Uncontrolled movement and symptoms, disability, dysfunction, recurrence, risk, and performance

5th October 2011

There is a growing body of evidence to support the relationship between uncontrolled movement (UCM) and symptoms (Dankaerts 2006a, b, Luomajoki et al. 2008, van Dillen et al. 2009).

Scientific literature and current clinical practice are linking the site and direction of UCM in relation to symptoms, disability, dysfunction, recurrence, risk, and performance (Comerford & Mottram in press).

Symptoms: individuals with pain present with aberrant movement patterns (Dankaerts et al. 2006a, 2009, Falla et al. 2004, Ludewig & Cook 2000, Luomajoki et al. 1998, O’Sullivan et al. 1997b, 1998).

Dysfunction: The process of identifying and measuring UCM, and linking UCM to musculoskeletal pain, and to changes in muscle function is a developing area of active research in the area of pain and movement dysfunction (Gombatto et al. 2007, Luomajoki et al. 2007, 2008, Mottram et al. 2009, Morrissey et al. 2008, Scholtes et al. 2009, Roussel et al. 2009, van Dillen et al. 2009). Muscle dysfunction is most clearly apparent in people with pain (Falla & Farina 2008, Hodges & Richardson 1996, Hungerford et al. 2003, Lin et al. 2005).  The changes in muscle function underlying pain can present in two ways: i) as altered control strategies (van Dillen et al 2009 O’Sullivan 2000), and ii) as physiological peripheral muscles changes (Falla & Farina 2008).

Recurrence: The correction or rehabilitation of dysfunction has been shown to decrease the incidence of pain recurrence (Hides et al. 1996, Jull et al. 2002, O’Sullivan et al. 1997a).  This reinforces the need for therapy to be aimed at correcting dysfunction in the management of musculoskeletal disorders and not just relieving symptoms. 

Risk of injury: Some recent research has highlighted the potential for linking UCM to risk of injury. A recent study on dancers identified two movement control tests that may be useful for the identification of dancers at risk of developing musculoskeletal injuries in the lower extremities (Roussel et al. 2009). Athletes with decreased neuromusculoskeletal control of the body’s core (core stability) are at an increased risk of knee injury (Zazulak et al. 2007).


Comerford M and Mottram S Kinetic Control: The management of uncontrolled movement (in press) Elsevier

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Roussel N A, Nijs J, Mottram S, van Moorsel A, Truijen S, Stassijns G. Altered lumbopelvic movement control but not generalised joint hypermobility is associated with increased injury in dancers. A prospective study. Manual Therapy 2009a; 14(6): 630-635

Scholtes SA, Gombatto SP, Van Dillen LR. Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests. Clin Biomech 2009; 24(1): 7-12

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

Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med 2007; 35(7): 1123-30

Keywords: Review 2011, Movement Control Impairments