SMARTERehab - Lumbar Spine & Pelvis: Movement Analysis, Sub-classification & Neuromuscular Retraining for Functional Movement and Translation Control

Cours donné par Sean Gibbons (SMARTERehab). Cours donné en anglais.

Description du cours

The most common problem in mechanical low back pain is the person's movement pattern. They habitually move their lower back into too much flexion and extension compared to their hips, which provokes their pathology and pain. With appropriate sub-classification, cognitively controlling movement patterns is more effective than general exercise, strength and various "core exercises".

Lumbo-pelvic pain can be related to a variety of factors including trauma or overuse, but frequently it is an insidious, recurrent and ongoing problem. This is often related to sub-optimal loading on the lumbo-pelvic region. The mechanism driving sub-optimal loading may be related to: Movement Pattern Control; Translation Control of the joint; or Biomechanical Exposures to Loading. There is considerable individual variation in how these present — from "too little control" to "too much control" — and they may occur in combinations or alone.

The underlying hypothesis is that the way the central nervous system coordinates movement can influence tissue loading. In normal function we need the ability to vary postures and movement patterns in order to avoid tissue overload. If the ability to vary the kinetic chain and control movement is lost, tissue load can be exceeded, tissue repair can become compromised and pathology may result.

Altered translation control can manifest as too little control (e.g., shear) or too much control (e.g., compression). Too much shear can place stress on articular structures that limit movement; compression with shear places more stress on articular structures such as the disc. Lumbar instability is not rare.

Biomechanical exposures to loading are the physical stresses experienced by the body — gross body position, exertion, forces and motions. This loading causes mechanical tension within the tissues which can lead to microdamage if load tolerance is exceeded.

Movement as a Clinical Reasoning Tool: Other models do not consider the true underlying mechanisms. These need to be considered in rehab or many people will not progress or quickly plateau. Targeting movement and motor behavior will allow you to be much more effective with whatever skills you already have. Treatment and progression will also be faster.

This is what a Sub-classification is for. Motor behavior issues represent a subgroup of patients and are not the priority for everyone. The sub-classification model shows you how to identify who will respond to this type of therapy. Some people do not have the ability to learn motor control based exercises; others can learn but won't respond; some do not have a nociceptive pain mechanism; while others have neuro-immune-sympathetic dysregulation or nociplastic pain. The Movement Exposures & Loading Tool© is a simple questionnaire which facilitates the need for load management.

This course will provide participants with skills in assessing movement and sub-classifying movement pattern and motor control deficits that relate to the functional movements that provoke the patient's symptoms. Rehabilitation strategies will provide a logical and functional-based starting point with directions for progression. A universal clinical problem-solving model is given to iron out real-life difficulties.

This is an evidence-based course. Several randomized controlled trials support the use of controlling movement of the lumbar spine. Five reviews and one meta-analysis support the use of specific segmental stabilizing exercises, and a recent review supports the use of specific segmental exercises for articular dysfunction in low back pain.

Objectifs spécifiques du cours

• Sub-classify patients' movement pattern deficit and translation control deficit (quickly identify poor motor learners)
• Assess for movement pattern control deficits in the lumbar spine and pelvis relating to functional movements that provoke the patient's symptoms
• Identify the need for translation control in lumbo-pelvic pain
• Understand the different mechanisms behind movement pattern control deficits
• Know when to use a battery of postural and primitive reflexes to quickly change movement
• Implement a targeted functional approach for rehabilitation
• Make a movement pattern control sub-classification and relate this to the client's presentation
• Utilize strategies to diagnose lumbar instability
• Use movement patterns as a clinical reasoning tool to help guide manual therapy and other techniques
• Integrate the treatment of movement patterns and translation control into clinical practice

Public cible

Physiotherapists. Prerequisite: Sub-Classification course (SMARTERehab).