Conference Report ICMD

Third International Conference on Movement Dysfunction, Edinburgh, October 30 to November 1 2009

Since the first ICMD in 2001 there has been growing world interest in understanding Movement Dysfunction as a key feature in the risk of injury, actual injury, disablement (including limiters of performance) and rehabilitation.  This 3rd ICMD was summarised at the conferences end, from the podium, as the ‘Best yet,’ and it truly was a good conference.

Over 600 delegates from nearly 50 countries listened with keen interest to the keynote lecturers, the guest presenters, the research paper presentations, and the poster displays over the 3 days of a rather wet but welcoming Edinburgh autumnal weekend.

Subgrouping
The first morning started a recurring theme that popped up over the entire conference from a significant number of the presenters about the importance of ‘subgrouping’ in research. Shirley Sahrmann’s keynote lecture discussing low back pain clearly identified that degeneration of the lumbar disc is a natural consequence of aging and normal repetitive movements. She identified that dysfunctional movements increase the degeneration. Modification of these movement faults can slow this process. Sahrmann pointed out that clinical examination is reliable in identifying movement faults and classification of the faults can be the basis for identifying sub groups in the diagnosis of low back pain. The implication of this is that the current ‘hiccup’ in low back pain treatment research – in which there has been no clear support for any treatment strategy – such as mobilisation, medication, specific or general exercise – over any other strategy – may soon change. It is clear that Sahrmann thinks that a movement diagnosis and a control of dysfunctional movement strategy will be shown to be effective once research looks at subgrouping low back pain into movement dysfunction diagnoses.

For those interested in the Performance Stability model in which movement faults are identified and a retraining strategy taught – this is good news.

Following directly on from this was Wim Dankaerts keynote – he too is looking at subgrouping and is about to publish a paper that shows that subgrouping is lacking in most randomised control trials (RCT’s) looking at chronic low back pain. He too indicated that clinicians can reliably classify movement faults and that targeted interventions will give better outcomes in both short term and long term gains.

Interestingly in the questions afterwards someone asked if there were plans to adopt a common vernacular and diagnostic types across the different research groups around the world – the mood of the meeting and the speakers was that it was time for this to happen!

Later in the conference Nadine Foster asked some searching questions about subgrouping in low back pain. She pointed out that subgrouping in this field is still in its infancy and is not yet the recommended practice due to the lack of evidence. The current diagnostic groups do not predict outcome so alternate subgouping is important.  Keele University have developed the STarT Back screening tool which divides patients by out come (risk of chronicity). She advocates its use as it is showing to be reliable, clinically useful, and simple.

This is a different approach to the movement diagnosis subgrouping advocated by Sahrmann or Dankaerts.

Movement Screening
Gray Cook, Mark Comerford and Wayne Diesel all discussed movement screening. Cook discussed his Functional Movement Screen and Diesel discussed the way Tottenham Hotspur puts a functional assessment system in place.

Comerford pointed out that current assessment strategies look at history of previous injury, joint range, muscle strength and muscle extensibility but it is only history that has any predictive legitimacy. So what are we not looking for? Comerford suggested that assessing the function of the body under real situations is important and that looking at identifying uncontrolled movements, where they occur and in what direction, and classifying them as to whether the uncontrolled motion occurs under low threshold or high threshold activities. Performance Stability launched their new online tool using this system developed by Comerford and Mottram at the conference www.theperformancematrix.com

A key distinction between the Functional Movement Screen and the Performance Stability tool is that Performance Stability tool can identify the threshold at which the uncontrolled movement occurs. Interestingly the tests can show failures in low threshold movements (postural loads) that don’t appear in the same movement under higher threshold testing and vice versa -allowing a more targeted intervention.

Some Snapshots of the conference

John Rothwell discussed that damage to the motor system causes the brain to have to reorganise itself– and the ability of the brain to ‘flip back’ to previous strategies is there but it can be difficult if the brain has been using the altered strategy for some time. The change can come about by altering the input, which by extension to his comments can be by focussed exercise. Drugs affecting dopamine or magnetic brain stimulation during the exercise looks like it can assist this process.

Caroline Alexander was discussing nontraumatic shoulder instability showed that neural stimulation from using the forearm muscles actually encourages the scapulo-thoracic muscles to work (improving stability). Even imagining tasks improved this reflex. Her work shows that functional exercise in rehabilitation is important.

Michael Callaghan was interested in proprioception of the knee joint. It can be tested by looking at: joint position sensation, kinaesthesia (knowing the threshold at which movement, and its direction, are first perceived) and vibration sense. He identified that patello femoral pain is related to poor proprioception.  Taping the knee doesn’t necessarily affect the mechanics of the knee but it does improve proprioception.

Paula Ludewig reported on shoulder impingement research that indicates mechanical entrapment can occur lower in the abduction range (less that 60 degrees) supporting that strengthening the serratus anterior releasing the pectoralis minor and stretching the posterior capsule is beneficial in impingement problems.

Laurie McLaughlan identified that disorders of breathing and continence have a strong association with back pain. The development of capnography to measure CO2 has shown a link between raised CO2 from altered breathing patterns and delays in recovery from musculo-skeletal injury. Treating the breathing mechanics and patterns reduces pain and improves function. A useful adjunct to a manual therapy program.

Steve Harridge gave a useful lecture on muscle fibre types and identified that within one classification (e.g. Type IIA) there is a continuum of fibres which make them a ‘hybrid’ some may be slower or faster than others within the fibre type. He asked if human muscle fibre can be switched from one type to another. The answer is basicly no, but under different circumstances such as bed rest for example, the balance of the fibre types recruited can substantially alter and other fibre types atrophy – effectively changing the way the muscle works.

Lorimer Moseley always both amusing and interesting discussed that physical tests such as 2-point discrimination shows that someone in pain has a larger threshold compared to a person not in pain. This shows a cortical response (and technically in chronic pain the intra-cortical inhibition is lost) This can in be affected by focussing attention on the body part – the client looking at the (unclothed) body part being touched. This can alter the body image the client has of themselves that has been altered by injury to be more correct and so  improve the clients condition. The body affects the mind and the mind affects the body.

Conclusion
You should have been there! Check the conference blog which assisted the writing of these notes….www.webducate.net/icmd_blog/