Robin R Varghese, PT.
Movement system impairment. Heard of this? Your Physical therapist is the right person who can help.
Understanding movement system helps in optimizing movement, promoting health and wellness and in mitigating the progression of impairments, and to prevent additional disability.
It was accepted as the identity of Physical therapists by APTA in 2013 as the foundation for optimizing movement to improve the health of society.
The movement system is the core of physical therapist practice, education, and research (American Physical Therapy Association. Physical therapist practice and the movement system. An American Physical Therapy Association White Paper. 2015.)
Movement is the result of the actions of muscular, skeletal, neurologic, cardiovascular, pulmonary, and metabolic components.
Definition of the movement system (According to APTA)
The movement system is the term used to represent the collection of systems (cardiovascular, pulmonary, endocrine, integumentary, nervous, and musculoskeletal) that interact to move the body or its component parts.
Movement Impairment Syndrome
The Movement Impairment Syndromes (MIS) approach or Movement System Impairment (MSI) offers a method of assigning a diagnosis, category and a treatment to patients with musculoskeletal pain.
What is Kinesiopathological model?
The framework that acts as the basis of Movement System Impairment Syndrome (MSIS) is the Kinesiopathological model or the KPM.
According to Shirley Sahrmann, movements in our daily activities causes impairment, which later progress to pathologic abnormalities. This happens due to the changes that occur to tissues when subjected to repeated movement and sustained position throughout these daily movements.
a large majority of conditions begin early in life and slowly develop over time until they reach a threshold that requires diagnosis and treatment.
musculoskeletal conditions are related to lifestyle particularly related to the movement pattern used in daily activities as well as in work, fitness, and sports activities.
Kinesiopathological conditions are those in which movement induces pathology
What leads to Movement Impairment? Let us try and understand.
Physical Stress Theory (2002)
PST says that changes in the relative level of physical stress cause a predictable adaptive response in all biological tissue.
According to this theory by Mueller and Maluf excessive tissue stress that can lead to injury may occur as a result of 1 or more of the 3 mechanisms:
(1) a high-magnitude stress applied for a brief period,
(2) a low-magnitude stress applied for a long duration, and
(3) a moderate-magnitude stress applied to the tissue many times.
An ideal alignment facilitates optimal movement, reducing the likelihood of repeated microtrauma. Whereas, abnormal movement can lead to degenerative trauma.
Mobilizers and stabilizers
Among the 4 major types of muscles based on the functional classification, lets look at the prime movers or the mobilizers and the stabilizers.
The prime movers perform the majority of work during an exercise
The stabilizers keep the body parts stable and steady so the primary movers can perform the exercise efficiently, effectively, and safely.
They control the posture and prevent excessive and unwanted movements at the joints.
Muscle recruitment pattern
Muscles follow a general pattern or sequence in which they get activated.
If this sequence is impaired, delayed or altered it may cause pain and disturbed functional movement.
For e.g. to generate hip extension, hamstrings activate first followed by glutes then contralateral erector spinae. A delayed activation of glutes after hamstrings followed by ipsilateral erector spinae was associated with low back pain.
In musculoskeletal patients, the movement patterns are exaggerated
Precision and balance in movement
They are essential to the maintenance and wellbeing of the movement system.
Microtrauma to tissue is caused by repeated lack of balanced or precise movements.
A Physiotherapist plays a major role in restoring or maintaining precise movements and in preventing musculoskeletal pain.
Path of Least Resistance for motion
According to this concept, movement occurs about a path of least resistance.
Increased stiffness of one muscle group or joint can lead to compensatory movement at an adjoining muscle group or joint that is less stiff.
Relative stiffness or flexibility in a muscle affects the path of least resistance.
A hypertrophied muscle has an increased passive tension. This can lead to compensatory movement. Thus there is susceptibility for a movement impairment syndrome to occur.
Having a muscle does not mean that they are functioning appropriately.
They may be missing in action. An atrophied muscle is weaker, and therefore other muscles may compensate. This again links to the path of least resistance for motion
Directional susceptibility to movement
It means the muscle is susceptible to move in a specific direction
If a muscle is trained to be strong, it will hypertrophy and develop more fibbers and become strong. As movement occurs along a point of least resistance, a trained muscle will be more resistant, yet tolerant. The movement occurs as per the Directional Susceptibility to Movement.
This results in tissues moving out of their optimum range. This concept is also linked with the patient’s Directional Susceptibility to Movement.
Movement Dysfunction Syndrome Is classified by different clinical tests
The results of these tests indicate the degree of impaired control and must reproduce the symptoms.
Screening tests are followed by symptom modifications to correct the alignment, activate inhibited muscles or eliminate excessive movement on a particular joint
Examples of Motor Impaired Syndromes:
· Thoracic flexion
· Scapular winging
· Lumbar extension
· Insufficient ankle dorsiflexion
Assessment and treatment
The KPM uses clinical tests to identify the impaired movement within the kinetic chain and optimizes interventions that are specific to this dysfunction.
Correction of impaired alignments and movement contributing to the tissue dysfunction through addressing presented stiffness, weakness and neuromuscular activation patterns is the proposed treatment for MSI.
This also involves:
Educating patients on:
The causes of their symptoms
At Valley Healing Hands, We provide the best Physical therapy for Movement Impairment syndromes (MIS) Movement System Impairments (MSI). We have highly qualified therapists who will assess you and customize and plan a regime that will fit your need perfectly. Our patients are highly satisfied with us and you can learn about their reviews here and get connected to us here. Our patient love us and you too will!!!
Physiopedia, Classification Of Low Back Pain Using Shirley Sahrmann’s Movement System Impairments, An Overview Of The Concept.
Shirley Sahrmann. The Movement System and the Kinesiopathological Model. https://:doi.org/10.24175/sbd.2018.000122
Mueller, M.J. Maluf, K.S. (2002) Tissue adaptations to physical stress: a proposed “physical stress theory” to guide physical therapist practice, education, and research. Phys Ther 82 pp. 383-403.
Sahrmann, S.A. (1998) Diagnosis by the Physical Therapist – a prerequisite for treatment: a special communication. Phys Ther. 68 pp. 1703-1706.
Sahrmann S, Azevedo DC, Van Dillen L. Diagnosis and treatment of movement system impairment syndromes. Brazilian journal of physical therapy. 2017 Nov 1;21(6):391-9