POSTURAL RE-EDUCATION TIP

Symptom: Where and why are they having pain, isolated muscle weakness or short- ened soft tissue structures?

Cause: How are they moving? What postur- al habits and movements are they using? What adverse biomechanical loads are being generated on which structures?

Resolution of symptoms and preven- tion of recurrence: Re-education of the habitual move- ment

look at how this approach views movement patterns from a neurological perspective.

Musculoskeletal anatomy is often taught in distinct anatomical areas, but the mus- culoskeletal system is fully embedded in, and controlled by, the nervous system. All functional movement generates muscular activity throughout the body, not just in isolated muscles or at isolated joints.

In neurological rehabilitation, it is acknowledged that the brain recognises functional and habitual movement pat- terns. These are learned through the process of repetition. Ayres (1960) sug- gested that quality of movement can be enhanced when attention is directed away from specific muscular action and towards a purposeful goal (2).

Using the idea that anatomical structures can be described as having a ‘hierarchy of intelligence’, for re-education of move- ment patterns to be most effective the more ‘intelligent’ structures need to be the focus of our treatment.

In the absence of neurological impairment these principles can still be applicable. Let us consider that all patients who pre- sent with faulty movement patterns are on a spectrum, with the boundaries being an intact nervous system at one end, and a disrupted nervous system at the other.

So what causes unskilled movement pat- terns? Gibson suggests that it is widely due to compromised proprioception (3). Alexander described this as unreliable sensory appreciation (4). We view unreli- able sensory appreciation of the static starting posture as the cause of the unskilled movement pattern.

Unreliable sensory appreciation

Malaligned static starting position/ posture

Faulty movement pattern Muscle Imbalance Pain

Figure 4: Cause and result of faulty movement patterns

In order to explore these thoughts further we will now discuss three concepts: 1. Specificity 2. Habit 3. Posture

SPECIFICITY There is much research from the fields of exercise physiology, sports science and movement re-education (neurological rehabilitation) about specificity (5). This can be most simply understood by consid- ering the following:

■ specific exercises make you better at doing those specific exercises and there is relatively little transfer of perfor- mance improvement into other activi- ties (6,7)

■ the effects of any exercises will be to Less effective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .More effective

Joint . . . . . . . . . . . .Soft tissue . . . . . . . . . . .II . . . . . . . . . . .Conscious . . . . . . .Sub-conscious structures

nervous system Figure 2: Hierarchy of intelligence of anatomical structures Intact nervous system eg. shoulder secondary impingement Figure 3: Spectrum of faulty movement www.sportex.net

Disrupted nervous system eg. hemiplegia

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Faulty movement pattern spectrum

nervous system Figure 5: Posterior view of alignment in standing

Figure 6: Anterior view of alignment in standing

Figure 7: Enhanced posterior view of STJ pronation

change specifically the movement that has been practised ie. strengthening a muscle within a certain direction, range, velocity and angle (8,9, 10, 11, 12).

Application of this research should make us question the sort of exercises that are com- monly advocated in the rehabilitation of sports or overuse injuries. The logical con- clusion is that we can dispense with iso- lated muscle strengthening programmes, and focus on the re-education of aligned movement patterns in functional activities.

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