jessephysio

Movement: it seems to me that this word has taken on a life of it’s on over the last few years. There was even a very popular book written by a prominent physical therapist with it as the title ‘Movement’.  In and of itself, the term is very ambiguous…what kind of movement are we talking about? There are so many types…off the top of my head:
– Passive range of motion
– Active range of motion
-Arthokinematic movement
– Osteokinemtaic movement
– Functional movement (whatever the hell that means…more on this later)
– Sport specific movement
– Single joint/double joint movement

This list is endless…

With so many avenues one could go with movement, how is one supposed to be a movement specialist? As a physical therapist I am supposed to be a movement specialist with the ability to assess and detect aberrant movement, which maybe causing a problem and then intervene with strategies to overcome these issues. Examples of this may include teaching someone how to walk again after a spinal cord injury, stretching a spastic muscle after a stroke, or teaching someone how to hip hinge so they can squat better. An old school chiropractor might say they are detecting subluxations which are causing a weak muscle thus limiting movement and then manipulate the spine. A Pilates teacher might try and isolate your transverse abdominus to help lumbar stabilization creating more optimal movement patterns. A personal trainer might teach you how to perform a proper pushup to facilitate better movement…again, this list goes on.

Here is the issue that I have with much of this ‘movement based therapy’ so many of us provide…I don’t think we know what the proper way to move is and really, is there even such a thing? Don’t get me wrong, I know that rounding your spine for a deadlift creates torque through the lower back and landing in knee valgus can cause ACL injuries. What I’m saying has more to do with screening of movement. I may use a combination of active range of motion via a selective functional movement screen to determine where I think a problem may exist while a massage therapist uses manual muscle testing to determine an inhibited vs facilitated muscle. We may come to very similar or dissimilar conclusions as to why someone has pain or “dysfunction” and our treatments maybe completely different for the same patient complaint…but we are both “movement specialist”…hmmmm

Imagine a patient with back pain… They can go to a physical therapist, chiropractor, and pilates instructor who all claim to be movement specialists. In my opinion, more times then not each professional will arrive at a VERY different diagnosis and treatment strategy. Who’s to say who’s right? Who’s wrong? And what is the standard we go by to make such determinations? The reality is there is not one standard of care in the movement based world of therapy. I know the FMS people are trying to make a movement checklist, which is good, but it has many loopholes. For instance, doing a movement screen of standardized movements will take two practitioners down very dissimilar roads of rehab. So in this case, the assessment maybe standardized, but the subsequent findings and treatment are most certainly not. I bet if a patient went to a 5 different dermatologist for acne the treatment would be pretty similar. When you see an orthopod for a torn ACL, the treatment is usually pretty standardized.  The same can not be said with the patient with back pain seeking conservative treatment. So are we truly specialized in the assessment of movement? Or are we all doing the best with what we know? (and there is NOTHING wrong with that)

So with so much ambiguity in the term movement, can anyone really be a movement specialist? A specialist by definition is someone who is highly skilled and has detailed knowledge in a specific area of study. As I mentioned earlier, there is no specific area of study in movement because it encapsulates so many different things.

So what is the point in all of this?

With so much differentiation in how we treat and assess based on our individual training and philosophies, we must still utilize a common panacea to help us understand what it is we do. And my friends, that common panacea is something I like to call research (uh oh, research is boring and so un-radical—this is what I hear a lot!) Research asks a question, uses different methods to try an answer that question and then determines which method works best based on various outcome measures. It does not rely on personal bias, monetary gain from taking a guru course, or personal anecdote. So, remember that patient with back pain who saw a chiro, phyio, and RMT? Well, if each of these professionals utilizes research to guide their practice to at least some extent my hope is that similar conclusions would be drawn based on the existing body of evidence detailing why we have back pain. Of course clinical experience and patient preference play a roll in therapy, but at the end of the day, I want to know if I refer to another physiotherapist they will treat them in a similar way that I would…and they would do that because they to know what research says works and does not work.

There will always be charlatans and snake oil salesmen promoting their methods as the best cure for…whatever. This will never change. It is then incumbent on the evidence informed professional to do what is best for the patient and provide care that we know works. In general this means active patient participation in the form of education of condition, minimizing psychological threats, hands on therapy (again, very ambiguous term), exercise and reassurance. Will this get everyone I see better? Nope. Can I rest assured knowing I’ve done everything my skill set allows be to do while utilizing research to guide me…you bet’cha

In conclusion, I don’t think anyone is truly a movement specialist. I think we need to understand anatomy, biomechanics, physiology, pain science, exercise science and bring it all together using research to treat our clients. This is the kind of specialist I would like to be…