Movement disorders, disordered movement patterns.  These are things that therapists for years have been pointing out as faults in the in their patients.  The goal has always been to correct these faults and in turn peoples pain.  Examples here include scapular dyskinesis, patellar maltracking, overpronation and knee valgus in dynamic conditions.  This article will briefly discuss each and why they are perhaps not as important as we have traditionally thought.  This is in line with other articles I have written debunking myths in structurally reasoned therapy as introduced here.

Scapular Dyskinesis

This basically means your shoulder blades are not moving as we would expect when you are performing shoulder movements.   I know it exists however and would agree poor motor control, muscle weakness or muscle tightness all play a part in its presentation.

However, I have doubts with regards its clinical relevance.  Too often in people with dyskinesis it is apparent in both shoulders despite only one shoulder being painful.  Sometimes its apparent in the healthy shoulder and not the painful one.  For this reason, I am not convinced of its worth.

Additionally I feel it is very subjective and as always people will always see what they want to see.  Determining whether it is improving week-to-week must contain bias particularly as you the patients can’t see it.  I think it is hard to target specific muscles as others will be working alongside and I feel any improvements to symptoms come about due to increased strength around the shoulder girdle as a whole rather than specific exercises hence why there is not need for scapula exercises.  If you are told or have been told you have scapula dykinesis, don’t worry many do (I see a lot of shoulder blades) and many don’t have pain.

Patellar Maltracking

Again something that I cannot deny occurs.  We see this frequently in young girls.  Often we see what we call a J sign where on extension of the knee when the knee cap travels straight and then at the end move out to the side.  Traditionally we have treated this by strengthening the inner part of the quads muscle (the VMO), stretching the lateral structures (the ITB) and taping the kneecap so it cannot move laterally easily.  All of these have proven to be wrong.  We cannot target purely the VMO, the ITB is unstretchable and tape cannot stop the patella from moving.  The J-sign is often a sign of anatomical problems, alignment issues and/or ligament deficits (most notably the MPFL).  It therefore cannot be changed by exercise alone.  Where we see J-signs and so called patella maltracking we cannot change it.   However what we can do is strengthen around the joint and reduce the load around the kneecap by changing our activities to reduce pain.  Making you the patient aware of maltracking is important however making you aware that it likely won’t change but your pain can is equally important.  This is a trick I feel is often missed.

Overpronation

Overpronation, thought of as the cause of plantarfascitis, calf strains, runners knee and hey and to some real extreme therapists neck problems.  In truth it will load certain parts of the body more than others.  Particularly the knee and the foot,  however it appears many can tolerate this. If you look at a world class running race many top athletes overpronate.  Haille Gebrsellasie the worlds greastest ever runner (well excluding Mo) is one such athlete.  They can do this as their tissues have learnt to deal with the loads that overpronation causes and they have enough capacity to cope with this. This is not just the preserve of elite athletes many amateur runner also overpronate and have no pain.

Should we always try to fix overpronation? My theory is that some of the time perhaps we should, we should be aware this may cause issues higher up the kinetic chain.  However I feel our first approach should be on offloading overloaded structures and then building resilience in the tissues through appropriate loading.

Knee Valgus in function

Often it is stated that the knee coming in when being flexed e.g. during a step up/down or squat / lunge is a problem.  Glute work and / or movement pattern training are often the treatment of choice to correct this.  Ultimately however it is often a case of our bodies natural alignment that cause this phenomenon to occur.

While we can correct it when we are focused on it often we cannot correct it all of the time.  Perhaps offloading it some of the time may be enough to get on top of your pain.  However it is important to bear in mind you may not permanently be able to correct it all the time as otherwise you setting yourself up to fail.  This in turn can lead to an increase in your pain due to poor beliefs an expectation.

There are examples however where working on knee valgus is important these include when trying to rehabilitate from tissue injury e.g. ACL or when dealing with people who put significant loads through their knee as there is no doubt knee valgus can predispose to injury.

Summary

There are various movement pattern disorders that can cause structures to have increased loads.  Sometimes they can be relevant however sometimes they are not.  There is often examples where people have similar issues however do not have pain.  The risk here is that being aware of these abnormal movement patterns can influence your thoughts about your body / injury which in turn can make your pain worse.  Do not think that if they cannot be corrected your pain cannot go.  By building capacity in your tissues your body can cope with a surprising amount of dynamic issues, focus on this rather than the issue itself.

If you would like me to add any other movement issue that you have been told about or are concerned about then get in touch.  If you would like a thorough assessment and honest treatment plan then get in touch also.