Towards Meaningful Movement in the Rehabilitation Process: The JEMS Approach

The most enduring relationship of a person’s life is the one that they have with their body.

Our body movement is closely tied to our identity, allowing us to explore our potential, interact with our environment and express ourselves physically through the activities that inspire us. When something happens to prevent this, it is more than a physical injury – it affects our relationship with ourselves, and what we communicate with the world.

Restoring a patient’s sense of awareness, connection and confidence is a critical part of their recovery. This requires skilled structuring of the rehabilitation programme, beginning with identifying the patient’s current strategies for managing the forces acting upon them, establishing a competent baseline, and systematically progressing in such a way that the patient learns to have confidence in themselves in varied and variable conditions, to whatever functional level is demanded of them.

It is important to distinguish between an approach which promotes movement integration, and one that is in fact an “anti-movement’ approach. Anti-movement techniques focus on maintaining the consistent position of a body part e.g. the “neutral” lumbar spine. While there are functional circumstances where this will be appropriate e.g. cycling, care must be taken in how this is communicated, to avoid patient perception that they should create a protective brace around the spine at all times, thus inadvertently immobilising it. This learned behavior can interfere with functional mobility and normal processes for maintaining equilibrium, such as rapid neuromuscular reactions to perturbation, and the small but important movements that are necessary for an effective recovery from such perturbation(1). Hodges himself noted in his 2009 paper that although there are protective benefits to increasing spinal stiffness, “its effect on compromised trunk dynamics may have long term consequences”(2).

In order to avoid such a result, integration of multiple elements can be implemented even at early stages. Balance, proprioception, neuromuscular response, functional mobility, coordination and timing are just some of the factors that can be manipulated to restore movement efficacy and the overall functional stability of the system(3).

Systematic and progressive integration of systems in rehabilitation underpins the JEMS® approach, a movement enhancement system that targets the body’s efficiency of motion and management of forces across the range of physical function. It emphasizes the development of awareness and connection between the patient and their body in order to build independent self management and confidence in exploring movement potential. In order to do this, it is critical to select tasks based on a functional level which matches the patient’s actual physical capability in order for them to be relaxed enough to be willing to try something new, and then to vary and progress tasks incrementally to stretch the boundaries of this capability. This involves accurate assessment of their capacity for functional force management ™, and an appreciation of the interplay between load and skill which is relevant both to patient presentation and to their eventual functional goals.

Developed over twenty five years, JEMS® is built upon a foundation of neuroscience, biomechanics, motor learning, psychology and rehabilitation research. It is a holistic, clinically reasoned approach to functional movement which draws firmly from the evidence base, and is used internationally across the spectrum of therapeutic, coaching and fitness applications, including paediatrics, geriatrics, orthopaedics, rheumatology, sports and athlete development.

The JEMS® Trunk and Lower Body Module launched by PhysioTools has been designed to support rehabilitation professionals by providing options at a variety of functional levels to enable development of spinal, lumbopelvic and hip mobility; balance; trunk and pelvic control; dynamic movement relationships between the trunk, pelvis and lower limb; posture and breathing. Uniquely, in addition to exercise instructions, it encourages the practitioner to include key words and sensory cues which are meaningful to the individual patient to support their independent practice.

The philosophy of JEMS® is to enable people of all backgrounds, ages and levels of physical ability to learn the art of working with their body instead of against it, to have confidence in their bodies, and to reclaim the activities that matter most to them. With the rise of pain science indicating that biopsychosocial aspects and fear avoidance are critical factors for clinical outcome, collaborating with the patient to make the link between rehabilitative exercise and confident, meaningful movement is fundamental now for the modern clinician.

(1). Mok NW1, Hodges PW. 2013 Movement of the lumbar spine is critical for maintenance of postural recovery following support surface perturbation. Exp Brain Res. 231(3):305-13

(2). Hodges P, van den Hoorn W, Dawson A, Cholewicki J. 2009 Changes in the mechanical properties of the trunk in low back pain may be associated with recurrence. J Biomech. Jan 5;42(1):61-6.

(3). Elphinston J (2013) Stability, Sport and Performance Movement: Practical Biomechanics and Systematic Training for Movement Efficiency and Injury Prevention. Second Ed. Lotus, UK

This article was written by Joanne Elphinston

Highly respected international lecturer, physiotherapist, performance consultant and author Joanne Elphinston has been developing JEMS® for over twenty five years. Taught internationally since the mid 1990s, Joanne’s approach is used with enthusiasm across the spectrum of therapeutic, coaching and fitness applications, including paediatrics, geriatrics, orthopaedics, rheumatology, sports and athlete development. JEMS® continuously evolves with the latest research in the fields of biomechanics, motor learning, neuroscience and psychology, making functional links for a holistic, clinically reasoned approach with a firm foundation in the evidence base.

JEMS® Dynamic Movement Progressions for Trunk and Lower Body 

PhysioTools has launched an exercise module JEMS® Dynamic Movement Progressions for Trunk and Lower Body  (PX67) in co-operation with Joanne Elphinston.

Read more about the new PhysioTools module.