As many of you have realized, a thirst for knowledge renders a habitual search, and a habitual search often reveals a discovery of more questions. So for this post, I seek not combat, but debate and, hopefully, through intelligent discussion, some answers.
Recently I have been on a quest to enhance my understanding about pain and dysfunction and through my endeavours, have come to a "roadblock " regarding the concept of MOVEMENT. In particular, the relationship between pain, movement and intent.
As an individual who makes a living from helping to improve one's pain and dysfunction, I have recently been asking myself, what is the true importance of movement?
To demonstrate my thought processes, I have included thoughts from three well respected physical therapists below.
Diane Jacobs writes:
A big implication in PT is that muscles are to blame for pain. Another implication is that somehow imparting motor control will help mop up pain .... movement of any kind will help "prevent" pain, an assertion I think can be supported by the idea of neurodynamics. But motor control? Why get that fancy about it? I don't think it can prevent pain any better than simply more of regular movement would.
So, why do we think/why are we being asked to believe that we can train individual muscles? It makes no sense. Not from a nervous system standpoint. And let's face it - without a nervous system a human organism is a motionless cadaver. So I give that system priority over anything anatomic/structural/mesodermal. Muscles are just the puppet strings, not the puppeteer. I want to interact with the puppeteer when I treat, and I don't mean only cognitive control over movement. I mean, ways to change behaviour patterns that may be contributing factors, and try to directly approach/affect the sensory cortex through handling its outer sensor array - skin, and physically drag about (slightly) various neural structures embedded from below into skin. Learning about cutaneous nerves, their names and locations, shifting the mental focal length up, closer to the surface, helps reframe a lot of this stuff automatically.
So.... coming back to the point about multifidus, seems to me the brain tries to figure out ways to use movement, get the movement goal accomplished, without using the same muscle the same way twice in a row. Why would you not want to frame the multifidus issue (apparent weakness) as a defense (which would mean that it's just inhibited, probably by pain), rather than as a defect (i.e., a target for some kind of intervention)?
Kyle Kiesel writes:
The response by the CNS to increase muscle activation to the outer core muscles in the presence of pain is known has a High Threshold Strategy (HTS). Increased activation of the outer core musculature is, of course, normal for the system to manage a high load task, but in response to a painful episode or a dysfunctional inner core, it is a compensatory strategy…
The inner core receives ongoing subconscious input from the CNS, which automatically maintains respiration, activates the pelvic floor for continence and segmental stabilization, and activates the TrA and LM for segmental stabilization in anticipation of a spinal perturbation. This is a highly automated, delicate functioning system…
Gray Cook writes:
The first thing you always need to consider is movement. If movement quality is not above a minimum standard, then this is the first problem you need to deal with.
Personally, I have gone well beyond the concept of training muscles. I understand that we have to employ movement. However, when it comes to the utilization of movement as a prophylactic and rehabilitative approach for pain and dysfunction, my personal preference would be to strive to achieve movement that is of ideal quality and not simply compensatory.
So my (vague) question for the masses is:
When it comes to pain and dysfunction, does quality of movement really matter?