Movement patterns are a well established subgroup in non-specific low back pain (NS-LBP) despite the criticisms on social media and a couple of rather poor publications. Movement patterns represent one possible tissue loading mechanism. There are others of course, but that is for another blog. One key aspect to the hypothesis is have functional or biological causes. The presence of primitive reflexes can be part of causation for altered movement patterns.

We must ask “if the movement pattern is the mechanism of tissue loading, why is someone moving that way?” I did present a paper on this at IFOMPT-2016 in Glasgow (albeit with an important mistake). I would like to discuss one aspect of that here – primitive reflexes.

Primitive reflexes are brain stem-mediated, complex automatic movement patterns that commence in utero.  They are considered “survival reflexes” (e.g., sucking reflex) and serve to facilitate sensory and motor development (among other things).

I started looking at the neurodevelopmental process about 20 years ago. It still baffles me as to why this is not mainstream in musculoskeletal pain circles. No matter what your rehabilitation school of thought is for rehabilitation, primitive reflexes should be of interest to you.

Movement patterns start early in life. There are many things that can influence them. A few key ones include:

  • Atypical birth history (e.g., premature birth, C-section)
  • Early life experiences (e.g., injury, surgery)
  • Milestones (e.g., crawling or walking stages)
  • Enrichment (e.g., opportunity to play)

Movement is highly complex and variable, which it needs to be. The problem exists when it isn’t variable.

One example is when someone has a movement pattern during trunk flexion when they always initiate with the lumbar spine, go to end range lumbar flexion and the thoracic spine follows and maybe some hip. The kinetic chain sequence is off considerably here. It is abnormal not to use one aspect of the kinetic chain during a functional movement pattern and I believe this should be considered a neurological soft sign.

So let’s break this down here: The central nervous system has learned to flex the lumbar spine during trunk flexion, but not the hips. Odd hey. Maybe they never developed a Moro flexion pattern? Maybe they didn’t develop a Symmetrical Tonic Neck Reflex flexion pattern? If you see this type of excessive trunk flexion pattern you will certainly see some flexion related primitive reflexes.

Is this causation? It doesn’t have to be. There are other reasons for this movement pattern (e.g., protecting hip loading). This is where your clinical reasoning comes in. Apply epidemiological principles of causation, take a birth history and assess the hip!

If primitive reflexes are present, they can be inhibited and the movement pattern can change.