Course Description
Lumbo-pelvic pain can be related to a variety of factors including trauma or overuse, but frequently it is an insidious, recurrent and an ongoing problem for many people. This is often related to sub-optimal loading on around the lumbo-pelvic region.
The mechanism driving the sub-optimal loading on the tissues may be the:
- Movement Pattern
- Translation Control of the joint
- Biomechanical Exposures to Loading
There is considerable individual variation in how these present. These loading mechanisms may present in combinations or alone. As well, how the central nervous system tries to control the loading could be too much or too little.
The underlying hypothesis of movement as a link to musculoskeletal symptoms is that the way the central nervous system coordinates movement can influence tissue loading. For example, people with lumbar low back pain can move the lumbar spine more than their hips into flexion and extension.
In normal function we need the ability to vary postures and movement patterns, or kinetic chain sequence, in order to avoid tissue overload. It is normal and necessary to use our end range movements, however it is abnormal to continuously use the same movement pattern or end range movement. If the ability to vary the kinetic chain and control movement is lost, tissue load can be exceeded, tissue repair can become compromised and pathology may result.
Altered translation control can manifest as too much little control (e.g., shear) or too much control (e.g., compression). Too much shear can place stress on articular structures that limit movement. Compression with shear places more stress on articular structures (e.g., disc). Altered translation control can present with altered movement patterns and can contribute to ongoing symptoms. For example, lumbar instability is not rare.
Biomechanical exposures to loading are the physical stresses experienced by the body. Biomechanical factors include gross body position, exertion, forces and motions. This loading causes mechanical tension within the tissues which can lead to microdamage if the load tolerance is exceeded. This can occur on its own, but is often combined with movement or translation control mechanisms.
Why is the central nervous system moving the body in a way that is potentially harmful?
This question should be answered or many people will not progress or quickly plateau. We review the functional causes of altered movement and motor behavior.
How does it fit in? – Movement as a Clinical Reasoning Tool
Targeting movement and motor behavior will allow you to be much more effective with whatever skills you already have! Treatment and progression will also be faster. These are discussed and numerous examples demonstrated during the practical sessions.
Why not just let it heal and load it?
Load management and progressive loading principles are appropriate for some people. However, everyone does not respond the same and multiple loading mechanisms can occur together. The Movement Exposures & Loading Tool© is a simple questionnaire which will facilitate the need for load management.
Is this for everyone? – Of course not!
This is what a Sub-classification is for. Motor behavior issues represent a subgroup of patients and are not the priority for everyone. The purpose of the sub-classification model is to show you how to identify who will respond to this type of therapy. Some people do not have the ability to learn motor control based exercises. Others can learn, but won’t respond. Some do not have a nociceptive pain mechanism. While others have neuro-immune-sympathetic dysregulation or nociplastic pain (newer term from central sensitization).
This course will provide participants with skills in assessing movement and sub-classifying movement pattern and motor control deficits that will relate to the functional movements that provoke the patient’s symptoms. Rehabilitation strategies will provide a logical and functional based starting point with directions for progression. A universal clinical problem-solving model is given to iron out real-life difficulties.
Course Objectives:
- Make a movement pattern control sub-classification and relate this to the client’s presentation
- Utilize strategies to diagnose lumbar instability
- Use movement patterns as a clinical reasoning tool to help guide manual therapy and other techniques
- Integrate the treatment of movement patterns and translation control into clinical practice