8th February 2019
THIS POST IS WRITTEN BY OUR KC ACCREDITED TUTOR BEATE STINDT
TO FIND OUT MORE ABOUT HER, CLICK HERE!
Movement is the subject of many conversations these days, with many people wanting to move better, quicker, faster, more powerfully and for longer. The role of the physical therapist (physiotherapist) as set out by The American Physical Therapy Association is to ‘be responsible for evaluating and managing an individual’s movement system across the lifespan…’. The term ‘Movement Health’ reiterates this statement. It is defined as ‘’a desired state that is not only injury free and absent of the presence of uncontrolled movement but also a state that allows the exerciser to choose how to move’’ (McNeill & Blandford, 2015).
Many different factors can affect how we move, not least pain, threat of pain, fatigue and injury. Dingenen et al (2018) have made use of the dynamic systems theory to illustrate this perspective. They consider the interaction of any element within the environment, the individual and the task at hand as potentially influencing the characteristics of each observable movement pattern individuals employ to achieve a movement outcome. Therefore, if any one of these factors were to change (for example, an increase in fatigue) one would expect to observe changes in the movement patterns used in order for the original movement outcome to still be achieved.
The ability of the body to adapt to changes in either the task, individual or the environment whilst still achieving the movement outcome, can be considered to rely on a concept called motor redundancy, more recently labelled ‘motor abundance’ (Latash, 2000). A suggested reason for the change in terminology is to emphasise the positive influence ‘motor abundance’ has on movement outcomes and function in general; motor abundance refers to the ability of the movement system to make use of a variety of structures to perform the same movement outcome (Latash, 2012). In terms of the musculature of the movement system, the availability of ‘choices’ introduces the concept of muscle synergies – a group of muscles that can work together in differing capacities and formations in order to provide the same/equivalent movement outcome.
Employment of different muscle synergies is likely to lead to alterations in the characteristics of movement patterns. Returning to the aforementioned dynamic systems theory, changes in either the task, environment or individual is also likely to result in a change in synergistic contributions during the performance of a desired movement outcome. Factors that have been well documented that may lead to a change in muscle synergies include pain (Butera et al., 2016; Hug et al., 2014; Falla & Hodges, 2017), fatigue (Bouillard et al., 2013), history of pain (Bourne et al., 2016) and restriction (Mills et al., 2015).
In ‘optimal Movement Health’, it could be hypothesised that the most efficient movement pattern will be selected by the central nervous system. If, however, the most efficient movement pattern is not available due to, for example, the presence of pain, our central nervous system will be able to select another suitable option because of motor abundance (Jull et al., 2018). As a temporary measure to avoid pain and sensitive tissue, this may appear to be a feasible solution. Yet, should this movement pattern continue, and the availability of suitable options decrease, the risk is run of exceeding the tissue tolerance of structures potentially resulting in pain and compromised function in the future.
To illustrate the workings of Movement Health, let’s consider a simple everyday task of pouring a glass of water. Suppose one would like to fill one’s glass with icy water from a jug that happens to be placed on the far side of a table. One has a few options. One can get up and walk to the far side of the table to fetch the jug. One could ask a friend who might be sitting closer to the jug to pass it over or one could simply reach across the table to pick the jug up. The option one chooses here might not necessarily be determined by one’s movement options but rather by one’s table manners! Regardless of the conscious choices one makes in order to achieve a specific task, one is also subject to subconscious choices. These subconscious choices result from a well-functioning central nervous system and play a significant role in Movement Health.
The central nervous system has the ability to select which muscles it uses to perform a task. Individual muscles are grouped with other muscles that are able to perform the same role; a muscle synergy. As with most groups, each individual within that group is able to perform the same task at varying levels of efficiency and accuracy. The same applies to a muscle synergy. There will be one synergy that is able to perform a role most optimally and efficiently whilst another, will still get the task completed but may not be as efficient. During the multitude of opportunities we have to make task orientated movement choices, our central nervous system is able to choose the most efficient muscle synergy to perform the task. This is a state of Movement Health. When one Movement Health is compromised, one lacks choice in how one moves. If at the end of the day the task of filling one’s glass with icy cold water has been completed, why the worry about whether it was efficient or not? Reaching across the table may not have been suitable in polite company notwithstanding the unexpected weight of the jug nor the subsequent spillage but also resulted in tissue strain.
Movement system specialists are motivated to attain and maintain Movement Health so as to sustain quality of life for each individual in the long-term. As a result of the strain sustained through the reach across the table, one may start to move differently in order to avoid further strain through these sensitised tissues. If this behaviour had to continue, one would end up placing unnecessary stress on previously healthy tissue. This may in turn lead to one avoiding the use of this movement unit eventually leading to reduced function. The art lies in the identification of limited movement choices before Movement Health is compromised and long-term changes in the movement system take place.
In conclusion, Movement Health allows one to move well, for longer due to the ability of the movement system to seamlessly adapt to changes in the environment, individual and task.
BEATE IS A KEYNOTE LECTURER IN EGYPT AT THE ORTHOPAEDIC MANUAL THERAPY CONGRESS - CAIRO - 15TH AND 16TH FEB.
Beate's lecture title: Approaching Movement Health of the neck: considering the shoulder
Beate is a clinic director and consultant physiotherapist in a central London clinic. She believes passionately that movement combined with the skills of a well-trained physio, can keep individuals of all backgrounds injury free, recurrence free and in good Movement Health. Through extensive clinical experience she can see that a systemised movement focussed assessment can achieve these aims.
This belief in the power of movement extends both personally and professionally, and as a passionate and experienced sportsperson, Beate enjoys ultra-challenges, especially trail running.
Beate will focus on the interrelationship of the neck and shoulder and how assessment of one area is incomplete without assessment of the other.