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