Classification Of Low Back Pain Using Shirley Sahrmann’s Movement System Impairments, An Overview Of The Concept

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"Movement System" and the Movement System Balance approach

Movement is the action of an entire physiologic system and its component parts, this includes musculoskeletal, neurologic, cardiopulmonary, and metabolic components. They therefore have a fundamental role in movement impairment syndromes.

Humans move in patterns, these patterns tend to be exaggerated in the musculoskeletal patient. Patterns can be organised into specific principles that best explain the movement patterns characteristics.These characteristics have been fundamentally drawn from the clinical observations of Dr. Shirley Sahrmann, however they are based on established concepts of anatomy, kinesiology and physiology, are established.

The Movement System Balance (MSB) approach regards precise and balanced movement as fundamental to the wellbeing of the movement system and its component parts. Microtrauma to tissue caused by repeated lack of balanced or precise movements will ultimately progress into macrotrauma. As a physiotherapist restoration or maintenance of precise movements is therefore elementary to preventing musculoskeletal pain.

Typically an examination should consist of two elements; observation of movement based on movement principles including identification of the patients Directional Susceptibility to Movement (DSM), and testing muscular strength and length. The MSB approach organises movement patterns into syndromes or diagnostic categories, and also identifies contributing factors. The name of the syndrome outlines the movement impairment and also provides a guide for treatment.

Ideal alignment facilitates optimal movement in both muscle and nervous systems, this reduces likelihood of repeated microtrauma. When movement deviates from the ideal degenerative change can occur, an analogy of an automobile can be used to explain this concept, to allow optimal rotation, the wheels require balance and alignment, this way both tyres wear evenly with time.

Movement System Impairment

A localised painful condition arising from irritation of myofascial, periarticular, or articular tissues. This originates from mechanical trauma, most often microtrauma. Microtrauma is ascribed to overuse, repeated use, or excessive load. Excessive load may occur in a single episode, or during repeated movements. Repeated use can include one hour of working at a desk, many years after stopping a similar activity, or someone who performs the same activity every day for many days. Microtrauma may also be caused by deviation from ideal anatomy.

Pain originating from musculoskeletal system is the most common group of individuals receiving physiotherapy.60% are treated for musculoskeletal pain, 25% are treated for LBP. Numerous reports cite the high cost of LBP to society.

It is the aim of the physiotherapist to assign a diagnosis, this is usually based on pathophysiological knowledge, and directs treatment. The use of categories for classification allows the use of diagnostic schemes for treatment programs, a method of treatment that paves the way for evidence based practice.

CAUSE IDENTIFICATION VS. SYMPTOM REDUCTION

Intervention has often been aimed at symptomatic relief, and has ignored the causation of tissue irritation. Management of MIS has been proven difficult as diagnosis is often based on symptomatic reporting rather than objective testing. When the patient understands how to control the factors producing their symptoms, they can be active in treatment, and prevention.

DEVELOPMENT OF HYPOTHESIS OF CAUSAL AND CONTRIBUTING FACTORS; SPECIFIC AND SYSTEMATIC EXAMINATION HIGHLIGHTING FACTORS. DIAGNOSIS TO DIRECT TREATMENT; TREATMENT STRATEGY BASED ON DIAGNOSIS AND CONTRIBUTING FACTORS; EVALUATION OF TREATMENT OUTCOME

Names of diagnostic categories of classification system are the names of joint motions, physiologic or accessory. The name of the syndrome is the movement or postural alignment during which pain is present. E.g. lumbar flexion syndrome is characterised by pain when the lumbar spine is flexed.

Examinations are combinatorial, meaning one test is not singularly diagnostic. Each test is used to verify the presence of the DSM. Specific tests for contributing factors, such as muscle stiffness, length and strength, and patterns of recruitment and compensatory secondary joint movement form part of an examination.

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