One of the components of my residency education at Honor Health and a component that we teach in Optim Manual Therapy COMT/Fellowship programs is Sahrmann's Movement Impairment Syndromes (MIS). For those of you unfamiliar with the topic, MIS involves assessing a painful region for a consistent regular abnormal movement pattern. The theory is established on the premise that normal movement requires a starting point of neutral posture. Should abnormal posture or abnormal repetitive motions be imposed, degenerative conditions may develop in a joint secondary to Wolff's Law. The last part here is definitely debatable with what we now know about pain science.
Another potential issue with MIS usage is the case of Double Crush Syndrome or radicular symptoms. While some may think a painful MIS will easily be picked up in the cervical spine upon examination, we must remember that there are cases of Double Crush Syndrome and cervical radiculopathy where no cervical pain is present. The same applies for other regions. Now a therapist using MIS in their assessment and treatment likely would do a thorough evaluation up the chain in order to spot these contributing MIS, but we must remember pain should not necessarily dictate our treatment.
Even though the use of MIS may have difficulty with certain diagnoses and the fact that there is a lack of correlation between degenerative conditions and pain, I believe using MIS can be incredibly useful in managing many conditions. While I don't typically treat via a pathoanatomical approach, I do believe that abnormal movement patterns can contribute to the development of pain. For example, an individual who displays lumbar rotation with extension, may show a hypersensitivity to loading the involved side. This pain may be a result of the abnormal movement pattern. This can be addressed with repeated motions, manual therapy, corrective exercises and more. Regardless, ensuring proper movement can decrease the likelihood of reinjur.
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