3rd International Conference on Movement Dysfunction

Wow – Just back from the 3^rd International Conference on Movement Dysfunction in Edinburgh. 600 delegates from every continent discussing movement impairments and treatment strategies. I have enclosed the conference programme below with links to abstracts contained on the Conference site.

For me the programme highlights were Shirley Sahrmann, Wim Dankaerts and Gray Cook.

Sahrmann’s work is well known on Movement Impairment Syndromes and of course her text Diagnosis and Treatment of Movement Impairment Syndromes has become a classic.  Since its publication she has made big strides on the scientific validation of her concepts and has been publishing regularly in Physical Therapy and the Journal of Orthopaedic & Sports Physiotherapy.  The thrust of her talk was on identification of specific movement impairment syndromes and the correct strategies to unload painful segments. The new information on this was largely the scientific validation using video analyses pre ?post intervention both to quantify the impairment and quantify the relative improvement.  As always she remains very grounded in the clinical implication.

The second highlight for me was Wim Dankaerts who teaches the movement impairment classifications originally described by Peter O’Sullivan from Australia.  Peter is a prolific publisher with some landmark articles in Manual Therapy and Spine looking at sub- classification of mechanical spinal disorders. Wim was much involved in this early research and now conducts a significant arm of this investigation through his laboratory and clinical work in Belgium. Note he is also speaking at the Irish Physiotherapy congress this week.

The recurrent theme of much of the discussion of both these and other speakers was the need to sub-classify Lumbar Spine presentations in order to provide a framework not only for treatment but also for epidemiological studies to evaluate the role of physical treatment in managing low back pain.  This massive grouping of 85% non-specific low back pain is a testament to the absolute failure of the medical model to guide patient management. I would add my own view here that large numbers of physiotherapists already (and rightly so) prioritise functional limitation over diagnostic labelling when delivering treatment.

As we know the evidence for the use of manipulation and exercise, although vaguely positive, is by no means excessively convincing and some of the reasons for this are thought to be the currently unacceptable crude classifications of patients as either severe pathology red flags, disease specific or non-specific low back pain.  A memorable example of a patient with pain on flexion was used to illustrate this point and one, which I have used in previous posts on the blog.  Patients who have pain on flexion may have several different mechanical problems producing tissue overload:

1. Lack of spinal joint flexibility.Lack of pelvic rotation.
2. Hyperactivity of the paraspinal muscles.
3. Hyperactivity of the posterior leg muscles particularly hamstrings.
4. Poor co contraction of abdominal and spinal bracing mechanisms
5. Inhibited lateral abdominal wall (transverse abdominus) activity with results in impaired tensioning of the thoracolumbar fascia.
6. Excessive global muscle tension.

As these are distinct clinical phenomena the challenge for us as therapists is to identify the dominant mechanism and institute treatment strategies to address it.   Obviously if these treatment strategies are effective it should manifest as an observable, report improvement in patient’s function/ symptoms.

The other notable conference feature was the increasing use of diagnostic ultrasound not only as feedback for core stability muscles, which of course has been around a considerable time now, but more for diagnostic applications in soft tissue pathology. This tool was used to facilitate treatment planning, quantify /predict absence from sports and monitor a graded return to activity.

It was also great to see so many young researchers presenting their work, some not always sufficiently clinically focused for my liking but nonetheless worthwhile academic exercises which will improve the overall standing of the profession.  That’s all for now.  Check out some of the links and bio’s together with the abstracts of the talks.  I didn’t miss any so I would gladly share my opinion if you have any questions.

And then there was Lorrimer Mossley, brain imaging and re-training. More on this again……..

Enjoy the clinical challenge.

David

Programme

FRIDAY 30 OCTOBER
08.45	Welcome address Mark Comerford, Kinetic Control UK, Performance-Rehab, Australia
09.00	Keynote Lecture: Low back pain: Isolated or degenerative problem – what are the implications? Shirley Sahrmann, Washington University School of Medicine, USA
09.35	Keynote Lecture: Chronic Low Back Pain Patients – unravelling pieces of the puzzle Wim Dankaerts, KUL-PHL, Belgium
10.10	Guest Lecture: Pain-Induced Changes in Motor Control Revealed by Muscle Imaging Deborah Falla, Aalborg University, Denmark
10.30	Coffee break, Exhibition and Poster Viewing
11.00	Keynote Lecture: Manipulating neural plasticity to enhance functional recovery after damage to the motor system John Rothwell, University College London, UK
11.35	Guest Lecture: Shoulder girdle control; some mechanisms of function to dysfunction Caroline Alexander, Imperial College Healthcare NHS Trust, UK
11.55	Guest lecture: Rehabilitative ultrasound imaging: Technology to improve assessment and treatment of those with musculoskeletal conditions Deydre Teyhen, Academy of Health Sciences, USA
12.15	Guest Lecture: What does proprioception testing tell us about patello femoral pain? Michael Callaghan, University of Manchester, UK
12.35	Panel Discussion
13.00	Lunch, Exhibition and Poster Session (13.45 – 14.30)
13.45 – 14.50	Sponsored Interactive Sessions Sels Instruments Demonstration of Capnograph: L. McLaughlin
14.30	Clinical Seminar 1 Demonstration of an examination for Movement System Low Back Syndrome Shirley Sahrmann, Washington University School of Medicine, USA	Clinical Seminar 2 Sub-classification of non-specific CLBP patients: Integrating pieces of the evidence into clinical practice Wim Dankaerts, KUL-PHL, Belgium	Clinical Seminar 3 Training the brain: principles, pitfalls and pearls Lorimer Moseley, Prince of Wales Medical Research Institute, Australia
15.20	Submitted Oral Presentations 4 presentations in each of 3 parallel sessions (15 minutes each)
16.30	Tea, Exhibition and Poster Viewing
17.00 – 18.10	Submitted Oral Presentations 4 presentations in each of 3 parallel sessions (15 minutes each). Click to download.
18.10 – 19.30	Welcome Drinks Reception
19.30	End of Day 1
SATURDAY 31 OCTOBER
8.00 – 8.45	Sponsored Interactive Sessions Pilates: Liz Ellis Gyrokinesis: Suzanne Scott
09.00	Keynote Lecture: Shoulder impingement: Biomechanical considerations in rehabilitation Paula M. Ludewig, The University of Minnesota, USA
09.35	Keynote Lecture: What Is Our Baseline for Movement? The Clinical Need for Movement Screening and Assessment Gray Cook, Averett University; Gray Cook Physical Therapy; Functional Movement Systems, USA
10.10	Guest Lecture: Breathing evaluation and retraining as a adjunct to manual therapy Laurie McLaughlin, NAIOMT, Canada
10.30	Coffee, Exhibition and Poster Viewing
11.00	Keynote Lecture: Skeletal muscle fibres.  What types have we got? Can we change them and does it matter? Steve Harridge, Kings College London, UK
11.35	Keynote Lecture: Diagnostic utility of clinical tests for spinal dysfunction Chad Cook, Duke University, USA
12.10	Guest Lecture: Recurrence of injury and pain in sport – What’s missing Mark Comerford, Kinetic Control UK, Performance-Rehab, Australia
12.25	Panel Discussion
13.00	Lunch, Exhibition and Poster Session (Poster session between 13.45-14.30)
13.45 – 14.50	Sponsored Interactive Sessions Kangoo Jumps: Paul Clarkson Pilates: Liz Ellis Gyrokinesis: Suzanne Scott Writing Workshop: Elsevier
14.30	Clinical Seminar 4 Treatment of shoulder impingement: Targeted intervention strategies Paula M. Ludewig, The University of Minnesota, USA	Clinical Seminar 5 Demonstration of the Selective Functional Movement Assessment (SFMA) Gray Cook, Averett University; Gray Cook Physical Therapy; Functional Movement Systems, USA	Clinical Seminar 6 Specificity in Assessment and Management of Hip Abductor Muscle Dysfunction Alison Grimaldi, University of Queensland, Australia
15.20	Submitted Oral Presentations 4 presentations in each of 3 parallel sessions (15 minutes each)
16.30	Tea, Exhibition and Poster Viewing
17.00 – 18.25	Submitted Oral Presentations 5 presentations in each of 3 parallel sessions (15 minutes each). Click to download.
18.30 – 19.30	MACP AGM (members only)
SUNDAY 1 NOVEMBER
8.00 – 8.45	Sponsored Interactive Sessions Pilates: Liz Ellis Gyrokinesis: Suzanne Scott
09.00	Keynote Lecture: The eyes have it – recent developments in training the brain for chronic pain Lorimer Moseley, Prince of Wales Medical Research Institute, Australia
09.35	Keynote Lecture: Subgrouping patients with low back pain in primary care: are we getting any better at it? Nadine Foster, Keele University, UK
10.10	Guest Lecture: Outcome following treatment for chronic low back pain. What are the processes of change? Steve Woby, North Manchester General Hospital, UK
10.30	Guest Lecture: Pre-season screening of professional footballers – The role of movement assessment Wayne Diesel, Tottenham Hotspur Football Club, UK
10.50	Coffee break, Exhibition and Poster Viewing
11.20	Keynote Lecture: Understanding the lateral stability mechanism of the hip & pelvis Alison Grimaldi, University of Queensland, Australia
11.55	Guest Lecture: Evidence from cognitive neuroscience supports action observation as part of an integrated approach to stroke rehabilitation Paul Holmes, Institute for Performance Research, Cheshire Faculty, MMU, UK
12.15	Guest Lecture: “What if”: the use of biomechanical models for understanding and treating upper extremity musculoskeletal disorders Dirk Jan Veeger, Vrije Universiteit Amsterdam, The Netherlands
12.35	Guest Lecture: Rehabilitating Achilles tendonopathy Jon Fearn, Reading Football Club, UK
12.55	Panel Discussion
13.10	Closing remarks and presentation of Elsevier Sponsored Awards Ann Moore, University of Brighton, UK
	End of conference

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