Diagnosis and treatment of movement system impairment syndromes

Shirley Sahrmann, Daniel C Azevedo, Linda Van Dillen, Shirley Sahrmann, Daniel C Azevedo, Linda Van Dillen

Abstract

Background: Diagnoses and treatments based on movement system impairment syndromes were developed to guide physical therapy treatment.

Objectives: This masterclass aims to describe the concepts on that are the basis of the syndromes and treatment and to provide the current research on movement system impairment syndromes.

Results: The conceptual basis of the movement system impairment syndromes is that sustained alignment in a non-ideal position and repeated movements in a specific direction are thought to be associated with several musculoskeletal conditions. Classification into movement system impairment syndromes and treatment has been described for all body regions. The classification involves interpreting data from standardized tests of alignments and movements. Treatment is based on correcting the impaired alignment and movement patterns as well as correcting the tissue adaptations associated with the impaired alignment and movement patterns. The reliability and validity of movement system impairment syndromes have been partially tested. Although several case reports involving treatment using the movement system impairment syndromes concept have been published, efficacy of treatment based on movement system impairment syndromes has not been tested in randomized controlled trials, except in people with chronic low back pain.

Keywords: Classification; Impairment; Movement system; Musculoskeletal; Pain; Rehabilitation.

Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Graphic of the human movement system. Developed by the faculty of the Program in Physical Therapy, Washington University School of Medicine in St. Louis.
Figure 2
Figure 2
The kinesiopathologic model of the movement system.

References

    1. Sahrmann S. Elsevier Health Sciences; 2010. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines.
    1. Sahrmann S.A. 1st ed. Mosby; St Louis: 2001. Diagnosis and Treatment of Movement Impairment Syndromes.
    1. de Oliveira R.G., Guedes D.P. Physical activity, sedentary behavior, cardiorespiratory fitness and metabolic syndrome in adolescents: systematic review and meta-analysis of observational evidence. PLoS ONE. 2016;11(12):e0168503.
    1. Medrano D., Jr., Smith D. Soccer: a comparison of knee joint laxity among male and female collegiate soccer players and non-athletes. Sports Biomech. 2003;2(2):203–212.
    1. Mascarenhas V.V., Rego P., Dantas P. Imaging prevalence of femoroacetabular impingement in symptomatic patients, athletes, and asymptomatic individuals: a systematic review. Eur J Radiol. 2016;85(January (1)):73–95.
    1. Kibler W.B., Sciascia A., Thomas S.J. Glenohumeral internal rotation deficit: pathogenesis and response to acute throwing. Sports Med Arthrosc. 2012;20(March (1)):34–38.
    1. Arnout N., Verhaar J., Bellemans J. How does lower leg alignment differ between soccer players, other athletes and non-athletic controls? Osteoarthr Cartil. 2016;24:S108–S109.
    1. Kim M.-H., Yi C.-H., Kwon O.-Y. Comparison of lumbopelvic rhythm and flexion-relaxation response between 2 different low back pain subtypes. Spine (Phila Pa 1976) 2013;38(15):1260–1267.
    1. Chleboun G.S., Howell J.N., Conatser R.R., Giesey J.J. The relationship between elbow flexor volume and angular stiffness at the elbow. Clin Biomech (Bristol, Avon) 1997;12(6):383–392.
    1. Gajdosik R.L. Passive extensibility of skeletal muscle: review of the literature with clinical implications. Clin Biomech (Bristol, Avon) 2001;16(February (2)):87–101.
    1. Herbert R. The passive mechanical properties of muscle and their adaptations to altered patterns of use. Aust J Physiother. 1988;34(3):141–149.
    1. Rakos D.M., Shaw K.A., Fedor R.L., Lamanna M., Yocum C.C., Lawrence K.J. Interrater reliability of the active-knee-extension test for hamstring length in school-aged children. Pediatr Phys Ther. 2001;13(Spring (1)):37–41.
    1. Ryan E.D., Herda T.J., Costa P.B. Passive properties of the muscle-tendon unit: the influence of muscle cross-sectional area. Muscle Nerve. 2009;39(February (2)):227–229.
    1. Valle M.S., Casabona A., Sgarlata R., Garozzo R., Vinci M., Cioni M. The pendulum test as a tool to evaluate passive knee stiffness and viscosity of patients with rheumatoid arthritis. BMC Musculoskelet Disord. 2006;7(1):89.
    1. Magnusson S.P., Simonsen E.B., Aagaard P., Boesen J., Johannsen F., Kjaer M. Determinants of musculoskeletal flexibility: viscoelastic properties, cross-sectional area, EMG and stretch tolerance. Scand J Med Sci Sports. 1997;7(August (4)):195–202.
    1. Sadeghisani M., Sobhani V., Kouchaki E., Bayati A., Ashari A.A., Mousavi M. Comparison of lumbopelvic and hip movement patterns during passive hip external rotation in two groups of low back pain patients with and without rotational demand activities. Ortop Traumatol Rehabil. 2015;17(6):611–618.
    1. Weyrauch S.A., Bohall S.C., Sorensen C.J., Van Dillen L.R. Association between rotation-related impairments and activity type in people with and without low back pain. Arch Phys Med Rehabil. 2015;96(8):1506–1517.
    1. Aartun E., Boyle E., Hartvigsen J. The most physically active Danish adolescents are at increased risk for developing spinal pain: a two-year prospective cohort study. BMJ Open Sport Exerc Med. 2016;2(1):e000097.
    1. Azevedo D.C., Pires T.L., Andrade F.S., McDonnell M.K. Influence of scapular position on the pressure pain threshold of the upper trapezius muscle region. Eur J Pain. 2008;12(2):226–232.
    1. Cattalini M., Khubchandani R., Cimaz R. When flexibility is not necessarily a virtue: a review of hypermobility syndromes and chronic or recurrent musculoskeletal pain in children. Pediatr Rheumatol Online J. 2015;13(1):1.
    1. Cole L.J., Farrell M.J., Gibson S.J., Egan G.F. Age-related differences in pain sensitivity and regional brain activity evoked by noxious pressure. Neurobiol Aging. 2010;31(March (3)):494–503.
    1. Cronstrom A., Creaby M.W., Nae J., Ageberg E. Gender differences in knee abduction during weight-bearing activities: A systematic review and meta-analysis. Gait Posture. 2016;49(September):315–328.
    1. Everhart J.S., Best T.M., Flanigan D.C. Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015;23(March (3)):752–762.
    1. Fearon A., Stephens S., Cook J. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. Br J Sports Med. 2012;46(September (12)):888–892.
    1. Gibson S.J., Farrell M. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain. 2004;20(July–August (4)):227–239.
    1. Glaviano N.R., Kew M., Hart J.M., Saliba S. Demographic and epidemiological trends in patellofemoral pain. Int J Sports Phys Ther. 2015;10(June (3)):281–290.
    1. Heneweer H., Vanhees L., Picavet H.S. Physical activity and low back pain: a U-shaped relation? Pain. 2009;143(May (1–2)):21–25.
    1. Janssen M.M., Drevelle X., Humbert L., Skalli W., Castelein R.M. Differences in male and female spino-pelvic alignment in asymptomatic young adults: a three-dimensional analysis using upright low-dose digital biplanar X-rays. Spine (Phila Pa 1976) 2009;34(23):E826–E832.
    1. Kayihan G. Relationship between daily physical activity level and low back pain in young, female desk-job workers. Int J Occup Med Environ Health. 2014;27(5):863–870.
    1. Mallows A., Debenham J., Walker T., Littlewood C. Association of psychological variables and outcome in tendinopathy: a systematic review. Br J Sports Med. 2017;51(May (9)):743–748.
    1. Pinheiro M.B., Ferreira M.L., Refshauge K. Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J. 2016;16(1):105–116.
    1. Scholtes S.A., Van Dillen L.R. Gender-related differences in prevalence of lumbopelvic region movement impairments in people with low back pain. J Orthop Sports Phys Ther. 2007;37(December (12)):744–753.
    1. Smith T.O., Jerman E., Easton V. Do people with benign joint hypermobility syndrome (BJHS) have reduced joint proprioception? A systematic review and meta-analysis. Rheumatol Int. 2013;33(11):2709–2716.
    1. Sorensen C.J., George S.Z., Callaghan J.P., Van Dillen L.R. Psychological factors are related to pain intensity in back-healthy people who develop clinically relevant pain during prolonged standing: a preliminary study. PM R. 2016;8(November (11)):1031–1038.
    1. Teraguchi M., Yoshimura N., Hashizume H. Progression, incidence, and risk factors for intervertebral disc degeneration in a longitudinal population-based cohort: the Wakayama Spine Study. Osteoarthr Cartil. 2017;25(July (7)):1122–1131.
    1. Toh W.S., Brittberg M., Farr J. Cellular senescence in aging and osteoarthritis: implications for cartilage repair. Acta Orthop. 2016:1–9.
    1. Walden M., Hagglund M., Werner J., Ekstrand J. The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective. Knee Surg Sports Traumatol Arthrosc. 2011;19(January (1)):3–10.
    1. Briani R.V., Pazzinatto M.F., De Oliveira Silva D., Azevedo F.M. Different pain responses to distinct levels of physical activity in women with patellofemoral pain. Braz J Phys Ther. 2017;21(March–April (2)):138–143.
    1. Barrett E., O’Keeffe M., O'Sullivan K., Lewis J., McCreesh K. Is thoracic spine posture associated with shoulder pain, range of motion and function? A systematic review. Man Ther. 2016;26:38–46.
    1. Ratcliffe E., Pickering S., McLean S., Lewis J. Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. Br J Sports Med. 2014;48(16):1251–1256.
    1. Azevedo D.C., Paiva E.B., Lopes A.M.A. Pelvic rotation in femoroacetabular impingement is decreased compared to other symptomatic hip conditions. J Orthop Sports Phys Ther. 2016;46(11):957–964.
    1. Brink Y., Louw Q., Grimmer K., Jordaan E. The relationship between sitting posture and seated-related upper quadrant musculoskeletal pain in computing South African adolescents: a prospective study. Man Ther. 2015;20(6):820–826.
    1. Lamontagne M., Kennedy M.J., Beaule P.E. The effect of cam FAI on hip and pelvic motion during maximum squat. Clin Orthop Relat Res. 2009;467(March (3)):645–650.
    1. Lawrence R.L., Braman J.P., Laprade R.F., Ludewig P.M. Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints. J Orthop Sports Phys Ther. 2014;44(9):636–638.
    1. Lawrence R.L., Braman J.P., Staker J.L., LaPrade R.F., Ludewig P.M. Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 2: glenohumeral joint. J Orthop Sports Phys Ther. 2014;44(9):646–655. B1–3.
    1. Neal B.S., Barton C.J., Gallie R., O’Halloran P., Morrissey D. Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: a systematic review and meta-analysis. Gait Posture. 2016;45:69–82.
    1. Scholtes S.A., Gombatto S.P., Van Dillen L.R. Differences in lumbopelvic motion between people with and people without low back pain during two lower limb movement tests. Clin Biomech (Bristol, Avon) 2009;24(January (1)):7–12.
    1. Van Houcke J., Pattyn C., Vanden Bossche L., Redant C., Maes J.W., Audenaert E.A. The pelvifemoral rhythm in cam-type femoroacetabular impingement. Clin Biomech (Bristol, Avon) 2014;29(January (1)):63–67.
    1. Sorensen C.J., Johnson M.B., Norton B.J., Callaghan J.P., Van Dillen L.R. Asymmetry of lumbopelvic movement patterns during active hip abduction is a risk factor for low back pain development during standing. Hum Mov Sci. 2016;50:38–46.
    1. Sorensen C.J., Norton B.J., Callaghan J.P., Hwang C.-T., Van Dillen L.R. Is lumbar lordosis related to low back pain development during prolonged standing? Man Ther. 2015;20(4):553–557.
    1. Van Dillen L.R., Bloom N.J., Gombatto S.P., Susco T.M. Hip rotation range of motion in people with and without low back pain who participate in rotation-related sports. Phys Ther Sport. 2008;9(May (2)):72–81.
    1. Van Dillen L.R., Gombatto S.P., Collins D.R., Engsberg J.R., Sahrmann S.A. Symmetry of timing of hip and lumbopelvic rotation motion in 2 different subgroups of people with low back pain. Arch Phys Med Rehabil. 2007;88(March (3)):351–360.
    1. Van Dillen L.R., Sahrmann S.A., Norton B.J. Effect of active limb movements on symptoms in patients with low back pain. J Orthop Sports Phys Ther. 2001;31(August (8)):402–413. (discussion 414–408)
    1. Van Dillen L.R., Sahrmann S.A., Norton B.J., Caldwell C.A., McDonnell M.K., Bloom N. The effect of modifying patient-preferred spinal movement and alignment during symptom testing in patients with low back pain: a preliminary report. Arch Phys Med Rehabil. 2003;84(March (3)):313–322.
    1. Salsich G.B., Graci V., Maxam D.E. The effects of movement pattern modification on lower extremity kinematics and pain in women with patellofemoral pain. J Orthop Sports Phys Ther. 2012;42(December (12)):1017–1024.
    1. Gombatto S.P., Collins D.R., Sahrmann S.A., Engsberg J.R., Van Dillen L.R. Patterns of lumbar region movement during trunk lateral bending in 2 subgroups of people with low back pain. Phys Ther. 2007;87(April (4)):441–454.
    1. Harris-Hayes M., Sahrmann S.A., Van Dillen L.R. Relationship between the hip and low back pain in athletes who participate in rotation-related sports. J Sport Rehabil. 2009;18(February (1)):60–75.
    1. Hoffman S.L., Johnson M.B., Zou D., Van Dillen L.R. Differences in end-range lumbar flexion during slumped sitting and forward bending between low back pain subgroups and genders. Man Ther. 2012;17(April (2)):157–163.
    1. Van Dillen L.R., Sahrmann S.A., Norton B.J., Caldwell C.A., McDonnell M.K., Bloom N.J. Movement system impairment-based categories for low back pain: stage 1 validation. J Orthop Sports Phys Ther. 2003;33(March (3)):126–142.
    1. Kim M.-H., Yoo W.-G., Choi B.-R. Differences between two subgroups of low back pain patients in lumbopelvic rotation and symmetry in the erector spinae and hamstring muscles during trunk flexion when standing. J Electromyogr Kinesiol. 2013;23(2):387–393.
    1. Marich A.V., Hwang C.T., Salsich G.B., Lang C.E., Van Dillen L.R. Consistency of a lumbar movement pattern across functional activities in people with low back pain. Clin Biomech (Bristol, Avon) 2017;44(May):45–51.
    1. Norton B.J., Sahrmann S.A., Van Dillen L.R. Differences in measurements of lumbar curvature related to gender and low back pain. J Orthop Sports Phys Ther. 2004;34(September (9)):524–534.
    1. Roussel N.A., Nijs J., Mottram S., Van Moorsel A., Truijen S., Stassijns G. Altered lumbopelvic movement control but not generalized joint hypermobility is associated with increased injury in dancers. A prospective study. Man Ther. 2009;14(6):630–635.
    1. Luomajoki H., Kool J., de Bruin E.D., Airaksinen O. Movement control tests of the low back; evaluation of the difference between patients with low back pain and healthy controls. BMC Musculoskelet Disord. 2008;9(December (1)):170.
    1. Hoffman S.L., Johnson M.B., Zou D., Van Dillen L.R. Sex differences in lumbopelvic movement patterns during hip medial rotation in people with chronic low back pain. Arch Phys Med Rehabil. 2011;92(7):1053–1059.
    1. Sadeghisani M., Namnik N., Karimi M. Evaluation of differences between two groups of low back pain patients with and without rotational demand activities based on hip and lumbopelvic movement patterns. Ortop Traumatol Rehabil. 2015;17(1):51–57.
    1. Hoffman S.L., Johnson M.B., Zou D., Van Dillen L.R. Gender differences in modifying lumbopelvic motion during hip medial rotation in people with low back pain. Rehabil Res Pract. 2012;2012
    1. Gombatto S.P., D’Arpa N., Landerholm S. Differences in kinematics of the lumbar spine and lower extremities between people with and without low back pain during the down phase of a pick up task, an observational study. Musculoskelet Sci Pract. 2017;28:25–31.
    1. Mazzone B., Wood R., Gombatto S. Spine kinematics during prone extension in people with and without low back pain and among classification-specific low back pain subgroups. J Orthop Sports Phys Ther. 2016;46(7):571–579.
    1. Gombatto S.P., Collins D.R., Sahrmann S.A., Engsberg J.R., Van Dillen L.R. Gender differences in pattern of hip and lumbopelvic rotation in people with low back pain. Clin Biomech (Bristol, Avon) 2006;21(3):263–271.
    1. Kajbafvala M., Ebrahimi-Takamjani I., Salavati M. Validation of the movement system impairment-based classification in patients with knee pain. Man Ther. 2016;25(September):19–26.
    1. Harris-Hayes M., Van Dillen L.R. The inter-tester reliability of physical therapists classifying low back pain problems based on the movement system impairment classification system. PM R. 2009;1(February (2)):117–126.
    1. Henry S.M., Van Dillen L.R., Trombley A.L., Dee J.M., JYB Reliability of the movement system impairment classification schema for subgrouping people with low back pain. J Orthop Sports Phys Ther. 2009;39:A97.
    1. Luomajoki H., Kool J., de Bruin E.D., Airaksinen O. Reliability of movement control tests in the lumbar spine. BMC Musculoskelet Disord. 2007;8(September):90.
    1. Trudelle-Jackson E., Sarvaiya-Shah S.A., Wang S.S. Interrater reliability of a movement impairment-based classification system for lumbar spine syndromes in patients with chronic low back pain. J Orthop Sports Phys Ther. 2008;38(June (6)):371–376.
    1. Henry S.M., Van Dillen L.R., Trombley A.R., Dee J.M., Bunn J.Y. Reliability of novice raters in using the movement system impairment approach to classify people with low back pain. Man Ther. 2013;18(February (1)):35–40.
    1. Azevedo D.C., Lauria A.C., Pereira A.R. Intraexaminer and interexaminer reliability of pressure biofeedback unit for assessing lumbopelvic stability during 6 lower limb movement tests. J Manipulative Physiol Ther. 2013;36(January (1)):33–43.
    1. Kajbafvala M., Ebrahimi-Takamjani I., Salavati M. Intratester and intertester reliability of the movement system impairment-based classification for patients with knee pain. Man Ther. 2016;26(December):117–124.
    1. Harris-Hayes M., Van Dillen L.R., Sahrmann S.A. Classification, treatment and outcomes of a patient with lumbar extension syndrome. Physiother Theory Pract. 2005;21(July–September (3)):181–196.
    1. Maluf K.S., Sahrmann S.A., Van Dillen L.R. Use of a classification system to guide nonsurgical management of a patient with chronic low back pain. Phys Ther. 2000;80(November (11)):1097–1111.
    1. Van Dillen L.R., Sahrmann S.A., Wagner J.M. Classification, intervention, and outcomes for a person with lumbar rotation with flexion syndrome. Phys Ther. 2005;85(April (4)):336–351.
    1. Van Dillen L.R., McDonnell M.K., Susco T.M., Sahrmann S.A. The immediate effect of passive scapular elevation on symptoms with active neck rotation in patients with neck pain. Clin J Pain. 2007;23(October (8)):641–647.
    1. Andrade G.T., Azevedo D.C., De Assis Lorentz I. Influence of scapular position on cervical rotation range of motion. J Orthop Sports Phys Ther. 2008;38(November (11)):668–673.
    1. Van Dillen L.R., Norton B.J., Sahrmann S.A. Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial. Man Ther. 2016;24(August):52–64.
    1. Harris-Hayes M., Holtzman G.W., Earley J.A., Van Dillen L.R. Development and preliminary reliability testing of an assessment of patient independence in performing a treatment program: standardized scenarios. J Rehabil Med. 2010;42(March (3)):221–227.
    1. Caldwell C., Sahrmann S., Van Dillen L. Use of a movement system impairment diagnosis for physical therapy in the management of a patient with shoulder pain. J Orthop Sports Phys Ther. 2007;37(9):551–563.
    1. Harris-Hayes M., Sahrmann S.A., Norton B.J., Salsich G.B. Diagnosis and management of a patient with knee pain using the movement system impairment classification system. J Orthop Sports Phys Ther. 2008;38(4):203–213.
    1. Hoffman S.L., Johnson M.B., Zou D., Harris-Hayes M., Van Dillen L.R. Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain. Man Ther. 2011;16(August (4)):344–350.
    1. McDonnell M.K., Sahrmann S.A., Van Dillen L. A specific exercise program and modification of postural alignment for treatment of cervicogenic headache: a case report. J Orthop Sports Phys Ther. 2005;35(January (1)):3–15.
    1. Spitznagle T.M., Sahrmann S. Diagnosis and treatment of 2 adolescent female athletes with transient abdominal pain during running. J Sport Rehabil. 2011;20(May (2)):228–249.
    1. Harris-Hayes M., Czuppon S., Van Dillen L.R. Movement-pattern training to improve function in people with chronic hip joint pain: a feasibility randomized clinical trial. J Orthop Sports Phys Ther. 2016;46(June (6)):452–461.
    1. Azevedo D.C., Van Dillen L.R., Santos Hde O., Oliveira D.R., Ferreira P.H., Costa L.O. Movement system impairment-based classification versus general exercise for chronic low back pain: protocol of a randomized controlled trial. Phys Ther. 2015;95(September (9)):1287–1294.

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