Movement System Impairment (MSI) classification and treatment effectively diagnose and treat the individual with neck pain. There is a lacuna in the current neck pain management guidelines addressing ...movement-specific mechanical diagnosis. MSI is based on the movement-specific mechanical diagnosis and kinesiopathologic model.
The present study aimed to investigate the effectiveness of the movement system impairment model among neck pain individuals.
This study was designed as a randomized controlled trial. Eighty-two participants were screened for eligibility; Sixty individuals fulfilling the inclusion criteria were randomized into the experimental group (n = 30) and control group (n = 30). A total of 52 individuals completed the study, 26 in both groups. The experimental and the control group received treatment as recommended by the MSI model and clinical practice guideline (CPG) for neck pain with mobility deficits. All participants were assessed for pain intensity, cervical range of motion, deep cervical muscle strength, endurance, and disability at baseline and the end of 3rd week of treatment.
Significant differences were found in pain intensity, cervical range of motion, cervical muscle strength, endurance, and disability with both groups at the end of 10 sessions of treatment spread over three weeks (p < 0.05). However, the experimental group (MSI) demonstrated more clinical benefits than CPG based neck mobility deficits treatment.
The movement system impairment model may effectively diagnose and treat neck pain in individuals with mobility deficits. Future research is warranted to establish its long-term effect.
•Neck pain individuals respond best to MSI model based treatment, with significant reduction in the clinical variables.•Identifying faulty posture, movements and prescribing corrective exercises are unique to Movement System Impairment treatment.•Movement System Impairment upon analysis, emphasizes the practice of maintaining the correction during daily functions.
Kinematic deficits such as fault in joint accessory motion is one of the most important contributing factors for developing the movement impairment in the lumbar spine. Functional radiography is ...accessible method for detecting the artherokinematic disorders. The aim of this study was to compare lumbar spine intersegmental motion between low back pain (LBP) subgroups of movement system impairment (MSI) model by functional radiography.
20 subjects with chronic LBP in two subgroups of the MSI model (Rotation with Flexion and Rotation with Extension) participated in this study. Five x-rays were taken in different positions. Intersegmental linear translation and angular rotation of the lumbar segments were calculated.
In the Rotation with Extension subgroup, the translation and rotation values of the L3-4 segment from full to full position were significantly more than their values in the Rotation with Flexion subgroup ((mean difference = −1.69 (mm) P = 0.01), (mean difference = −3.80 (mm) P = 0.02) respectively). The translation of L2-3 segment from the neutral to the mid-flexion position was significantly greater in the Rotation with Flexion subgroup compared to the Rotation with Extension subgroup (mean difference = 1.12 (mm) P = 0.04). cumulative intersegmental angular rotation of all lumbar segments from mid to mid position was greater in the Rotation with Flexion subgroup compared to the Rotation with Extension subgroup (P = 0.03).
Changes in intersegmental translation and angular rotation of lumbar segments in subgroups of patients with LBP may be important contributing factors that induce direction specific lumbar spine loads and contribute to the development or persistence of LBP problems.
The movement system impairment (MSI) model is a clinical model that can be used for the classification, diagnosis, and treatment of knee impairments. By using the partitioning around medoids (PAM) ...clustering method, patients can be easily clustered in homogeneous groups through the determination of the most discriminative variables. The present study aimed to reduce the number of clinical examination variables, determine the important variables, and simplify the MSI model using the PAM clustering method.
The present cross-sectional study was performed in Shiraz, Iran, during February-December 2018. A total of 209 patients with knee pain were recruited. Patients' knee, femoral and tibial movement impairments, and the perceived pain level were examined in quiet standing, sitting, walking, partial squatting, single-leg stance (both sides), sit-to-stand transfer, and stair ambulation. The tests were repeated after correction for impairments. Both the pain pattern and the types of impairment were subsequently used in the PAM clustering analysis.
PAM clustering analysis categorized the patients in two main clusters (valgus and non-valgus) based on the presence or absence of valgus impairment. Secondary analysis of the valgus cluster identified two sub-clusters based on the presence of hypomobility. Analysis of the non-valgus cluster showed four sub-clusters with different characteristics. PAM clustering organized important variables in each analysis and showed that only 23 out of the 41 variables were essential in the sub-clustering of patients with knee pain.
A new direct knee examination method is introduced for the organization of important discriminative tests, which requires fewer clinical examination variables.
Background: Other than pathoanatomical diagnosis, physical therapy managements need the diagnosis of movement-related impairments for guiding treatment interventions. The classification system of the ...Movement System Impairment (MSI) has been adopted to label the musculoskeletal disorders in physical therapy practice. However, reliability study of this classification system in individuals with shoulder pain has not been reported in the literature.
Objective: This paper investigated the intertester reliability of the diagnosis based on the MSI classification system in individuals with shoulder pain.
Methods: The patients with shoulder pain, between the ages 18–60 years, were recruited if he or she had pain between 30 and 70 on the 100
mm visual analog scale for at least three months. The examiners who were two physical therapists with different clinical experiences received a standardized training program. They independently examined 45 patients in random order. Each patient was examined by both therapists on the same day. The standardized examination scheme based on the MSI approach was used. Patients were identified to subgroup syndromes according to scapular and humeral syndromes and also determining their subcategory syndromes. Six scapular subcategory syndromes included downward rotated, depressed, abducted, wing, internal rotated
/
anterior tilted, and elevated. Three humeral subcategory syndromes were anterior glide, superior glide, and medial rotated. More than one subgroup and subcategory of syndromes could be identified in each patient. The test results of each session were blinded to another therapist. The percentages of agreement and kappa statistic were determined.
Results: The results showed that agreement levels in identifying subgroup syndromes was fair
(
71.11% agreement, kappa coefficient
=
0.34
)
and classifying subcategories syndromes were poor to substantial
(
73.33
–
91.11% agreement, kappa coefficient
=
0.20
–
0.66
)
. The overall agreement and kappa value of the MSI classification of subcategory syndromes was poor (kappa coefficient
=
0.11; 95% CI 0.05–0.18
)
. The agreement level of subcategories for scapular depression and humeral superior glide syndromes was substantial. The scapular winging, depression, and downward rotation were the three syndromes that were most frequently identified by both the examiners.
Conclusion: The intertester reliability between therapists with different experience according to the MSI approach for shoulder pain classification was generally acceptable to poor due to the nature of the classification system. The standardized procedure and intensive training can be used for inculcating novice therapists with adequate level of intertester reliability of examination.
Background: The movement system impairment (MSI) model is a clinical model that can be used for the classification, diagnosis, and treatment of knee impairments. By using the partitioning around ...medoids (PAM) clustering method, patients can be easily clustered in homogeneous groups through the determination of the most discriminative variables. The present study aimed to reduce the number of clinical examination variables, determine the important variables, and simplify the MSI model using the PAM clustering method. Methods: The present cross-sectional study was performed in Shiraz, Iran, during February-December 2018. A total of 209 patients with knee pain were recruited. Patients' knee, femoral and tibial movement impairments, and the perceived pain level were examined in quiet standing, sitting, walking, partial squatting, single-leg stance (both sides), sit-to-stand transfer, and stair ambulation. The tests were repeated after correction for impairments. Both the pain pattern and the types of impairment were subsequently used in the PAM clustering analysis. Results: PAM clustering analysis categorized the patients in two main clusters (valgus and non-valgus) based on the presence or absence of valgus impairment. Secondary analysis of the valgus cluster identified two sub-clusters based on the presence of hypomobility. Analysis of the non-valgus cluster showed four sub-clusters with different characteristics. PAM clustering organized important variables in each analysis and showed that only 23 out of the 41 variables were essential in the sub-clustering of patients with knee pain. Conclusion: A new direct knee examination method is introduced for the organization of important discriminative tests, which requires fewer clinical examination variables. Keywords * Movement system impairment model * Knee * Cluster analysis * Classification * Syndrome
Low back pain (LBP) is a common problem in sports. There is high risk for back pain occurrence in athletes. The knowledge about LBP in overhead athletes is limited. The Movement System (MS) approach ...is based on association of symptoms and incorrect movements of the spine. The main goal is to identify the localization and direction of improper movements and to restore appropriate motor control of the movement pattern.
To present functional evaluation and therapeutic approach based on the MS in the case of LBP in overhead athlete.
The study presents a 26-year-old overhead athlete with chronic mechanical LBP, which is related to his sports activity. He reported exacerbation incidents, which had eliminated him from physical activity.
Physical examination of the patient had shown deficit of lumbar motor control in directions of extension and rotation of pelvis coupled with functional alterations in muscles. These movements were associated with pain symptoms. The patient had undergone a 4-month-lenght-therapy program, which was focused on spine motor control training and functional reeducation of muscles. A subsequent examination showed an improvement in motor control of the movement and considerable decrease of pain symptoms.
(1) The MS approach allows to identify the incorrect movement and to relate it with pain symptoms. (2) Reeducation of motor control based on movement system evaluation allows decreasing pain symptoms.
There are several systems of classification and treatment of patients with low back pain (LBP) based on assessment of the effect of lumbar postures and movements on symptoms. The efficacy of one of ...these systems, The Movement System Impairment (MSI) method, has not yet been demonstrated in the literature. The purpose of this case report is to describe the approach of the MSI method for an individual with lumbar radiculopathy.
A 79-year-old woman with a history of chronic LBP was referred to PT with a physician's diagnosis of sciatica. The patient was classified utilizing a standardized MSI evaluation. She was instructed to modify her daily postures and movements, as well as perform specific exercises to address these impairments.
Her Oswestry LBP disability score improved by over 30% and pain level per the NPRS improved by 3 out of 10 points.
Despite the challenges of advanced joint degeneration and neurological involvement, this approach of identifying and addressing specific movement impairments appeared helpful for this older individual.
This case report demonstrates the diagnosis and management of a low back pain patient using the Movement System Impairment (MSI) diagnostic system. The patient was a 69 year-old female with low back ...pain after falling from a stepladder and suffering L1 compression fracture 2 months ago. Through a standardized movement examination, early and increased lumbar extension / rotation movements were identified as the cause of her low back pain exacerbation, which lead to the MSI diagnosis of Lumbar Extension / Rotation Syndrome. With a combination of in-person treatments and teletherapy treatments, treatments focused on progressing from simple isolated movements to functional movements, all with emphasis on preventing lumbar extension / rotation movement impairments. After 5 months of PT treatments at 1-2 times a week frequency, her symptom significantly decreased and she was able to resume her prior level of activities. Compared to her initial 10-15 minutes of standing tolerance, she was able to go shopping, perform gardening, and return to her decorating hobby without symptoms.
本症例報告では，Movement System Impairment diagnostic system（運動系機能障害診断システム：MSI診断システム）における肩関節患者の診断・介入の一例を示す。患者は25歳女性プロのクラリネット奏者で，5週間前にジムでオーバーヘッドプレスの最中に右肩本症例報告では，Movement System Impairment diagnostic ...system（運動系機能障害診断システム：MSI診断システム）における腰痛患者の診断・介入の一例を示す。患者は69歳の女性で，2ヵ月前に脚立から転倒しL1圧迫骨折のため腰痛を患っていた。系統的な運動検査を通して，運動初期のタイミングで起こる過剰な腰椎伸展・回旋動作が腰痛を悪化する原因で，MSI診断名は腰椎伸展・回旋症候群とされた。訪問治療とテレヘルスの治療を合わせて，腰椎伸展・回旋を防いだ基礎的なエクササイズおよび機能的動作の指導による介入を行った。週1–2回，5ヵ月間の理学療法介入で，患者の症状は大幅に軽減し，圧迫骨折受傷以前の活動レベルに復帰できた。初診では立位保持時間は10～15分であったが，買い物や園芸や趣味のテーブルセッティングも症状を悪化せず行えるまで改善した。
Abstract Background Motor retraining for non-specific chronic low back pain (LBP) often focuses on voluntary postural tasks. This training, however, may not transfer to other known postural ...impairments, such as automatic postural responses to external perturbations. Objectives To evaluate the extent current treatments of motor retraining ameliorate impaired postural coordination when responding to a perturbation of standing balance. Design Planned secondary analysis of a prospectively registered ( NCT01362049 ), randomized controlled trial with a blinded assessor. Method Sixty-eight subjects with chronic, recurrent, non-specific LBP were allocated to perform a postural response task as a secondary assessment one week before and one week after receiving either stabilization or Movement System Impairment (MSI)-directed treatment over 6 weekly 1-h sessions plus home exercises. For assessment, subjects completed the Oswestry disability and numeric pain rating questionnaires and then performed a postural response task of maintaining standing balance in response to 3 trials in each of 4 randomly presented directions of linear surface translations of the platform under the subjects' feet. Integrated amplitudes of surface electromyography (EMG) were recorded bilaterally from the rectus abdominis (RA), internal oblique (IO), and external oblique (EO) muscles during the postural response task. Results No significant effects of treatment on EMG responses were evident. Oswestry and numeric pain ratings decreased similarly following both treatments. Conclusions Stabilization and MSI-directed treatments do not affect trunk EMG responses to perturbations of standing balance in people with LBP, suggesting current methods of motor retraining do not sufficiently transfer to tasks of reactive postural control.
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