Physical Therapists are Movement Specialists: Let's Start Acting Like It

In the March 2014 edition of the Physical Therapy Journal, Shirley Sahrmann wrote a perspective paper regarding our role as movement specialists. Her paper was written in response to the 2013 APTA House of Delegates new vision statement, "transforming society by optimizing movement to improve the human experience." A key guiding principle of that vision statement is that "the physical therapy profession will define and promote the movement systems as the foundation for optimizing movement." 

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Sahrmann states several purposes of the paper, two of which I am going to elaborate on in this post:
1. Advocate for promoting both kinesiopathology and pathokinesiology as important movement system concepts 
2. The movement system must be embraced by physical therapists who seek to achieve the full potential of their critically important role in society. 

1. Advocate for promoting both kinesiopathology and pathokinesiology as important movement system concepts 
Without question, movement is at the heart of the physical therapy profession. In a sense, it is our identity. This message has been proclaimed for decades, most notably by Florence Kendall who throughout her career discussed "the importance of the profession establishing a relationship with a system of the body." However, if movement is truly what we do, we need to start promoting a model that reflects our practice. These models are both pathokinesiology and kinesiopathology.     

Pathokinesiology: study of abnormal movement resulting in pathology.
Kinesiopathology: imprecise movement or a lack of movement resulting in pathology. 

By promoting pathokinesiology and kinesiopathology, we are intentionally moving away from the standard pathoanatomical model. Rotator cuff tear, disc herniation, trochanteric bursitis, etc. will not be the focus of our treatments as they do not incorporate the underlying movement dysfunction. For example, a person with a referring dignosis of disc herniation might actually have a disc herniation, but that is not what we are treating. Our job is to treat the movement pattern that is causing that person's symptoms. The cause of their disc herniation could be due to poor proximal strength, adverse neural tension, poor lumbopelvic disasociation, or others. Documenting in your assessment that the patient has a disc herniation provides no explanation for the type of physical therapy treatment you intend to perform. This is a difficult concept to fully grasp as much of PT school and the APTA are still focused on the anatomy of the pathology. If you look at the Orthopaedic Section's monographs, most of the content is broken down by pathology: osteoarthritis, tendinopathy, impingement, etc. If we are going to identify ourselves as movement specialists, we need to begin moving away from pathoanatomical terms and starting speaking the language of pathokinesiology. We are not treating the anatomy, we are treating the underlying movement dysfunction. 

2. The movement system must be embraced by physical therapists who seek to achieve the full potential of their critically important role in society. 

If we are not treating the anatomy and we are focusing on the movement dysfunction, we need to start identifying ourselves with a specific movement system. The system needs to be universal and recognized by all individuals that practice it. Current systems I have been exposed to are the Sahrmann movement impairment systems and the Selective Functional Movement Assessment (SFMA). Both of these systems focus on identifying the cause of the cause of a patient's symptoms.. For example a patient with a rotator cuff tear may present as a Sahrmann shoulder downward rotation syndrome. Using the SFMA, they could be classified as dysfunctional painful (DP) in the shoulder patterns. Both systems would likely find the primary impairments as weak lower traps, weak serratus anterior, strong downward rotators, and poor thoracic mobility depending on how the patient presents. The impairments were found by analyzing movement and help guide the therapist in his or her diagnostic process.  

Adopting a movement system will standardize our treatment programs, improve outcomes, and help us reach autonomy. As Sahrmann states in her perspective paper, "if we are able to successfully define the components of the movement system such that they can be reliably tested and validly treated, we will be illuminating that area of human function and be recognized for that expertise." 

I want to conclude with another Sahrmann quote:
""Labeling a condition is most often the first step in treatment. Referral sources should expect a label from us. Yet, currently, "Physicians refer to consultants for diagnosis. They refer to PTs for treatment. Autonomy will be actualized when physicians refer to PTs to obtain diagnoses."" 

At the student physical therapist, we know we do not have all the answers, but at the very least we want to bring the question to the table. Are you practicing and documenting in a model of pathoanatomy or pathokinesiology? What movement system do you follow? Do you think physical therapists should adopt a specific movement pattern? 

Article: The Human Movement System: Our Professional Identity

-Jim       

References: Sahrmann, Shirley. "The Human Movement System: Our Professional Identity."Physical Therapy (2014): 3.1-29. Web. 15 June 2014.