Assessing for movement impairments – does it matter for your health care practice?

Movement is the key to living

It maximizes function for people of all ages. It’s important for all well being, both physically and mentally, for young and for old. Its the system we have to allow us to move from A to B. It’s the means of being active in our own lives and has been scientifically linked with our health at cellular level that is necessary to keep our vital bodily processes ticking over.

Movement outcomes are valued by all of us. The first steps our children take, the first time our children ride their bike without stabilizers. The races we win or partake in, the sponsored runs we train for with friends or work colleagues and the return to sport after injury for every athlete. Keeping our elderly parents active enough to maintain function and independence in their every day life is a movement outcome that is becoming more and more important as we grew older and live longer. These movement milestones, throughout our life carry tremendous weight and are highly valued. In this context Movement means function and it significantly contributes to the emotional and physical well being in our everyday life.

Movement Lifespan

What happens throughout life? Well life happens, we have active periods and then not so active. At times we spend too many hours at work, too much time sitting at a desk and then less and less time in exercise or even simple motion. We have ambitions to return to play squash, tennis or other sport again just like our teenage years except twenty something years have passed so fluidity and agility in movement patterns has gone a bit by the wayside. As we get older, our body adapts to our current lifestyle, previous injury can play a role, inactivity and cumulative strain also changes the way we move. The body takes the path of least resistance, we move according to how we use our muscles habitually both good and bad. Some of us have certain beliefs and justifications about our life and how we move. Previous knee injury means I can’t jog, 3 disk protrusions in my neck means I am scared to cycle. Not only do our habits change so does our movement system and the belief system surrounding this changes to and this creates risk. The risk of not maintaining a healthy musculoskeletal system, a healthy heart and cardiovascular system and even a healthy mind. With not enough movement in our lives, we face a problem, perhaps a major problem but at the very least great worry for the future.

The Mission is Movement

‘Movement is the key to optimal living and quality of life for all people that extends beyond health to every persons ability to participate in and contribute to society’ (2020 vision statement from the American Physical Therapy Association, APTA)

This means the way we move our “machinery”: the pattern, the coordination of one joint under the other, the walking pattern, lifting pattern, sitting and standing posture, the way we bend forward for example. Are the movement patterns optimal, do we use compensation strategies because of tight muscles or stiff joints that then lead to dysfunction, pain, and further compensation? Are there movement impairments in the system that need to be identified and retrained in order to maintain a control and balanced body?

Movement and movement assessment, this is the key. Shirley Sahrmann has noted that she has seen the profession go from a clinically based profession to an academically driven one (Sahrmann 2014). A change, which she argues, is essential to assume a place amongst the worlds leading health professions. However we should not forget our strengths and the principles behind why we do what we do.

The aim of The APTA’s vision statement and those involved in this process is to inspire the physical therapy profession to create systems and optimize movement and function for all people. To go back to what we are good at and to use our skills to do something positive for the lives of our clients and patients

The need to assess and evaluate movement here and now is important in order to manage current musculoskeletal issues, correct dysfunctions and optimize movement control and hence function.

Sahrmann discusses the idea of a lifespan screen where people can come no matter what stage of life they find themselves in and we as the movement experts can evaluate their movement patterns (Sahrmann 2014). How does my movement pattern look, how does this relate to my pain and my function, what are my assets and most importantly how do I make this better so that I get involved in the activities I want to do?

Patients, clients, customers have goals. They have ambitions of where they want to see themselves in their everyday lives. It may be a Sunday morning bike ride with the family, it may be a daily stroll with the dog without back pain, it may be a 10 km run in the springtime, it does not matter what the activity is, movement and motion should be attainable. It should not be hindered by poor movement control.

As Sahrmann has stated we as a profession have been moving more into a research based reality. This has provided strong scientific evidence that movement matters. Pain related restrictions and impairments can be changed with movement, we see this time and time again that if we correct the control fault and correct the movement impairment, and we make a difference. As a profession this speaks volumes.

How can we move forward?

We are building a research base and we are taking baby steps forward. How can we make sure that we get there the best way we can?

We have to believe in the process and acquire the skills to teach movement.

We should be better at understanding and observing movement and really engaging in the process. Do we really understand what movement control is and can we take ownership of this task to analyse and correct impairments? Communication with peers and with clients and an active intervention to identify, find and fix the movement faults. This simple action is a massive push in the right direction.

Health care delivery models demands best practice. Can we work to professional standards by assessing and implementing movement control in a structured way and build upon the evidence base we have already started. Shirley Sahrmann challenges us:

‘Accountability will be a core characteristic of the profession and will be essential to demonstrating value

Result based intervention speaks volumes. Modern movement analysis means that we can find movement faults and we can correct those movements that matter for function, even those, which eradicate pain episodes and prevent recurrence. This is a major skill. (Mottram, 2014).

Can you assess for movement impairments and does it matter for your health care practice? We argue that it should because this is absolutely the way forward.

‘There has never been a better time to define our identity and move forward’ (Sahrmann 2014)


About the Author

This post was written by Clare Pedersen, Physiotherapist, Performance Matrix Tutor and Consultant & part of the Movement Performance Solutions team, Get Movement, Sweden