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Why? Movement
1stFridays Specials
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조규행, PTEdu CEOInternational Instructor of PNF
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PTEdu-Health & wellbeing center
PTEdu-Musculoskeletal
PTEdu-Neuro
PTEdu-Sports
PTEdu-Rehab Pilates
PTEdu-Customer service
PTEdu-Movement
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Why MOVEMENT for the patient who has PAIN?
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The goal of PT is
Enhancing the Quality of life of the client that is related with movement!!!
Goal direct
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Movement
Approach for the
Movement
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Characteristics of movement
• Dynamic, changeableTask specific and environment dependent
• ActiveMuscle activation!!!
Whole motor control system
Executive, effector and feedback stage
• Inter-limb & intra-limb coordination
• Problem solving, Function
Systemic knowledge
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Task specific
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Environment dependent
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Executive stage
Effecter stage
Feedback stage
Stimulus
identification
Response
selection
Response
programming
Muscle
Joint
Reference for
the correctness
Whole motor control system
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Characteristics of movement
• Dynamic, changeableTask specific and environment dependent
• ActiveMuscle activation!!!
Whole motor control system
Executive, effector and feedback stage
• Inter-limb & intra-limb coordination
• Problem solving, Function
Systemic knowledge
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Inter-limb & intra-limb coordination
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Type of Knowledge of Professions and Expert
Systemic Knowledge
We know already what we need to do for practice!
BUT!!!
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Systemic Knowledge
Anatomy
Kinesiology
Neurology
Psychology
Pathology
Pathology
Motor control
Motor learning
Therapeutic Ex.
…
Ability to get new and best
information!
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Movement
or
Therapeutic Exercise
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Critical Thinking for
Creative Thinking
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1. Medical diagnosis
Asymptomatic shoulder abnormalities were found in
96% of participants
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the EC and FC muscle tests nine and eight other shoulder
muscles were equally highly activated as
supraspinatus.
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Patient centered
Physical therapy
Patient is not a
medical object!
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2. Core stability
LM-muscle activation does not appear to be a clinical feature that predicts patients with LBP.
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Lumbar Multifidus-The systematic review revealed clear evidence supporting dynamic free weight exercises.
Transverse Abdominis-Core stability exercises showed no differences with others.
The labile surface increased LROM (p=0.35) and CoPdispersion
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3. Posture
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Perfect Posture
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5.9 cm to 6.3 cm in the asymptomatic group and from 6.0 cm to 6.5 cm in the symptomaticgroup.
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“NO evidence to support scapula posture with impingement syndrome”
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Behavior!
Ability to change!!!
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Postural Control
vs.
Movement Control
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“If the only tool you have is a
hammer, to treat everything as
if it were nail”
Maslow(1962)
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the complex, multifactorial nature of the syndrome
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There is no answer! We just have Question!!!
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How we can make the question?
We know already what we need to make question.
Movement Analysis with systemic knowledge!!!
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Answer is notfrom a theory, it’s from our patient and client!!!
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Pain
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is perception.
Perception is everything.
PAIN
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PSYCO
PAIN
BIO
SOCIAL
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PSYCO
PAIN
BIO
SOCIAL
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PAIN
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PAIN receptor
Pain network in brain
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Woby et al, 2005
Fear-avoidance model: Self-efficacy
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Kinesiophobia
Who is afraid of moving?
Patients with low back pain the most studied group
(Vlaeyen et al, 2000)
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How to erase pain memories?
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1. Depth
understanding of complex pain mechanism
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2. Cognition targeted
movement
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Experience about
the movement
without PAIN!!!
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Physical therapy intervention
RemediationMaintain
Prevention
CounsellingPersuade
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Multidimensional clinical
reasoning framework
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Let’s expand our management and ability
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