The movement potentiation scale and movement therapy – A study of three cases

INTRODUCTION

Around 65.8 million people in the US alone receive medical attention for musculoskeletal (MSK) injuries each year, accounting for 77% of all injury-related visits and contributing significantly to the global leading burden of disease.^[1] Per year, treating MSK injuries costs $176.1 billion US dollars, with traditional methods of care such as pharmaceutical interventions, imaging, and/or surgery contributing significantly to this number.^[1] Beyond the financial strain, the time burden MSK-related injuries can have on primary care personnel, medical doctors, general practitioners, and hospital emergency facilities is immense.^[2,3] Effective and viable conservative treatment strategies that allied health-care professionals carry out should be explored. David Johnson (neurosurgeon) considers “Movement Dysfunction” (MD) the primary cause of MSK nociception and inflammation. Effective treatment of MD requires specific and distinctive movement therapy. In 2015, based upon this paradigm, he began delivering movement therapy, NeuroHAB™, coined to reflect its contrasting focus on qualitative neural control of the MSK system. NeuroHAB™ not only provides an industry-first definition for “Movement Proficiency” but also a training protocol that corrects MD.^[4,5]

This study looks to build upon the foundations laid by Johnson by utilizing a movement screening scale called “The Movement Potentiation Scale™” (MPS) [Table 1]. This movement screen covers the functional movements required to test the prerequisites for quality movement, such as stability, control, tissue integrity, muscular strength, and neural coordination. The MPS scores pre- and post-intervention were juxtaposed with pain scores, and the correlations were documented.

This case report aimed to explore the efficacy of MPS and movement therapy. Through the study of three separate MSK rehabilitation cases, observations of potential changes in pain and disability were investigated.

CASE REPORT

A case report of three female participants was conducted, each presenting with different primary complaints. The variability of symptoms was the deciding factor and inclusion criteria for selecting participants for this case series. Each participant provided a pre-intervention primary complaint and pain rating between 1 and 10 using the Visual Analog Scale (VAS) for pain, followed by a comprehensive history and MPS assessment. The six core movement challenges in the MPS model have a combined point value of 26. Three categories are set to determine between 0–15: Not yet competent, 15–20: Competent, and 20–26: Proficient movement. After the MPS evaluation, every subject underwent a consecutive five-day functional movement training program. With an emphasis on proprioception, balance, coordination, and optimal biomechanics under suitable stimuli and applied stress, this program emphasized movement quality over quantity. Daily activities and significant provocative movements were determined. All participants received education regarding safe movement techniques, postural stress, hip hinging, squats, overhead lifting, and bracing coordination. Each movement therapy class took 1^1/2-2 h and consisted of 11 movement tasks broken down into two parts [Table 2]. Day six post-intervention data was gathered, including the findings of the repeated MPS assessment and a VAS pain rating [Figure 1]. The lead researcher and sports scientist with 20 years of training experience completed the assessment protocols, exercise movement training, and data collection. No ethical issues existed in this case series, and all participants gave informed consent.

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Figure 1:

Movement potentiation scale score pre- and post-intervention. P: Patient.

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RESULTS

Positive results were documented following a five-day movement therapy program intervention. The program itself lasted between 1 and 2 h daily, and rather than concentrating on general non-specific cardiovascular “traditional” exercise, it was designed to refine key movement qualities that are pre-requisites to healthy, proficient, and functional movement.

DISCUSSION

The frequency of chronic, disabling LBP has increased significantly during the past two decades, as has the cost of treating it. As the second most prevalent cause of disability in the US, 80% of the general population will have a substantial episode of LBP at some point in their lives, resulting in 149 million days of work missed per year, for a total estimated cost of $100–200 billion.^[6] Shoulder pain has a prevalence of 16–34% in the US, with rotator cuff injuries responsible for 4.5 million doctor visits per year alone.^[7] Furthermore, it is estimated to be the third most common MSK complaint in the UK primary healthcare.^[8] Shoulder conditions, although not as common as LBP, are still very complicated, with up to 50% of the patients not improving 18 months following their initial presentation.^[8] Moreover, shoulder interventions can be costly and do not always yield the most favorable outcomes.^[8] Over 60% of women in the US experience some type of urinary incontinence.^[9] This number is significantly rising; some hypothesize that this may be due to obesity and/or population changes.^[9] However, the statistics show women over 70 years old, with an >40 body mass index or those who gave birth vaginally had the strongest association with urinary incontinence (UI).^[9]

The MSK injuries carry a significantly sizeable financial disease burden of $176.1 billion annually in the US alone.^[1] With the prevalence of LBP rising, the poor long-term health outcomes associated with shoulder injuries, and the significant rise of UI in females over recent years – it is clear other strategies must be explored.^[6,8,9] It is essential to investigate efficient and practical conservative treatment approaches used by allied health-care professionals. The MD clinical model described by David Johnson offers a paradigm shift in MSK rehabilitation strategy by defining a disease process causing MSK pain symptoms, defining proficient movement points of performance for the lumbopelvic spine, and setting forth a treatment protocol to restore movement proficiency.^[10] In alignment with David Johnson, the MPS Model was created as a standardized assessment model that can be reproduced and taught to allied health-care professionals worldwide to assist in diagnosing and identifying the disease that is MD.

Moving forward, the proposed suggestion is that current rehabilitation guidelines be reconsidered to acknowledge MD as a distinct disease entity. The various symptoms, both clinical and structural, string together one common similarity – they have all been caused by MD, which is currently poorly described and categorized. The MPS scale draws the therapist’s attention back to movement quality and enables a structured method for recording the severity of MD over time.^[11] A positive feedback cycle is envisaged to accelerate the process of pain and disability when MD is not resolved effectively. Pain causes MD, and this, in turn, causes more pain. As a result, the affected individual’s functional capacity rapidly declines, accompanied by a contraction of lifestyle movement activities of daily living. This keeps functional demands in check with the affected individual’s declining functional capacity.^[5,12] Further research should explore specific movement quality-based interventions across various populations and symptoms.

CONCLUSION

This study examined the global impact of MSK injuries and the benefits of functional movement as a specific therapy. It is necessary to provide proper education of such knowledge to our allied health-care professionals to reduce the burden on primary healthcare, surgical interventions, and pharmaceutical consumption. The potential impact of a movement therapy paradigm shift on patients and the effectiveness of the MSK rehabilitation industry is enormous. While these reported cases are a start in the right direction, our clinical model and observations still require validation from further high-caliber investigations.