The kinesiopathologic model
The movement impairment syndrome (MIS) was developed by Sahrmann and colleagues . The kinesiopathologic model (KPM) was developed to explain the occurrence of MIS. Sustained posture and repetitive movement are believed to be risk factors for impairments in the movement system. There are intrinsic, such as characteristics of an individual, and extrinsic factors, such as work and fitness that can contribute to the degree of tissue changes.
The combination of micro-instability, relative stiffness, the neuromuscular activation pattern and motor learning contribute to the development and persistence of the impairment.
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.
The KPM uses clinical tests to identify the impaired movement within the kinetic chain and optimizes interventions that are specific to this dysfunction.
The following steps are used to assess and treat MSI:
- determine the syndrome
- identify the contributing factors
- determine the corrective exercises
- identify the alignments and movements to correct during daily activities
- educate the patient about factors contributing to the musculoskeletal condition by practicing correction during activities
Functional Muscle Classification
There are two classifications of muscle functions developed by researchers:
1-Stabilizers and Mobilizers
2-Local and Global muscles
Stabilizers are believed to have postural role and control excessive joint movement. Examples: gluteus medius, subscapularis, multifidus, semispinalis. Mobilizers, such as rectus femoris and latissimus dorsi are responsible for movement production.
The classification of local and global muscles was developed to describe the control across the lumbar spine Local muscles maintain the mechanical stability of the spine while global muscles are responsible for the load transfer.
Examples of abnormal recruitment:
- Normally, 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
- The normal sequence of muscle recruitment for shoulder abduction is as follows: Deltoids - Contralateral upper trapezius- ipsilateral upper trapezius -lower scapula muscles. This normal sequence was found to be disturbed in painful shoulder and neck
Classifications of Movement Dysfunction Syndromes
Different clinical tests can be utilized to classify movement impairments. The results of these tests indicate the degree of impaired control and should be aimed to 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:
- Cervical flexion-rotation
- Thoracic flexion
- Scapular winging
- Lumbar extension
- Hip lateral rotation
- Tibiofemoral hypomobility
- Insufficient ankle dorsiflexion
Management of MSI
Different management strategies can be used in the treatment of movement impairment. Educating patients on the causes of their symptoms and lifestyle and ergonomic modifications is essential for patient's engagement in the treatment plan.
Exercises can be used to teach patients how to use their muscles properly and to increase the kinesthetic awareness.
Refer to the following pages to find out more on the treatment of MIS:
- Lumbar Motor Control Training.
- Deep Neck Flexor Stabilisation Protocol.
- Classification Of Low Back Pain Using Shirley Sahrmann’s Movement System Impairments, An Overview Of The Concept
- Sahrmann S. Movement System Impairment Syndromes of theExtremities, Cervical and Thoracic Spines. Elsevier Health Sci-ences; 2010.2.
- 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.
- Maluf KS, Sahrmann SA, Van Dillen LR. Use of a classification system to guide nonsurgical management of a patient with chronic low back pain. Physical Therapy. 2000 Nov 1;80(11):1097-111.
- Comerford MJ, Mottram SL. Movement and stability dysfunction–contemporary developments. Manual therapy. 2001 Feb 1;6(1):15-26.
- Cervical Motor Control Example . Available from: https://www.youtube.com/watch?v=QkILlxNhwpU[last accessed 29/02/2020]
- Motor Control and Shoulder Mobility. Available from:https://www.youtube.com/watch?v=iZbrxIkU3jo[last accessed 29/02/2020]
- Van Dillen LR, Norton BJ, Sahrmann SA, Evanoff BA, Harris-Hayes M, Holtzman GW, Earley J, Chou I, Strube MJ. Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. Manual therapy. 2016 Aug 1;24:52-64.