LATEST BUZZ FROM KC

Current practice for long term individualised outcomes

9th July 2018

The opening keynote lecturer at The 2018 Movement Conference, Professor Deborah Falla, Director, Centre of Precision Rehabilitation for Spinal Pain, (CPR Spine) University of Birmingham, presented some powerful messages:

  • Exercise is the most effective treatment for the management and prevention of spinal pain
  • However, it delivers only small to moderate treatment effects, which are rarely long lasting
  • The outcome of exercise interventions can be optimised when targeted toward the 'right' patients and when tailored to address the neuromuscular impairments of each individual.

More on the importance of movement message can be found in a recent paper [1].

Key to this message is exercise or retraining interventions can be targeted to the individual.

We all know everyone moves differently and we need to give our patients the right retraining at the right time. Too much time and too many resources are wasted prescribing generic retraining, the effects of which are watered down across the board.

Let’s get better outcomes with client specific retraining

A recent editorial in the BJSM [2] questions whether Is it time to reframe how we care for people with non-traumatic musculoskeletal pain? The authors conclude this ‘requires those of us working in the musculoskeletal field to acknowledge the limitations of current surgical and non-surgical interventions for persistent and disabling non-traumatic presentations, as well as upskill and reframing of our practice, language and expectations to consider aligning our current practice with that supporting most chronic healthcare conditions’. The authors suggest treatment paradigms (such as ‘correcting’ upper body posture and muscle imbalances) do not conform to current research evidence and should be shelved.

We absolutely agree clinicians should be familiar with current research trends and we hope ‘muscle imbalance’ and correcting posture has been left in the 90’s.

WHAT WE KNOW:

  • Everyone moves differently
  • Movement patterns are result of innumerable components: THE TASK e.g. activities performed (walking, bending, sitting) THE INDIVIDUAL e.g. (age, gender, pain, fatigue, history of pain, recurrence, physiological and psychological system (fear of movement, beliefs) THE ENVIRONMENT (society, work, friends, family, loading factors or protective equipment [3]
  • Therapists can focus on movement outcomes rather than components and assess movement control impairments [3]
  • Movement alters in the presence of pain [1, 4])
  • Pain influences movement outcome and influences co-ordination and synergy interactions [5, 6]
  • Individuals possess unique muscle coordination strategies which have specific mechanical effects on their musculoskeletal system. It appears some strategies make people more at risk of developing musculoskeletal disorders than others [7]

So as clinicians we need to be able to evaluate movement – is it optimal or will changing it help our patients reach their goals? We need to assess our patients as individuals so as to deliver specific retraining to match their presentation in terms of changing co-ordination strategies and muscle synergy patterns. 

At Kinetic Control we can help you with your do this in a clinical reasoning framework:

  • Are there changes in movement patterns? - co-ordination strategies and muscle synergy patterns
  • Can we change mechanisms?
  • If so, how?
  • Teaching each clinician to test every patient and so deliver individualised retraining

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Gain clinical excellence in Movement

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[1] Falla D, Hodges PW. Individualized Exercise Interventions for Spinal Pain.Exerc Sport Sci Rev. 45(2):105-115. 2017

[2] Lewis J, O’Sullivan P. Br J Sports Med Epub ahead of print doi:10.1136/bjsports-2018-099198

[3] Dingenen B, Blandford L, Comerford M, Staes F, Mottram S The assessment of movement health in clinical practice: A multidimensional perspective Physical Therapy in Sport doi.org/10.1016/j.ptsp.2018.04.008

[4] Hodges PW, Smeets RJ Interaction between pain, movement, and physical activity: short-term benefits, long-term consequences, and targets for treatment Clin J Pain. 2015 doi: 10.1097/AJP.0000000000000098.

[5] Claus AP, Hides JA, Moseley GL, Hodges PW Different ways to balance the spine in sitting: Muscle activity in specific postures differs between individuals with and without a history of back pain in sitting. Clin Biomech 2018 doi: 10.1016/j.clinbiomech.2018.01.003

[6] The effect of muscle fatigue and low back pain on lumbar movement variability and complexity Bauer CM, Rast FM, Ernst MJ, Meichtry A, Kool J, Rissanen SM, Suni JH, Kankaanpää M.J Electromyogr Kinesiol. 2017 doi: 10.1016/j.jelekin.2017.02.003

[7] Hug F, Tucker K Muscle coordination and the development of musculoskeletal disorders. Exerc. Sport Sci. Rev., Vol. 45, No. 4, pp. 201–208, 2017.

Keywords: Kinetic Control, Kinetic Control Education, Movement Control Impairments