Most movements require the co-ordinated contraction and relaxation of numerous muscles. The neurological control of this is known as a muscular activation pattern (MAP). Research published in the Journal Manual Therapy describes an abnormal MAP found in patients with neck pain. The researchers state that this causes abnormal function which may increase adverse loading on sensitive cervical structures. The way this happens is described elsewhere, discussing how abnormal MAPs produce poorly coordinated movement and joint control, increasing stress on tissues, increasing wear, and increasing the risk of injury and impingement syndromes.
Exercises are often prescribed to remedy abnormal function and the pain syndromes they produce, so the researchers tested whether these did actually change these abnormal activation patterns. Subjects with this abnormal pattern were each given one of two different six-week supervised exercise programs, then the neurological control was re-measured. Neither exercise program changed the abnormal control.
Abnormal neurological control was said to create abnormal movement and joint control which increases stress upon tissues, increases wear, and increases the risk of injury. When this eventually leads to pain exersises are often prescribed. However, they don't fix the problem. Worse than that, the exercises are the same movements that cause the damage and problems, only done more frequently and forcefully. It could be strongly argued that they did even more damage.
There is a discussion on how this neuological control works, why it becomes abnormal and how it is corrected elsewhere on this website. However, in summary these abnormalies are an attempt by the nervous system to adapt or compensate when part of the body is not able to work properly. Rather than "corrective exercises" the correct way to normalise this control is by correcting the issue that the nervous system is compensating for. We discuss two examples on this website.
Trigger points are those tender lumps in tight muscles that masseurs love to find. In a trial researchers found that when trigger points were present it caused the neurological control of the shoulder movement to became abnormal. After the treatment of those trigger points the neurological control became normal.
In this trial it was found that the addition of manual therapies to an exercise program for the treatment of shoulder pain produced dramatically better results. The manual therapies were direct at trigger points, tightened muscles and restrictions to joint movements. These are all well known issues that would require the nervous system to adapt or compensate.
Trigger points, tightened muscles and joint restrictions are probably the three main causes of the adaptations and compensations that cause the development of abnormal neurological control, resulting in pain, joint wear and injury. They should definately be checked for before doing any exercises. Our article on trigger points covers their treatment in more detail. The detection and correction of joint restrictions is something that needs to be done by a chiropractor or another qualified professional with extensive training in that field.
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.