What the research shows us
- Altered MAPs have been shown to cause abnormal poorly coordinated movement in both the shoulder and neck.
- The treatment of trigger points was shown to normalise abnormal MAPS
- Exercise was shown to not normalise abnormal MAPs
- There was speculation that MAPs became abnormal due to pain. However, the reduction of pain failed to change the abnormal MAPs
Serious questions about exercises to remedy pain syndromes
The need for exercises as part of rehabilitation is well understood. However, lets consider at what actually happened during this trial. Subjects were shown to have an abnormal MAP. It was hypothesised that the resultant abnormal movements produced would increase adverse loading on sensitive cervical structures. Subjects in this in this abnormal state were instructed to do exercises, which according to the researcher’s hypothesis would place even more adverse load on the sensitive cervical structures.
After six weeks of placing extra load on those sensitive cervical structures pain had reduced but function was still abnormal. What would the consequences be of continuing to do this? Surely it would include rapid degeneration and an increased risk of injury.
Guidelines for rehabilitation
The need for exercise as part of rehabilitation is understood. However, the implications of abnormal function should be recognised. The goal should be to perform exercises using correct function. It is possible to instruct patients in “correct techniques”, but much of the function is determined at a subconscious level involving “pre-programmed” patterns, the sensors in the muscles and joints, and so forth.
Put simply, it appears that MPTs and other factors that will be considered in future summaries interfere with these “pre-programmed” sensor based patterns. Practitioners should focus on remedying these to allow the body to function normally and the body to perform rehabilitation exercises in the normal correct manner.
Falla, D., Jull, G. and Hodges, P. (2008) Training the cervical muscles with prescribed motor tasks does not change muscle activation during a functional activity. Manual Therapy, 13 6: 507-512.