**DISCLAIMER: With this discussion I do not intend to single out a particular point of view, nor a particular system, technique, philosophy, or the like. I simply want to put a flow of thought down into words (call it self induced therapy).
Now…this is a LONG POST…however there IS a point, which relates back to conditioning/manual therapy, and the like. One must only execute patient.
What I want to discuss is the concept of “movement” which has become somewhat of a “catch phrase” as of late in the world of training and manual medicine. In order to do so I think it first pertinent to discuss the perpetuator of movement, the nervous system and what we ACTUALLY know about it…
It would appear to me that conflicts and arguments occur on any topic most likely form in the areas of the topic that we know the least about. For manual therapy (and most medical discussions for that matter) that area of ‘blurriness’ seems to be regarding the function of the nervous system. Any neurologist/neuroscientist will tell you, although progress is being made at a staggering rate, that realistically they know very little about the one topic that they specialize in. This is not an attack on neurologist or brain researchers, only an admission that their ‘topic’ is one that is far, far more complex than is given credit for. Consider if you will that the human brain is estimated to be comprised of approximately 100 billion neurons. That is a lot of inventory to account for. Even simple tasks can involve several billion of those acting in a complex, interconnected fashion. Also consider the plasticity of the brain. New ‘connections’ are constantly being formed, lost, and altered, etc., ad infinitum.
Keeping this complexity in mind, it is almost inevitable that people will attempt to create conceptual frameworks or analogies in the hopes of trying to bring order to the disorder inherent to a lack of understanding. For the brain and nervous system, the “Central Processing Unit/Computer” analogy is the one most often called upon by all areas of science…including manual therapy. In other words, we most often take a mechanistic approach when contemplating the brain/mind thinking of it as a functioning computer. HOWEVER, one must ask them self, is this conceptual framework factual, or is it rather simply scientific dogma? In other words, do we actually know that the brain/CNS functions in this fashion? A look into the literature would suggest that we in fact DO NOT.
Consider the line of research pertaining to memory. We assume that memories are somehow ‘stored’ in the brain’s circuitry. Further that there is some magical retrieval system that is able to ‘find’ the memories and ‘upload’ them to our consciousness. This is a beautifully constructed analogy. Unfortunately, it is NOT based on scientific evidence; in fact, evidence contradicts this concept. Despite years of effort, and billions of dollars spent, no one has been able to “find memories” in the “hard ware” of the brain. Further, when complicating this topic, one must also consider the difference between “memory” and “recall of memory.” If we find that there is indeed a hardwired storage method for memories, there must then also be a “retrieval method” for which to extract these memories on demand. This raises yet another question…how does the retrieval system know where to find the memory that needs to be recalled? For this to occur we must assume that the retrieval system itself has a form of memory. This problem is one of infinite regression where memory is needed to find memory…which also requires memory??
We can also consider the lines of research that looked at what happens when animals are taught concepts (assumed to be stored as memory), and then large sections of their brains were surgically extracted. What was the result? It did NOT affect the memory. They were able to effectively recall the memory as they did before. Some studies also looked at motor processing in the same way. Teach a motor task, then remove large sections of the motor cortex….what happens? Nothing. The physical ability remains. I KNOW that this sounds impossible, but it has indeed been shown!
Other studies have noted that humans with severe hydrocephaly at birth leaving them with only a small portion of a ‘normal’ brain were able to carry on ‘normal lives.’ Others point to our complete lack of understanding of consciousness, as well as the difference between the ‘brain,’ and the ‘mind.’
Anyway…..bringing this back to the realm of manual therapy…
Based on the above information, one must question a theory that is constantly utilized by manual therapists to describe the execution of movement – “Motor Engrams/Programs.” We use this concept in order to try to understand movements and how they are executed and/or controlled. However, is their existence reality, or an attempt to simplify an otherwise poorly understood concept? Appraisal of the scientific evidence available favors the latter.
When we observe ‘movement’ and/or try to categorize, interpret, or grade it, we are doing so with a pre-conceived notion that we have a good grasp of how that motion is performed, remembered, and recalled time and time again. However, we DO NOT. The truth is that movement involves extremely complex combinations of neural integration (or so we think) in a highly plastic brain, made up of BILLIONS of neurons, which are CONSTANTLY changing.
Based on this line of thinking I pose the following questions:
- If we know so little about how movement patterns are stored and executed, than how can one claim to know the ‘correct’ way for someone to move? (Especially considering that the BILLIONS of neurons, and the uncountable number of interconnections are constantly changing. Further that we are only ASSUMING that a particular movement created by one individual is ‘run’ with the same, or at least a similar neurological pattern as another person)
- Can we grade anyone as a “good” or “great” mover based on observation of a series of set movements?
- If we can grade someone as a “great” mover….can we assume that when run through a battery of movement screens or tests, that they will fare better than someone who is a “bad” mover? (I ask this question as I have seen first hand a cirque du solei performer who scored poorly during a simple movement screen)
- Do we have to grade movement? Or can we just concentrate on optimizing articular function/mobility thus improving the POTENTIAL for movement?
- Can anyone claim to truly understand movement?
Again this is not an attack at anyone attempting to categorize movement, grade it, assess it, or correct it. I in fact have the UTMOST RESPECT for each and every person who is currently pioneering these concepts. Perhaps these proposed methodologies will indeed yield beneficial clinical results in the future. However I think it important to really think about the knowledge base available from which to create the theoretical constructs with which to do so.
I propose another way of tackling the problem of movement in my seminars. The way that I interpret the literature and clinical observations regarding movement are as such…
We know that the more complex the movement, likely the more complex the originating plan executed by the nervous system (note that I did not say the more complex the plan created by the nervous system as we cannot logistically make that claim). We also know from research in exercise physiology that training results seem to be VERY specific to the type of training itself including rate of loading, angle of loading, frequency of input, etc. Thus when assessing movement by asking a person to perform a movement ‘test,’ we cannot account for:
1. Their history of performing similar movement tasks
2. Their history of actually performing the test
After providing exercises to ‘correct the test’ we then cannot account for:
1. The familiarity/learning effect of having previously performed the test
2. Any further complexity of performing the test
movement in uncontrolled situations.
I therefore wonder if we should be assessing and correcting for the test, or should we simply be assessing the articulations involved in said movement looking for dysfunctions that would decrease the ABILITY of the nervous system to do its job? I tend to lean towards the latter. My systems look to assess articular function…not against a pre-conceived “optimal joint function,” but rather to get a baseline of its function. I then consider it our job to induce functional improvements via therapeutic and/or training interventions. Once we are dealing with well functioning articulations, I then want to begin patient/client on a movement-training program with ever increasing neurological complexity so as to build their ability to move.
This can be summed up by my equation:
Mobility ∝ Movement Potential
(where mobility is directly proportional to movement potential)
Mobility simply refers to the amount of active motion capable in a particular articulation (a concept wrongfully, and commonly used as a synonym for ‘flexibility’). It would seem through my experience of training myself, training others, and spending much of my time as a manual therapist, that this equation is clinically accurate. One cannot execute a movement task if one, or several articulations involved in said task lack the necessary mobility (the ACTIVE ability to created the ranges needed). Once the necessary articular mobility is achieved, the nervous system will be free to gradually learn the necessary neurological execution to create the movement.
I thus conclude that in order of importance, we must first assess, and correct/improve the capability individual articular function as this is a pre-requisite of sorts. Then and only then can we expect the nervous system to learn, and subsequently execute the movement pattern. If we reverse this sequence by observe someone’s movement capability first finding deficiencies, this does not negate the need to assess individual joint function which, unfortunately, is a common occurrence as many practitioners immediately prescribe ‘corrective’ exercises in an attempt to correct “the movement” itself.
In reality “the movement” does NOT exist, as there is an infinite number of confounding variables making each movement execution distinctive. We therefore should focus on improving movement…not “the movement.”
In conclusion, it is my opinion that the best way to improve movement capability is to prepare the body for movement in general…and then practice moving.
