Are Movement Dysfunctions Not Dysfunctional At All?
Health and exercise professionals that apply corrective exercise strategies to their clients should ponder upon the following question: are movement dysfunctions really dysfunctional at all? If we look up the definition of the word dysfunctional, we soon realize that all it means is “not operating normally or properly.” Now, what is normally or properly – what is the norm referring to movement? If we then look up the word functional, the question becomes even more interesting as it often means “designed to be practical or useful.” What does that mean?
Where is he going with this analysis you might think?
Now, imagine this, you and I are walking around in Africa on a vacation trip. Suddenly out of nowhere a hungry lion runs at us looking for an easy lunch. Thank goodness there are some trees ahead of us and hell over heels we sprint to them to save our lives. Unfortunately while sprinting I step in a hole and sprain my ankle – what are my options now? A., I become lunch meat or B. I keep going, right? Now, after I hurt myself, I will probably be limping, causing a movement dysfunctional gait, but I am functional at the same time as I keep on going, right – I am functional by running to save my life.
More and more evidence shows that movement dysfunctions associated with pain happen reflexively and are probably related to very old survival mechanisms like running away from the lion as explained above. These movement dysfunctions have allowed us to survive and complete our tasks at hand in the past, and although we don’t have too many lions chasing us these days, we have other tasks to accomplish, such as going for a jog after sitting down for several hours at our jobs. KI believes that not only do movement dysfunctions occur after injury, but they actually also occur because of repetitive movements like typing on a keyboard, moving improperly when for example we move boxes incorrectly as a UPS delivery person and when we have a sedentary lifestyle.
The Functionality of Dysfunction
The old saying holds that there are only two certainties in life: death and taxes. This can be accurately expanded to include the word “adaptation.” We humans adapt from the cradle to the grave. We adapt to both internal and external forces as we grow, mature, develop and interact with our environment and the tasks of daily life.
It was Selye who identiﬁed adaptation as the feature that characterizes our development, and mal-adaptation as the feature that characterizes our eventual failure to adapt adequately, leading to collapse – in response to the stresses of life. He noted that anything that makes a demand for adaptation could be labeled as ‘stress’. Stress in this context can be seen as being potentially beneﬁcial, and only harmful when the demands it makes cannot be met. Since all therapeutic endeavors – ranging from manipulation to dietary change, medication to insertion of an acupuncture needle – make demands for adaptation, all therapy is axiomatically a form of stress. Whether outcomes are beneﬁcial or harmful ultimately depends on the interaction between the stress demand and the abilities of the individual to respond (Selye 1976).
If an individual, with its unique inborn attributes and characteristics is unable to appropriately compensate for, and adapt to the stresses of life, symptoms appear. And when adaptation processes are in action, symptoms are also apparent. Some symptoms represent a failure to adapt, and some represent adaptation in action. The healing process is itself a process of adaptation to a dysfunction or illness, which is itself is an example of a failure of the organism to adequately adapt to current demands, with symptoms simply being the signposts indicating where the adaptation process is at any given time.
Can dysfunction be functional? Are there times when apparent musculoskeletal dysfunction represent changes, which are, in fact, potentially or actually beneﬁcial? Can painful spasm be protective? Undoubtedly. Without it the area would be moved, and frank tissue damage might occur, for example in
the case of an imminent disc rupture, or of a fragile osteoporotic spinal joint. This does not mean that all spasm, or all pain, is helpful/protective, but that in some instances they certainly appear to be.
Could hypertonicity sometimes be a useful adaptive response, where increased tone is required to stabilize a region? Without question. Take for example the paraspinal tissues of a hypermobile individual. This does not make all hypertonicity useful, but suggests that at times it may be, and should be respected. In both the spasm and the hypertonicity examples therapeutic attention should ideally focus on offering other ways of supporting the structures requiring protection, so easing the need for these often painful and limiting protective responses.
Could a trigger point, producing as it does increased tone in the muscle housing it, as well as in tissues to which pain is being referred, be offering an energy-efﬁcient way of protecting a vulnerable joint? It would seem highly probable. Take for example a hamstring trigger point creating increased tone in that muscle group, and by doing so placing additional load on the sacro-tuberous ligament, so protecting a vulnerable sacro-iliac joint from excessive movement. Since trigger points are outside of neurological control, with the phenomenon being chemically mediated, this makes this mechanism super-efﬁcient in terms of energy usage. Even if this functional example of an apparent dysfunction (a useful trigger point) is valid, it does not mean that all trigger points are helpful and undeserving of therapeutic attention, since some may be residual entities, left over from past stresses, unable to resolve, while newly developed trigger points are commonly the inevitable result of the effects of already active trigger points (Simons et al. 1999).
It does, however, mean that there may be situations where trigger points serve useful roles, where therapeutic input should be toward removal of the need for their presence, rather than deactivating them without thought as to what defence processes they may be involved in. Might the responses of the tissues of the body to overuse, misuse, and abuse often be both predictable and appropriate – often with pain and inﬂammation as the end result? Many of these responses are well recognized to be essential aspects of the recovery and healing processes, to be interrupted only if clinically essential. Where would we be without spasm and inﬂammation? Almost certainly we would be moving and using areas that are in need of immobilisation, so that repair processes can progress. Where would we be without pain?
Undoubtedly, we would be actively employing tissues and structures that should not be used. But while it is standard practice to rest inﬂamed and damaged tissues in their early healing stages, following trauma or surgery, a similar degree of recognition is not always offered to features of self-repair/defence such as spasm, hypertonicity and trigger point activity. Moving away from musculoskeletal health to general health, it takes little thought to recognise that a fever is life saving when a person is infected. It requires little imagination to conceive that vomiting and diarrhoea can save a life when a person has food poisoning. Many symptoms therefore clearly represent health enhancing processes, albeit uncomfortable ones, in action.
The random selection of symptoms listed above represent only a fraction of beneﬁcial responses on the part of the defense and repair mechanisms of the body, that we classify as ‘symptoms’. And yet health-care providers, over-the-counter retailers, and the majority of the population spend inordinate amounts of time, money and effort trying to remove or modify these signs and symptoms of adaptation, recovery and repair. To be sure there are times when symptoms are extremely unpleasant, and in some instances life threatening. At such times, it makes sense to attempt to modify, modulate and/or ease the intensity of the symptoms. At other times it makes more sense to focus on why the symptom exists, and to aim to remove or modify what causes can be removed or modiﬁed, and/or to enhance the adaptive capacities of the body (rehabilitation training, re-education in use patterns, etc.) – as well, perhaps, when appropriate and helpful, to focus attention on the signals the body is sending, the symptoms on display.
- Selye H 1976 The Stress of Life. McGraw-Hill, Toronto, Simons D, Travell J, Simons L 1999
- Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1, Upper Half of Body, 2nd edn. Williams and Wilkins, Baltimore