Pain with Uncontrolled Movement & Overprotective Movement Strategies
Pain due to uncontrolled movement is a common symptom in people with chronic low back pain. Patients will describe having full or good range of movement and being able to do everything they want to but ONLY if they do the movements ‘properly’. For example, they can bend forward and touch or get close to their toes, they can rotate, and side bend with relatively little or no pain. But, they will get pain if they bend the ‘wrong way’ or get a surprise knock or twist. This can make identifying the problem in clinic difficult because the ‘wrong way’ only happens when the patient isn’t paying attention and typical osteopathic range of motion and pain provocation tests won’t elicit the pain because they don’t reflect the random, flowing, functional nature of everyday movement.
Often the main problem is an overprotective movement strategy which has persisted long after an original injury has cleared up. The pain occurs they either forget to employ their ‘protective’ movement strategies or are caught out by a sudden movement and don’t have time to prepare. This usually results in a short sharp jolt which will serve as a powerful reminder to the brain that it should only move carefully and reinforces the pattern.
Identifying Overprotective Movement Strategies
However, over protective movement strategies are not impossible to spot. There are a few tell tale signs:
Hand to thigh bracing: This is a classic sign of overprotective movement. When the person bends over they may put their hand on their thigh. Sometimes they are aware of it, sometimes it’s completely subconscious and usually it’s a mixture. Ie they are aware of it but often not aware how often they do it.
Rigid trail arm: A rigid trail arm, which they stick out behind them when bending over to pick something up with their other arm.
Arm swing in brisk walking: Swinging the arm from the elbow rather than the shoulder in walking.
Poor body positioning: Not putting their centre of gravity as close to an object they want to pick up as someone who does not have this issue.
This list is by no means exhaustive. Over the years I’ve developed a large inventory of tell-tale signs which I can use to easily spot poor movement strategies. And more importantly it’s often fun easy and engaging for the patient because they learn to take back control of their movement patterns in a way which can quickly and significantly reduce their pain.