The Cor-Kinetic "Movement Neuromatix"- A multifactoral approach to movement.
The ‘movement neuromatrix’ model is designed to show our movement as more than just the mechanical operation of bones, joints and muscles. All of the inputs we have listed in our model below have an affect on how our brain recognizes and responds to movement.
The movement of the body should be seen as the physical expression of a neurological process, a brain 'output'. The graphic in the middle of the diagram below represents the movement 'output' and is influenced by the surrounding 'inputs'. Often we see movement purely as an 'output' of the body rather than being influenced by the many 'inputs' that the brain receives and uses to determine our motor or movement 'output'.
It has been influenced by Melzack’s “neuromatrix” which introduced a multi factorial model for pain and the many contributing 'inputs' that shape the pain experience. One of the largest departures from traditional views of pain, is that in the 'neuromatrix' pain is an 'output' of the brain rather than than simply an 'input' or signal from the body.
Melzack describes this:
"I have labeled the entire network, whose spatial distribution and synaptic links are initially determined genetically and are later sculpted by sensory inputs, as a neuromatrix"
Everything that flows through our 'neuromatrix' is shaped by it. 'Inputs' only trigger 'neurosignatures' or 'output' patterns from the 'neuromatrix' rather than the 'input' creating the 'neurosignature' at source An example of this is pain being created in the periphery and transported to the brain and 'neuromatrix' rather than sensory input triggering a pain "neurosignature' and resultant pain 'output' from the 'neuromatrix'. Other 'inputs' to the 'neuromatrix' such as stress levels can influence and modulate the pain 'neurosignature' 'output'. We could also have a pain 'output' in lieu of sensory 'input' from tissue and structure.
Our "movement neuromatrix" is designed to highlight one single output of the neuromatrix, movement. It is not a revision, adaptation or a replacement. More a focus and opinion on one of the many outputs from the 'neuromatrix'. The addition of 'movement' to the title is to highlight this focus.
In fact we could even see the process behind the 'movement output' as the reverse of how we perceive the pain process. Pain is mainly seen as an 'input' when in reality it maybe more of an 'output'. Movement is often seen as an 'output' ignoring the many 'inputs' and contributing factors.
We believe movement is similarly influenced by a multitude of contributing factors that are modulated by the brain to produce our unique movements.
This model works on the premise the brain is the controlling factor in our movement. In fact our brain is able to rewire itself, strengthening the connections it uses regularly and eroding the ones it doesn’t. This is a process described as neural pruning.
"Axon branches more active in releasing neurotransmitters persist at specific neuromuscular sites, whereas less active axon branches retract, resulting in the canonical elimination of polyneuronal innervation"
Jackie Yuanyaun Hau et al.
This is a fancy way of saying, “use it or lose it” in terms of our neural connections, one of the major principles of neuroscience and neuroplasticity.
This rewiring is a based on a multiple inputs that include our memories, structure, sensory systems, vitality and environment that create our unique ‘movement fingerprint’ or neural circuitry that defines an individuals movement potential. This all happens in the cerebral cortex where the sensory and motor systems, which rely on each other for successful movement, live. These cortical areas are now being seen as vital to understanding both our movement and pain.
“Without constant and accurate feedback from our touch maps, our motor maps can’t do their job. And so a feedback loop of mutual degradation is set up: Your touch map worsens so your motor map worsens, which worsens your touch map more”
The body has a mind of its own. Sandra and Matthew Blakeslee.
"One aspect of the changes that occur when pain persists is that the proprioceptive representation of the painful body part in primary sensory cortex changes. This may have implications for motor control because these representations are the maps that the brain uses to plan and execute movement. If the map of a body part becomes inaccurate, then motor control may be compromised – it is known that experimental disruption of cortical proprioceptive maps disrupts motor planning"
Lorimer Moseley, Professor of Clinical Neurosciences and Chair in Physiotherapy, School of Health Sciences, University of South Australia.
Our movement is made up of our previous experiences collected over our lifetime, both internal and external. To see the body as a purely mechanical structure misses the great depth of experiences that constitutes the ‘movement neuromatrix’ and the role the brain, nervous system and memory play in our movement. We are able to now understand the influence of our previous movement problems on our future problems at a motor control level by looking at the brain and its various inputs. Research has shown that a big predictor of future injury is past injury!
"Adaptation to pain has many short term benefits but with potential long term consequences"
Hodges 2011
Our daily demands and postures, previous movement problems and sensory inputs are major players in dictating what happens in our future movement. Previous pain causes changes within the brain to our motor and sensory cortex that then controls our movement potential. Getting out of pain is the gold standard of rehabilitation but rarely is previous movement assessed or restored, often we take a symptom or pain reduction approach. This altered movement can then potentially create movement issues and pain at a local and global level at a later date. This means a move away from a more biomechanical or postural biased model that may look at specific structures, such as the feet, to blame for the problems the body may experience. The available research does not consistently support specific pathomechanics in relation to the pain experienced.
“Although pain provides a potent stimulus to change the movement strategy to protect the painful or injured part, resolution of pain or injury does not necessarily provide a stimulus to return to the initial pattern"
Hodges 2011
In fact pain can be the body’s opinion of a tissues health based on all of the information contained within the neuromatrix rather than actual damage.
This means that assessing in a low threshold way, such as a treatment table, may not allow you to create the right environmental factors to find the movement problems associated with an injury or restriction.
Our Cor-Kinetic SAID principle of assessment tells us that the body will give us a Specific Answer to an Imposed Demand. As the demand of the assessment changes so will the response to the demand. This can be especially important with elite level athletes and the more athletic population in general.
We believe the brain works on a model of:
Patterns – Memory recognition of situation
Perception – Interpretation of sensory feedback
Prediction – Response-Including reduced movement or pain
Only by feeding the body the right patterns of sensory information, which comes from movements authentic to peoples movement needs, can be expect to get the true response or prediction from the body that would happen away from an assessment/treatment situation in their functional situations. Problems can often be simply an opinion or prediction of what is going to happen in response to a motor command/ planning or movement situation. Much of what happens in terms of sensory processing is simply an interpretation or perception that can change on a minute-by-minute basis. Nerve signals are amplified or attenuated at a central level according to others factors included within the “movement neuromatrix”
“Pain is an opinion on the organism’s state of health rather than a mere reflective response to an injury. There is no direct hotline from pain receptors to ‘pain centers’ in the brain”
VS Ramachandran
Our sensory systems are also key players in our ‘movement neuromatrix’
All of our senses have an impact on the way that we move to successfully process the large volume of available information our body needs to navigate our environment. Mismatches in this sensory information can cause sub optimal movement and pain. The sensory system is not just our movement information but also, and possibly more importantly, our visual and vestibular systems.
“it remains possible that in a sensitized or disrupted neurological system such as in neuropathic pain, sensory-motor incongruence might contribute to, or maintain, pain”
Moseley and Flor 2012
Our internal health including stress hormone levels, diet, hydration and breathing will also affect our movement and pain levels. These are also included with the ‘movement neuromatrix’ when considering movement ability.
Only by interacting with the ‘movement neuromatrix’ through effective movement, sensory and health based assessment within an authentic environment can we truly understand the individual and their movement potential.
References
Blakeslee S, The body has a mind of its own, Random house, Sept 2008
Hodges P Walker K, Moving differently in pain, PAIN 152 (2011) S90–S98
Jackie Yuanyuan Hau et al, “Regulation of axon growth in vivo by activity based competition” Nature, 2005 Vol. 434 21
Kandel E et al, Principles of Neural science, fifth edition, November 2012
Lederman E, The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain, CPDO Online Journal (2010), March, p1-14. www.cpdo.net
Melzack R, Pain and neuromatrix in the brain, J Dent educ, 2001 Dec, 65(12):1378-82.
Moseley G, Flor H, Targeting cortical representations in the treatment of chronic pain, Neurorehabilitation and neural repair, XX (X) 1-7
Moseley L et al, Cortical changes in chronic low back pain: Current state of the art
and implications for clinical practice, 3rd International conference on movement dysfunction 2009
Moseley L, A pain neuromatrix approach to patients with chronic pain, Manual therapy 2003, 8(3) 130-140
Ramachandran VS et al, Touching the phantom limb. Nature. 1995;377:489-490.
Ramachandran VS and Blakeslee S, Phantoms in the brain, New York: William Morrow, 1998
