Week 14 Movement and Pain

functional movement

complex activity of the whole organism that is directed at performing a behavior or task, ability to maintain a balance between mobility and stability along the kinetic chain while performing fundamental movement patterns with efficiency and accuracy

optimal function

is characterized by behaviors that are efficient in accomplishing a task goal in a relevant environment

pain and the 4 element movement system model

can affect all elements, can be an environmental, personal factor, and can affect motion, force, motor control, and energy

classic definition of pain

a noxious sensory input to the brain as a result of tissue model, based on the cartesian model

contemporary definition of pain 

an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage 

cartesian model

pain is a direct result of tissue damage

nociception

the neural process of encoding and processing noxious stimuli

nociceptors

free nerve endings, encode stimuli in nocicpetive range

primary afferents of pain

c-fibers, a-delta-fibers (others include muscle spindle, golgi tendon organ, meissners corpuscle, pacinian corpuscle…)

mature organism model 

pain is a survival tool- adapt behavior for survival by taking in sample, scrutinizing, and responding. altered thoughts occur in the cognitive dimension and altered feelings occur in the affective dimension, which alter output of behavior and physiology 

neomatrix model

adaptation of the mature organism model, pain is an output that is a result of central processing of peripheral inputs in addition to cognitive and affective inputs- so BRAIN and SPINAL CORD are what produce pain, not tissue damage, and various parts of the CNS work together to produce pain

Neomatrix View of Pain

pain, a phenomenon of the brain = nociception + threat

biopsychosocial perspective

whole person (ICF model), threats (protective mechanism) like injury, surgery, accident, disease, aging, trauma, brain map, fear, catastrophizing, social, stress and anxiety, others

further context of pain

1. pain is always a personal experience that is influenced by biological, psychological, and social factors

2. pain and nociception different phenomena- pain cannot be inferred soley from activity in sensory neurons

3. through life, people learn the concept of pain

4. a person’s report of pain should be respected

5. although pain serves an adaptive role, it may have adverse effects on function adn social and psychological well-being

6. verbal description is only one way to express pain- inability to communicate doesnt negate the experience of pain

aberrant movement 

patterns of movement that deviate from the typical or expected movement, change in gait pattern is an example of change in motor control in response to teh pain of an acute injury  

motor control and pain

the motor, sensory, and information processing elements associated with generating motor functions - move differently with the presence of pain, and when threatened with pain, and when pain resolves

changes in motor control in conjunction with pain

1. suboptimal movement

2. impaired movement

3. modification of movement

4. modified movement

suboptimal tissue loading hypothesis

strategies arise out of habit, environmental and functional factors, presumed benefit, energy minimization, and previous exposure to pain-injury

pain/injury interference/inaccuracy hypothesis 

nociceptive and non-nociceptive sensory inputs, and disrupted peripheral input, multiple levels of the NS, change motor behavior, muscle changes may cause to not meet demand, leading to inaccuracy that is not necessarily serving a role in protection- maladaptive effect on motor function- compromise function, predispose to pain/injury, or remain without a clear effect 

conditioned response hypothesis

classical conditioning, pain become associated with movement and then occurs without nociceptive stimulus, continue with motor adaptations