Academy of Orthopaedic Physical Therapy

American Physical Therapy Association (APTA)

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29.1 Physical Therapy Approaches to the Lower Quarter
Table of Contents

The Relationship Between Movement and Pain

Abstract:

This monograph discusses the current theories on the relationship between movement and pain and presents clinical and experimental evidence to support these theories. It discusses the evolution of ideas regarding the transition from acute pain to chronic pain to address the diversity of painful experiences observed experimentally and clinically. Contemporary theories on the relationship between movement and pain support a biopsychosocial framework for patient-centered management of pain.

Keywords:​

physical activity, movement adaptation, motor control, nociception, exercise

References:

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Role of a Movement System Approach in Physical Therapy Management of Musculoskeletal Pain

Abstract:

This monograph discusses the role a movement system approach can play in the diagnosis and management of musculoskeletal pain conditions. The aim is to enhance physical therapists’ ability to use their movement system knowledge and skill and effectively communicate with patients/clients, physical therapist colleagues, other health care professionals, and the community at large. Prior models, constructs, common terminology, and examples in physical therapy practice will provide a language for discussing a movement system approach within the person’s context. We use a biopsychosocial framework and emphasize person-centered practice to synthesize the movement system in a comprehensive patient/client management model. The critical elements to movement system diagnosis will be reviewed and key components of a movement system intervention will be provided. Other monographs in this series will drill into details of a movement system approach in specific musculoskeletal pain conditions related to the hip, knee, and ankle/foot.

Keywords:​

outcomes, task analysis, movement dimensions, person-centered care

References:

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A Movement System Approach to the Hip

Abstract:

The purpose of this monograph is to drill down from Monographs 1 and 2 in this series and present a movement system approach to the hip. This approach leads to a movement system diagnosis that focuses on underlying movement related influences on the experience of pain. It is believed that by identifying a movement system diagnosis, the practitioner can focus on teaching the patient how to modify specific movement patterns, and related impairments, that contribute to pain provocation. Through an iterative process of examination/ evaluation and movement related interventions, the patient is guided toward tasks with less (or no) pain and eventual return to meaningful activities and social roles at preferred, or perhaps even higher than expected, levels. A review of the anatomy and morphologic variations along with kinesiology is provided as a foundation for clinical decision-making involved in the diagnostic process. Components of a hip examination/evaluation, including symptom modifying procedures, are presented with emphasis on both femur-on-pelvis and pelvis-on-femur movement patterns. Results of the examination/evaluation are used to determine a movement system diagnosis of the hip. Examples of hip movement system diagnoses are presented along with primary objectives of movement related interventions. Case studies are offered to practice the clinical decision-making process. This monograph reviews the functional anatomy of the hip joint and the relationship between the acetabulum and proximal femur. Examples of movement system diagnoses of the hip joint are introduced. The critical elements of the movement system diagnosis will be reviewed, and key components of exercise and functional training interventions will be provided. Four case studies will provide opportunity for the learner to practice applying the diagnosis and management methods described.

Keywords:​

kinesiology, injury, femoroacetabular, coxae

References:

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Movement Systems Impairment Approach to Diagnosis and Treatment of Knee Pain

Abstract:

Knee pain accounts for approximately 25% of office visits to primary care clinics and nonoperative management is often recommended. Given the multifactorial nature of these pain conditions, a systematic physical therapy evaluation is needed. This evaluation should lead to a diagnosis that directs treatment that is individualized based on the patient’s presentation. This monograph discusses the movement system impairment (MSI) approach to the evaluation, diagnosis, and treatment of patients with knee pain. The goal of the MSI examination is to identify movement system impairments that may contribute to symptoms. In this approach, diagnoses are named according to the impairment(s) observed and the ability to modify symptoms by changing the patient’s preferred, but impaired, movement pattern. Once identified, treatment is not only directed toward addressing impairments in muscle length and strength that contribute to the suboptimal movement patterns, but also toward optimizing movement patterns in daily activities, work, and recreation. In this monograph, the basic anatomy and kinesiology of the knee joint will be reviewed to set the basis for the movement examination. Cases will be presented to describe common patient presentations and the flow of the movement system examination. Following each case example, the associated tibiofemoral and/or patellofemoral diagnosis will be reviewed with an explanation of key tests/signs and contributing factors. General treatment recommendations for each diagnosis will be discussed, with the emphasis on individualizing treatment. Finally, for each case, the patient’s specific treatment and outcomes will be discussed to illustrate a typical patient progression.

Keywords:​

tibiofemoral joint, patellofemoral pain, intervention

References:

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Movement Systems Approach to Classification and Treatment of the Foot and Ankle

Abstract:

Movement system impairment is a paradigm that bases physical therapy clinical examination on underlying anatomy and kinesiology. This monograph outlines common movement impairments of the foot and ankle as they relate to injury and function, including an overview of underlying biomechanics, standardized movement analysis, and symptom modification procedures. In addition, evaluation and treatment of common foot and ankle injuries are addressed based on movement presentation. Case examples are outlined and described to illustrate each movement diagnosis.

Keywords:​

movement examination, movement analysis, rehabilitation

References:

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Strategies for Optimizing Sustainable Therapeutic Outcomes Related to the Treatment of the Movement System

Abstract:

Physical therapists and their patients want to achieve the highest level of movement and function using the most effective interventions in as short a timeframe as possible. The path to this outcome is rarely linear and is impacted by a number of variables, only some of which are within the physical therapist’s control. The physical therapist must listen and attend to the patient’s perspective on the gap between current and preferred movement, and be armed with the most current best evidence to narrow that gap. Beyond use of best evidence for interventions, understand the impact of issues in the cognitive and affective domains that can facilitate or impede progress. These might include patient and therapist mental models, previous experiences, family and peer support, self-efficacy, co-morbidities, and health behaviors. These issues can impact exercise and home program activity dosage and patient education can mitigate barriers to independent exercise prescriptions. A number of dosage variables are available, and patient education regarding use of these variables to keep exercise activity and loading within tolerance is essential. Additionally, the psychomotor aspects of the exercise program should be designed for success, with an exercise prescription remaining within what the patient can safely and effectively perform. Outcome tool choice should be patient-centric, reflecting the movement limitations important to that individual patient. The tool must also have psychometric properties that are appropriate for the intended use. Finally, the physical therapist is charged with ensuring that outcomes are sustainable beyond discharge from formal therapy, and that discharge planning includes a seamless transition into exercise and activity for a lifetime of health and wellness.

Keywords:​

treatment outcome, health status indicators, outcome assessment, lower extremity

References:

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