More of this Motor Control business. See the previous Background and Learning post to get caught up.
“Science is built up of facts, as a house is built of stone; but an accumulation of facts is no more a science than a heap of stones is a house.”-Jules Henri Poincare
Practice is built upon theories, as a house is built of stone… Let’s put these theories into practice. Time to build a house…..
Here is the Algorithm I made to decide if the patient is presenting with a motor control problem.
First- off, traditional causes of poor movement (as judged by the movement experts!) must be ruled out.
- Pain: When an individual is in pain they will compensate or move in a way that often relieves their symptoms or seems to help them in some way. A shortened step length on the contralateral foot, for example, could indicate an unwillingness to put pressure through the ipsilateral foot in toe-off.
- Weakness: A rotator cuff tendon may be damaged or an individual may be deconditioned from inactivity. Strengthening is the key here, not so much motor control (… at least not yet). We have all seen the 5/5 MMT patient who cannot stand -up due to limited functional strength or a splash of pain mixed in.
- Fatigue: Tired? Yeah, well you move funny when you’re tired. Also gross and fine motor actions can be affected by one another. For example; after running a 5K sprint, sure your leg muscles will be tired and may not move normally, but it is also difficult to write your name in small letters or fill out a form right after the race due to endogenous responses and gross->fine motor transfer. Try it out for yourself and see how you do.
- Joint/Soft tissue: restrictions of the joint and/or soft tissue will restrict movement in many complex ways. Address this first, perhaps through manual techniques or repeated motions, stretching, etc to free up the available ROM.
- Nerve Damage: Well, if Long Thoracic is damaged we all know that scapular motion and possibly glenohumeral motion will be altered. Look to the MOI, the neck/back or MMT, etc to rule this out before you go headlong into motor control retraining.
If you can rule these out, then you can start to look at re-training and teaching better movement through practice. Now, some things will just be appropriate movement strategies, I mean, TTWB has a purpose right? But we want to look for when a movement can be improved upon.
Now, again, do all movements need retraining? Take a look here….
She is one of the fastest runners in the world and, presumably, not in pain. What do you want to fix? Think about it… then click this Your back is not “out”, your leg length is fine.
It is a challenge to figure out what the problem is… and when it is that you need to address coordination and motor control. This is my first attempt at an algorithm to aid in conceptual understanding. I’m sure I left stuff out or could expand on others. They will get better, let me know what you think…
More? See my post on Motor Learning and Balance here.
Future Motor Control issues to be addressed are pain… for now. Thanks for viewing.
Reference: Lederman E. The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain. CPDO Online Journal. March 2010: 1-14