CLINICIAN EDUCATION:  dissociative movements

One of the primary causes of musculoskeletal pain outside of trauma is compensatory movement patterns. Individuals often lose the ability to perform a movement due to muscular tightness, joint/capsule restriction or muscular weakness. The brain automatically creates compensation to try to maintain movement homeostasis. This single segment hypomobility often creates dysfunction (hypermobility) and pain in the compensating structures. Often, the patients feel they have full range of motion due to the compensation but present clinically with abhorrent movement patterns. Appropriate treatment should emphasize not only stabilizing the hypermobility but finding and mobilizing the hypomobility.

Common movement compensations:
Trunk flexion for limited cervical flexion
Trunk rotation for limited cervical rotation.
Scapular elevation for limited shoulder flexion/abduction
Scapular protraction for limited shoulder IR
Scapular retraction for limited shoulder ER
Shoulder IR for limited radio-ulnar (elbow) pronation
Shoulder ER for limited radio-ulnar (elbow) supination
Trunk extension for limited shoulder flexion
Trunk extension for limited hip extension
Posterior pelvic tilt for limited hip flexion
Anterior pelvic tilt for limited hip extension
Increased knee flexion for limited hip flexion
Increased knee extension for limited hip extension
Increased knee flexion for limited ankle dorsiflexion
Increased tibial (knee) rotation for limited ankle inversion/eversion
Increased midtarsal supination for limited ankle inversion
Increased midtarsal pronation for limited ankle eversion

Look for upcoming posts on evaluation and treatment options for each dissociative pattern!