Thursday Thoughts: The Importance of Dissociation with Movement

Thanks to my colleague, former student and balance freak extraordinaire, Dr. Lee Krol, DPT for asking this question. What is my take on dissociation?

Like most concepts that are ingrained in our profession and fitness in general, I look at dissociation as multifaceted.

The old school take on dissociation and why it's important

Pain alters motor control. With this in mind, movement patterns often become jumbled and coordinated, smooth movement without compensation is lacking. Therapists have success with motor control strategies because you end up reinforcing patterns that are most likely already ingrained. We are not talking about skill acquisition but something easier, like restoring head on neck movement without trunk movement or restoring hip hinge without excessive lumbar flexion. Re-learning these patterns is important to get away from the compensatory patterns that are often associated with pain, or are just plain inefficient for more demanding tasks than AROM.

Where it goes wrong

- patients have the belief that x-movement (often lumbar spine flexion or anything outside of neutral is harmful)

- the take is decidely mechanical

- as in, moving your hips will "spare" your back

- this message is incorrect because of the way dissociation really works

New school take on dissociation

Like most things I discuss in The Eclectic Approach, dissociation is not purely mechanical. When I think "dissociation" I think removing an association of threat and/or pain with a movement pattern or static position. Novel techniques, patient education, removing misconceptions of imaging, can all dissociate threat from activity or position. I think traditional motor control works this way as well, by dissociating the neurotag associated with the movement pattern.

Once this occurs, make sure to

- Reeducate on other movements
- make the the patient understands all movements and positions should be attainable
- provocative movements and positions should only be avoided for so long
- being pain free, but avoiding lumbar flexion for example, is not full restoration of function.

In summary, like many things, the reasons why things like corrective exercise and motor control strategies work are most likely not mechanical.

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...