• ​MOVE, WALK, CHALLENGE, LIVE

  • Movement System Health: Good Medicine

  • (As featured in Dothan, Alabama Neighbors Magazine, Sept. 2016 issue)

     By Mark Mashburn, PT, OCS and Danny Peters, PT, CHT

    For decades, research has shown that exercise across our lifespan is critical to our overall health. God designed us to move, to be active daily, and to do good for others –beyond our self. Our musculoskeletal system, cardiovascular system, immune system, sleep cycle/regulatory patterns, and the brain is all connected to the need for efficient and dynamic movement. We need a “healthy and functional movement system”!

    From a lifespan view, our ability to move begins as an infant. We do not all develop at the same speed, pattern, or functional ability, and much depends on how much movement and postural variability we receive as an infant vs. our brain and neural system.¹ Most of us are deemed to have “normal development” because we crawl, then walk, play and meet the key developmental milestones. However, more recent movement and brain research are identifying brain “software” deficits that tie health problems not previously recognized as “brain problems”. For example, a percentage of people with recurrent low back pain are being identified in functional MRI brain studies to have deficits in the postural control part of their brain.² In these people, the part of their brain that acts as a “map” of their muscle patterns is missing for the “map” of their low back/pelvis postural control, and sometimes with specific areas in their cerebellum. ³ This type of research is exciting, and is improving how well we accurately identify and correct abnormalities in the movement systems of our physical therapy patients and in working with our area physicians toward quality wellness program design.

    A comprehensive movement system evaluation includes not only assessment of one’s “software” or brain/neural system functioning, but also the “hardware”. This includes the more traditional biomechanical or “kinetic chain” view of a person’s legs, joints, and walking pattern.   The “kinetic chain” view of movement notes that if one joint is moving abnormally, this affects the adjacent joint or a part of the body in another area. For example, if one leg is shorter, or one foot pronates excessively, this often creates a problem up the “kinetic chain” – such as the knee, or even the low back. Current research is showing more and more that movement dysfunction is the root cause of many overuse and sports- related injuries of the musculoskeletal system. 4

    Now, much more research and available technology (including a sophisticated video camera, sensors, and motion analysis systems) are being offered to special populations – including athletes, adults with diabetes or arthritis, acute or chronic stroke, or our aging “healthy seniors” who seek to stay highly active. In a detailed analysis of an individual from any group, when it comes to movement, gait or agility, we start with foot contact with the ground. There are significant “ground reaction” forces that occur with each step we take.

    Our foot posture and toe functions are key components to our walking function and health through our entire lifespan, including with athletic performance and aging success. Foot and ankle control functions by our nervous system, combined with our foot posture/muscle function are important to evaluate in detail, and to rehabilitate fully to maximize athletic performance,5 as well as long-term joint health, and future mobility in adults. 6   A recent longevity/aging population study showed that our toe flexor strength is associated with a decrease in activity levels more than hand grip or knee extensor (quadriceps) strength.

    Moving above the foot, a complete movement analysis includes the knee to hip/pelvis “alignment” and muscle “firing patterns” that are unique to each of us, and relate to our functional movement and abilities. Using the video camera and motion gait analysis system, with “kinetic chain” views, when applied to the knee, there is now predictive value vs. the need to have a future total knee arthroplasty. 4 Use of this gait analysis approach with earlier identification of an individual’s specific gait and movement problems shows promise to prevent excessive joint arthritis “damage”, and improve efficiency and effectiveness in total joint rehabilitation — and potentially to reduce the number of future knee joint replacements.

    An additional application of current movement system analysis and one selected tool that can be used in an evidence-based approach — is Kinesio tape – just like we saw often used by the Olympic athletes in the Rio Summer Games.   The use of Kinesio tape in an evidence-based manner is technical and is most effective when applied based on careful examination of each individual’s “kinetic chain”, neurological system vs. joint or muscle function. Kinesio tape is helpful with extremities in sports, but also in stroke patients, pediatric motor/gait rehab, and back pain. When used by physical therapists with low back pain, Kinesio tape has been shown to positively impact the part of our brain tied to postural control improvement. 8 Specific to muscle and athletic performance, Kinesio tape should be applied by the trained clinician for a targeted outcome – such as if the specific need is one of stability, selective muscle firing /recruitment, or to reduce/”inhibit” an overactive muscle which may be “stuck in protective mode”.

    We hope this blog information on our Movement Health System is encouraging to our readers.

    References

     

    1. Dusing SC. Postural variability and sensorimotor development in infancy. Dev Med Child Neurol. 2016 Mar;58 Suppl 4:17-21. doi: 10.1111/dmcn.13045.
    2. Tsao H et al. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain. 2008 Aug;131(Pt 8):2161-71.
    3. Pijnenburg M. et al. Microstructural Integrity of the Superior Cerebellar Peduncle Is Associated with an Impaired Proprioceptive Weighting Capacity in Individuals with Non-Specific Low Back Pain. PLOS One. June 2014 Volume 9: Issue 6
    4. Hatfield GL et al. Three-Dimensional Biomechanical Gait Characteristics at Baseline Are Associated With Progression to Total Knee Arthroplasty. Arthritis Care & Research

    Vol. 67, No. 7, July 2015, pp 1004–1014.

    1. Choi et al. Postural control systems in two different functional movements: a comparison of subjects with and without chronic ankle instability. Phys. Ther. Sci. 28: 102–106, 2016
    2. Carroll M et al. Gait characteristics associated with the foot and ankle in inflammatory arthritis: a systematic review and meta-analysis. BMC Musculoskeletal Disord. June 2015; 16: 134.
    3. Masataka et al.   Early reduction in toe flexor strength is associated with physical activity in elderly men.   J. Phys. Ther. Sci. 28: 1472–1477, 2016
    4. Bae S. et al. The Effects of Kinesio Taping on Potential in Chronic Low Back Pain Patients Anticipatory Postural Control and Cerebral Cortex. J. Phys. Ther. Sci. 25: 1367–1371, 2013.

     

     

     

     

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