Pain & the Human Movement System
Movement: "The action of the physiological system that produces motions of the body by various component parts" (Dirdckx, J.H., 1997).
The age old debate in the world of Manual Therapy re-emerges, and if Shakespeare himself were alive as a Manual Therapist he would ask "to treat local or regionally, that is the question". In order for Human movement to occur, each system must communicate with one another. The musculoskeletal, neurologic, cardiopulmonary, and metabolic systems (and possibly the interstitium, yes i went there lol) must all talk with one another. And when one system fails to communicate well.... you may move different, but where does your pain arise from?
Some Manual Therapists believe that impairments within the movement system may be the cause of your pain, while other Manual Therapist believe the local structure (i.e. meniscus) is the source of your pain... So who is right?
The term movement impairment system (Sahrmann, S.A., 2002) is believed by some to be used synonymously with musculoskeletal pain. In short, Movement Impairment Syndromes rationalize how repeated motions and sustained postures alter tissue characteristics which may impacts one’s pattern of movement (Sahrmann, S.A., 2002). When these patterns manifest with either high stress (ie Heavy lifts) or repetitive loads (ie running), it is believed that ones strength and flexibility can become limited causing negative muscular and or boney changes. A mouthful. yes I agree.
So what does it all mean basil? And why is considering movement important. Well neither treatment philosophy can exists without the the other half. Meaning that if you treat local pain, and fail to restore a lingering movement disorder, your patient may return to their desired sport or activity with less pain, but they still may move "different".
Throughout my 13 years of practice what I have noticed is that not only has medicine changed but so has Manual Therapy. While in PT school I learned that certain structures have particular pain characteristics. Your hip labral pain maybe sharp, your knee osteoarthritis may crunch, and your lumbar herniated disk may radiate down your legs. But, while doing my postgraduate fellowship I was taught to consider more, to think of the "Why." Why are all these common structures placed on undue stress?
During my 3 year fellowship training we considered all aspects of the patient. For example what are the daily stresses placed on the patients body. Is the patient sitting all day at a computer, or are they lifting heavy bags of cement? These details are only revealed through talking with and getting to know each patient, so unfortunately this part takes time and lots of questions and in my opinion should not be rushed. But, what takes even longer is learning a whole list of these patterns.
When you visit your medical doctor, they are excellent at recording and identifying patterns of serious systemic illness and infection. However when you visit your doctor of Physical Therapy we are experts at recognizing your movement impairments and sources of your pain.
The human body was not intended to sit for 10 hours at a time, so when this sustained posture occurs over time, your body may move different. Compound the previous statement over years and you may have a few tissues, that develop issues, (Haha) that become painful or sensitive.
Have you ever sat down for a while only to rise with a new onset of stiffness in your body. This is not an uncommon phenomenon when considering the hip and knee. There are many sensitive structures around the knee, but when hip weakness and loss of flexibility sets in you may rise with knee pain, stiffness, or noises. Understanding movement around the hip and the knee & examining the entire lower extremity should occur when evaluating each patient with knee pain… and addressing hip strength in addition to knee pain may enhance your patients recovery” (Rowe, J, et.al., 2007, p.164).
In summary the cause of a patient’s pain may not only be at the specific tissues, but more so the result of movement dysfunctions impacting the strength, weakness, and flexibility. If you have a sedentary job, but an active lifestyle, it is important that you have a qualified Manual Therapist in your corner to provide you with annual check ups. If you don't, feel free to shoot me an email at New York Manual Therapy (www.nymanualtherapy.com) I would be honored to examine you and make sure you continue to live an active lifestyle.
Dirckx, J.H. (1997). Steadman’s concise medical dictionary, ed 3, Baltimore, MD. Williams & Wilkins.
Rowe, J., Shafer, L., Kelley, K., West, N., Dunning, T., Smith, R. & Mattson, D.J. (2007). Hip strength and knee pain in females. North American journal of sports physical therapy. 2(3), 164-169
Sahrmann, S.A. (2002). Diagnosis and treatment of movement impairment syndromes. St. Louis, MO. Mosby, Inc.