Understanding causation goes hand in hand with “mechanisms” in Motor Behavior Therapy. Hip adduction is considered one common movement pattern that may increase tissue loading in some areas of the lower limb.
When assessing movement pattern control in the lower limb and there is a pattern of hip adduction (+/- medial rotation), the clinician should just not automatically conclude that “weakness” of gluteus medius and maximus is the main cause.
There are some primitive reflexes that produce this movement pattern (e.g., Babinski). The failure to address the causation involved in the mechanism(s) may increase the likelihood of:
- poor response to the intervention
- slow progression of rehabilitation
- sooner recurrence
Looking at any tone change in the hand, shoulder girdle, cervical spine and trunk can provide insight into the presence of primitive reflexes. However, since adults have a highly variable amount and situational dependent cortical inhibition, the reflex will always need to be assessed in a broader clinical reasoning framework.
Summary
Understanding the causation of the movement pattern control deficit is a key aspect of rehabilitation. Neurological dysregulation is not a well recognized mechanism in musculoskeletal pain, but should be considered. Primitive reflexes are common and can influence movement and motor behavior.
They can be treated with specific primitive reflex inhibition techniques.
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