14th April 2013
People move differently in pain - the mechanisms are poorly understood - what's new?
Paul Hodges presents a new theory to explain the motor changes in pain.
Moving differently in pain: a new theory to explain the adaptation to pain Hodges PW, Tucker K
Pain. 2011 Mar;152(3 Suppl):S90-8. doi: 10.1016/j.pain.2010.10.020.
This paper presents a new theory for the motor adaption to pain
Pain leads to redistribution of activity within and between muscles
Adaptation to pain changes mechanical behaviour
Pain leads to protection from pain or injury, or threathened pain or injury
Adaptation to pain involves changes at multiple levels of the motor system
Adaptation to pain has short-term benefit, but with potential long-term consequences
Here is another paper on the theory
Pain and motor control: From the laboratory to rehabilitation.
J Electromyogr Kinesiol. 2011 Apr;21(2):220-8. doi: 10.1016/j.jelekin.2011.01.002.
Movement is changed in pain and is the target of clinical interventions. Yet the understanding of the physiological basis for movement adaptation in pain remains limited. Contemporary theories are relatively simplistic and fall short of providing an explanation for the variety of permutations of changes in movement control identified in clinical and experimental contexts. The link between current theories and rehabilitation is weak at best. New theories are required that both account for the breadth of changes in motor control in pain and provide direction for development and refinement of clinical interventions. This paper describes an expanded theory of the motor adaptation to pain to address these two issues.
The new theory, based on clinical and experimental data argues that: activity is redistributed within and between muscles rather than stereotypical inhibition or excitation of muscles; modifies the mechanical behaviour in a variable manner with the objective to "protect" the tissues from further pain or injury, or threatened pain or injury; involves changes at multiple levels of the motor system that may be complementary, additive or competitive; and has short-term benefit, but with potential long-term consequences due to factors such as increased load, decreased movement, and decreased variability. This expanded theory provides guidance for rehabilitation directed at alleviating a mechanical contribution to the recurrence and persistence of pain that must be balanced with other aspects of a multifaceted intervention that includes management of psychosocial aspects of the pain experience.
ITS ALL IN THE BRAIN AND NERVOUS SYSTEM! INTERVENTIONS NEED TO TARGET THE IMPAIRMENT - WE FOCUS ON COGNITIVE RETRAINING TO FACILITATE THESE CHANGES