate in the ribcage or pelvis (non-segmental) These muscles respond to any change in posture and low external load These muscles respond to changes in the line of action/High magnitude of external load Their Action is independent of load direction/ Athletic and biased toward low-load activities They generate high torque, encouraging movement

Stability Complexes

Shoulder

1. The rotator cuff helps stabilize the shoulder (supraspinatus subscapularis teres minor). Their function is critical to maintaining optimal function and biomechanics of the shoulder joint.
2. The scapula stabilizer (trapezius anterior serratus rhomboidus levator scapulae) works with the rotator cuff and deltoids to rotate the scapula up and down as the shoulder joint and arm move from the back to the upper back or away from the core.

Hip

• The hip stabilizer complex is made up of several muscles, but the primary muscle is the gluteus medius (which maintains proper biomechanical function of the lower body while walking or running).
• It is certainly not the only muscle that stabilizes the body, as it is only part of the kinetic chain. [6]

Trunk

• Primary muscles used for core stability include: pelvic floor; transversus abdominis; internal obliques; multifidus; diaphragm; some literature also includes deep fibers of the psoas and deep hip rotators as part of the inner core. view core muscles

Examples of Abnormal Recruitment

1. Typically, to generate hip extension, the hamstrings are activated first, then the glutes, and then the contralateral erector spinae. Delayed gluteal activation of hamstrings closely behind ipsilateral erector spinae is associated with low back pain
2. The normal sequence of muscle recruitment for shoulder abduction is as follows: deltoid – contralateral upper trapezius – ipsilateral upper trapezius – lower scapular muscles. This normal sequence has been found to be disturbed in painful neck and shoulders [7]

Read more on this page Motor Control Changes and Pain

Classification of dyskinesia syndromes

Clinical tests can be used to classify movement patterns. The results of these trials indicate poor management and should aim to restore symptoms.

The screening tests are followed by symptom adjustments to correct alignment to activate blocked muscles or eliminate excessive motion at specific joints[5].

Glut med exercise

Examples of Motor Impaired Syndromes[5]:

• Cervical flexion-rotation
• Thoracic flexion
• Scapular winging
• Lumbar extension
• Hip lateral rotation
• Tibiofemoral hypomobility
• Insufficient ankle dorsiflexion

Management of Movement System Impairment

A variety of management techniques can be used in the treatment of weak motion. Educating patients about the causes of their symptoms and lifestyle and ergonomic modifications is important to engage the patient in the treatment process[8].

Exercises can be used to teach patients how to use their muscles effectively and increase their motor skills[5].

Check out the following pages to learn more about MIS treatment:

• Lumbar Motor Control Training.
• Deep Neck Flexor Stabilisation Protocol.
• Classification of Back Pain Using Shirley Sahrmann’s Movement System Impairments Concept Theory