Patrik Pedersen contributes a chapter on Kinetic Control

19th May 2014

Patrik Pedersen contributes a chapter on Kinetic Control

We will be posting some excerpts from the book: Here is part 1

Kinetic Control is a comprehensive system for identifying, diagnosing and retraining movement control to correct faulty movement patterns, improve function, reduce symptoms and prevent recurrence.

1. Uncontrolled movement

The key to managing movement control is a thorough examination and a comprehensive clinical reasoning, leading to a clinical diagnosis of uncontrolled movement (UCM). Identifying and classifying movement dysfunctions has quickly become a cornerstone of contemporary neuromusculoskelletal rehabilitation (1-5). Sahrman (3) argues that faulty movement patterns may contribute to the pathology and pain, not only be a result of it. There is a growing bank of evidence for a strong relationship between movement dysfunction and symptoms (6-8), and that the direction of UCM relate to the direction of tissue stress and pain producing movements (9). It is therefore essential that the subjective and objective assessment identifies and classifies the direction of UCM and relate to the patient's symptoms and pathology (1,2).

2. Clinical reasoning - 3 clinical diagnoses

In order to sub-classify neuromusculoskeletal dysfunctions we need to set the following three clinical diagnoses: 

1. Diagnosis of movement dysfunction (site and direction of UCM). The initial priority is to identify the site and direction of UCM that relate to the patient's mechanical symptoms. If there are several sites with UCM, it is important to identify the priority (1,2). (e.g. UCM in lumbar flexion during low load) 

2. Clinical diagnosis of pain-sensitive structures. Identification of structures or tissues that generate the symptoms. All the therapist's knowledge, tools and modalities is to be used to optimize the healing process of affected tissue (1,2). (e.g. dorsal ligaments structures) 

3. Clinical diagnosis of ongoing pain mechanisms. Discern the proportions of the different pain mechanisms, the degree to which the pain is nociceptive (mechanical / inflammatory), neurogenic sensitization, behavioural or psychosocial. The dominant mechanisms must be addressed as a priority (1,2). (e.g. primary mechanical / nociceptive pain). 

In addition we need to evaluate and consider contextual factors (both personal and environmental)

1. Comerford MJ, Mottram SL. Functional stability re-training : principles and strategies for managing mechanical dysfunction. Manual therapy . 2001 , 6 (1) :3- 14.

2. Comerford Mark, Mottram Sarah . Kinetic Control The Management of Uncontrolled Movement. Elsevier 2012.

3. Sahrman S. Diagnosis and Treatment of Movement Impairment Syndromes . St. Louis : Mosby ; 2002.

4. Fersum KV, Danks Aerts W, O'Sullivan PB , Maes J Skouen JS, Bjordal JM , et al. Integration of subclassification strategies in randomized controlled clinical trials Evaluating manual therapy treatment and exercise therapy for non -specific chronic low back pain : a systematic review . Br J Sports Med. 2010 Nov ; 44 (14) :1054 - 62.

5. Dankaerts W, O'Sullivan P , Burnett A, Straker L , Davey P , Gupta R. Discriminating healthy controls and two clinical Subgroups of nonspecific chronic low back pain patient using trunk muscle activation and lumbosacral kinematics of postures and movements : a statistical classification model . Spine ( Phila Pa 1976). 2009 Jul 1 , 34 (15) :1610 - 8.

6. Dankaerts W, O'Sullivan PB, Straker LM , Burnett AF , Skouen JS . The inter -examiner reliability of a classification method for non -specific chronic low back pain patient with motor control impairment . Man Ther. 2006 Feb , 11 (1) :28- 39.

7. Dankaerts W, O'Sullivan P , Burnett A, Straker L. Altered patterns of superficial trunk muscle activation During sitting in nonspecific chronic low back pain patient : importance of subclassification . Spine ( Phila Pa 1976). 2006 Aug 1; 31 ( 17) :2017 -23.

8. Luomajoki H, Kool J , de Bruin ED, Airaksinen O. Movement control tests of the low back ; evaluation of the difference between patient with low back pain and healthy controls . BMC Musculoskelet Disord . 2008: 9:170 .

9. Van Dillen LR, Maluf KS, Sahrmann SA . Further examination of modifying patient -preferred movement and alignment strategies in patient with low back pain During symptomatic tests . Man Ther. 2009 Feb , 14 (1) :52 -60.

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