Meaningful Task Analysis, Altered Motor Control and Retraining
Motor control refers to timing, control, and coordination of movement in your body. When we are doing it well, we aren't even aware that it is happening! You don't think about stabilizing your spine or shoulder girdle to reach for a glass of water, it just happens, so it is essential that your body choose an appropriate, efficient strategy for the task that you are trying to perform.
Our therapists use a concept called "meaningful task analysis" to determine what activity to screen to determine if you have altered control. For example, if you get pain in your right low back every time you go for a walk, she will analyse how you are moving when taking a step to determine if you are controlling all parts of your body well and using an optimal amount of muscle activity for the task.
Sometimes we are inclined to believe that more muscle activity is always a good thing, but it is not. If you are simply lifting your leg to walk, you should not be using all the muscles in your back, trunk and hip to do this "low-load" task. However, if you were an Olympic sprinter taking off from the blocks, you would want to use almost every muscle in your body as this is a "high load" task. After injury, our bodies often compensate and may continue to use the wrong type of strategy even when the injured tissues have healed.
You can also have a problem in a different part of your body from where you are experiencing pain that is impacting on your problem. To see how this works, stand for a moment and flatten one of your feet while increasing the arch height on the opposite side. Notice what happens to the rest of your body to compensate for this change in your normal alignment. Now imagine walking that way for an hour, and you will be able to understand this concept.
Why do some people adapt better to tasks than others? The answer is that we all have different natural abilities to control our body, injury histories that impact our control mechanisms, muscle strength, balance, sensation, and even fear or emotion about what you are doing (for example, imagine walking like you are on top of the world after getting a promotion compared to walking in to a funeral). Pregnancy, delivery, gender, flexibility, occupation, sport training and stress are examples of factors that can change the way you develop and impact your motor control.
It is likely that poor control not only results from injury, but may also be a factor in determining whether or not you are injured in the first place. There are programs aimed at young soccer players all over the world to help to prevent common noncontact knee injuries that result from poor motor control in the hips and pelvis. These training programs are designed to encourage a better squatting and landing pattern to prevent injury. The poor control pattern could cause acute injury (like ACL or meniscus damage) or, over a longer time period, could contribute to the development of patellofemoral pain or arthritis.
Motor control is not structural - nothing is physically wrong with the muscle itself. The problem is neurological - the brain alters your control mechanism in response to dysfunction and pain.
One of our therapists has taken extensive training (Discover Physiotherapy and ConnectTherapy with Diane Lee and Linda Joy Lee) in the assessment and treatment of motor control in neurologically intact clients who have developed various compensation strategies after injury. We do a very thorough assessment of all parts of your body to determine if motor control is an important factor delaying or halting your recovery. Often with persistent pain, the problem is no longer a structure that is injured, but the way the body and mind have compensated and changed secondary to the original insult.
You may have lost your normal, optimal movement in favour of a suboptimal strategy that can cause not only the original area of injury to persist, but can also cause spreading of the problem to other areas of your body as you try to continue activity despite the altered strategy. If a problem is identified, we will teach you how to correct these patterns (with persistence and repetition to train your brain) so you can improve your function and performance and decrease your pain.