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1st Nov

2012

Nervous System Training to Correct Abnormal Movement Patterns

There has been much research over the last few decades which has shown that, for various reasons, we can develop abnormal ways of moving, which can either cause, or be caused by painful musculoskeletal conditions. If this has resulted from an injury or episode of pain, the altered movement pattern often remains even after the pain has resolved. This is believed to be one reason why injuries or pain recur, as multiple studies have shown that the strongest predictor of future injury is previous injury.

The cause is believed to originate in our nervous system, including the brain. Actions of specific muscles and sensations are mapped in our brain. Studies have shown that e.g. episodes of pain may change this map, especially if the pain has been prolonged, making it more difficult to contract individual muscles, altering our coordination, and increasing our perception and distribution of pain. Such changes can be programmed in our nervous system, which becomes our “default” program.

Certain individual muscles may either become too tensed (increased nerve input), or inactive (inhibited nerve input), again resulting in altered movements and compensatory movement patterns. This can lead to problems in and around joints even far away from where the local muscle changes have occurred.

In addition, many people who have had chronic pain may develop a fear of certain movements, which further adds to this movement disorder, and often increases the perception of pain and disability.

If only the local area of pain and injury is treated, but the abnormal movement pattern is left unchanged, the results are most often temporary, or limited. Today we know that the brain is extremely changeable throughout our lives, referred to as neuroplasticity. What we need to do is identify the abnormal movements and muscle recruitments, use techniques to correct them, and reprogram our nervous system-including the brain-to create a new “default program” of more normal movement.

The local muscles which have abnormal tension need to be either facilitated or inhibited, e.g. through soft tissue and joint mobilization techniques, and specific exercises performed and dosed in such a way that the muscle activation is increased or decreased.

Coordination training becomes the most important focus, using multisensory training to fully engage the nervous system. This may include visual input with mirrors, tactile stimulation with touch and assisted motions, auditory input by repeatedly describing the motions and using analogies and metaphors which make sense to each individual person, and kinesthetic stimulation by performing many repetitions of correct movements until you “can feel” the motion.

Common mistakes in rehabilitation are strengthening or stabilization exercises when there is too much isolated muscle tension, or only relaxation training (e.g. massage) if there is local muscle inhibition, in both scenarios leading to marginal improvement at best, or worsening movement pattern.

Best wishes,

Gunnar

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