LATEST BUZZ FROM KC

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).

References

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

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 patients using trunk muscle activation and lumbosacral kinematics of postures and movements: a statistical classification model. Spine 2009; 34 (15): 1610-8

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 patients with motor control impairment. Manual Therapy 2006a; 11(1): 28-39

Dankaerts W, O'Sullivan P, Burnett A, Straker L. Altered patterns of superficial trunk muscle activation during sitting in nonspecific chronic low back pain patients: importance of subclassification. Spine  2006b; 31(17) : 2017-23

Falla D, Bilenkij G, Jull G  Patients with chronic neck pain demonstrate altered patterns of muscle activation during performance of a functional upper limb task. Spine 2004; 29:1436-1440

Falla D and Farina D. Neuromuscular adaptation in experimental and clinical neck pain. J Electromyogr Kinesiol 2008: 18(2): 255-61.

Gombatto SP, Collins DR, Sahrmann SA, Engsberg JR, Van Dillen LR. Patterns of lumbar region movement during trunk lateral bending in 2 subgroups of people with low back pain. Phys Ther 2007; 87(4): 441-54

Hides J A, Richardson C A, Jull G A. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine 1996; 21(23): 2763-9

Hodges P W and Richardson C A. Inefficient muscular stabilisation of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine 1996; 2(22): 2640-50

Hungerford B, Gilleard W, Hodges P. Evidence of altered lumbopelvic muscle recruitment in the presence of sacroiliac joint pain. Spine  2003; 28(14): 1593-600.

Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine 2002; 27(17): 1835-43

Lin JJ, Hanten WP, Olson SL, Roddey TS, Soto-quijano DA, Lim HK, Sherwood AM. Shoulder dysfunction assessment: self-report and impaired scapular movements. Phys Ther 2006; 86(8): 1065-74

Ludewig P, Cook T M. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Physical Therapy 2000; 80(3): 276-291

Luomajoki H, Kool J, de Bruin ED, Airaksinen O. Reliability of movement control tests in the lumbar spine. BMC Musculoskeletal Disorders 2007; 8: 90

Luomajoki H, Kool J, D de Bruin E, Airaksinen O. Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. BMC Musculoskeletal Disorders 2008; 9: 170

Mottram S, Warner M, Chappell P, Morrissey D, M Stokes. Impaired control of scapular rotation during a clinical dissociation test in people with a history of shoulder pain.  2009 3rd International Conference on Movement Dysfunction Edinburgh, UK. Manual Therapy; 14:1 pS20

Morrissey D, Morrissey MC, Driver W, King JB, Woledge RC.   Manual landmark identification and tracking during the medial rotation test of the shoulder: An accuracy study using three dimensional ultrasound and motion analysis measures. Manual Therapy 2008; 13:6: 529-535

O'Sullivan P, Twomey L, Allison G. Altered abdominal muscle recruitment in back pain patients following specific exercise intervention. J Orthopeadic Sports Physical Therapy 1998; 27(2): 114-24.

O'Sullivan P B, Twomey L, Allison G. Evaluation of specific stabilising exercises in the treatment of chronic low back pain with radiological diagnosis of spondylosis or spondylolisthesis. Spine 1997a. 22(24):2959-67.

O'Sullivan P B, Twomey L, Allison G, Sinclair J, Miller K, Knox J. Altered patterns of abdominal muscle activation in patients with chronic low back pain. 1997b. Australian J Physiotherapy 43(2): 91-8.

O'Sullivan PB. Lumbar segmental `instability': clinical presentation and specific stabilizing exercise management. Manual Therapy 2000; 5(1): 2-12

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