Kinetic Control: The Management of Uncontrolled Movement
by Mark Comerford and Sarah Mottram
In Press from Elsevier
This book presents a comprehensive system for the assessment and retraining of movement control. It has been in evolution for the last 25 years. Uncontrolled movement has a significant impact on the development of movement disorders and pain. The scientific support for the process of the assessment and retraining of uncontrolled movement has been steadily expanding particularly in the last 10 years. The influence of uncontrolled movement on symptoms, especially pain, movement function, recurrence of symptoms and disability is now well established. We believe that in the next 10 years the literature will support that the presence of uncontrolled movement will also be recognised as a predictor of injury risk and as having an influence on performance.
Uncontrolled movement can be identified by movement control tests. People with pain demonstrate aberrant movement patterns during the performance of these movement control tests. A growing body of evidence supports the use of movement control tests in the assessment and management of chronic and recurrent pain. The identification of uncontrolled movement in terms of the site, direction and threshold of movement impairment is a unique subclassification system of musculoskeletal disorders and pain. The movement testing process proposed enables the classification of uncontrolled movement into diagnostic subgroups that can be used to develop client-specific retraining programs. This process can determine management priorities and optimise the management of musculoskeletal pain and injury recurrence. Subclassification is now recognised as being the cornerstone of movement assessment and the evidence for subclassification of site, direction and threshold is growing. This book details a structured system of testing, clinical reasoning and specific retraining. This system does not preclude other interventions as it is designed to enhance the management of musculoskeletal disorders.
The Kinetic Control process has come a long way in last 25 years. The motivation for the development of the Kinetic Control process was to find a way to blend the new and exciting concepts in movement dysfunction into an integrated clinical process, built on the foundation of a solid clinical reasoning framework. Our aim is to gain a better understanding into the inter-relationship between the restrictions of movement function and movement compensations. The breakthrough came with the realisation that some compensation strategies are normal adaptive coping mechanisms and do not demonstrate uncontrolled movement, while others are maladaptive compensation strategies that present with uncontrolled movement. This led us to develop the structured assessment process detailed in this text including the Movement Control Rating System (Chapter 3). This clinical assessment tool can identify movement control deficiencies and be valuable for reassessing improvements in motor control efficiency.
Recurrent musculoskeletal pain has a significant impact on health care costs, employment productivity and quality of life. Uncontrolled movement can be identified by observation, and corrective retraining of this uncontrolled movement may have an influence on onset and recurrence of symptoms. To date, outcome measures in terms of changes in range and strength, have not influenced the onset and recurrence of injury. The ability to assess for uncontrolled movement and to retrain movement control is an essential skill for all clinicians involved in the management of musculoskeletal pain, rehabilitation, injury prevention, and those working in health promotion, sport and occupational environments. Preventing the recurrence of musculoskeletal pain can both influence quality of life and have an economic impact.
Movement control dysfunction represents multifaceted problems in the movement system. Skills are required to analyse movement, make a clinical diagnosis of movement faults and develop and apply a patient-specific retraining program and management plan to deal with pain, disability, recurrence of pain and dysfunction. The mechanisms of aberrant movement patterns can be complex, so a sound clinical reasoning framework is essential to determine management goals and priorities. We present an assessment framework which will provide the option to consider four key criteria relevant to dysfunctional movement: the diagnosis of movement faults (site and direction of uncontrolled movement), the diagnosis of pain-sensitive tissues (patho-anatomical structure), the diagnosis of pain mechanisms and identifying relevant contextual factors (environmental and personal). This clinical reasoning framework can help identify priorities for rehabilitation, where to start retraining and how to be very specific and effective in exercise prescription to develop individual retaining programs.
Uncontrolled movement can be reliably indentified in a clinical environment and
related to the presence of musculoskeletal pain, to the recurrence of musculoskeletal pain and to the prediction of musculoskeletal pain. We hope this text will enable clinicians worldwide to effectively identify and retrain uncontrolled movement and help people move better, feel better and do more.
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