Clinicians are familiar with norms when it comes to laboratory testing, physical evaluation, etc. Pavel Kolar, PaedDr, PhD and Alena Kobesova, MD, PhD eloquently describe the need for functional norms in the evaluation of musculoskeletal pain. Manual medicine and rehabilitation is clinically effective, cost effective, and encouraging to those in pain. Since the majority of craniofacial and cervical spine pain is functional, we should all be vigilant in having a rehabilitation roadmap in order to provide what research has shown to be the best care. Assessing this system does not take very long and can be easily included in the standard examination of any new case of neck, face, or head pain. Similarly, cervical and craniofacial pain syndromes often involves the masticatory system. One should ultimately address the faulty pattern. One ends up treating a patient’s symptoms with a “whack-a-mole” philosophy – simply addressing whichever may be painful from episode to episode. Without acknowledging these patterns of dysfunction, there is no clinical roadmap for rehabilitation. Craig Liebenson’s paper entitled Functional Reactivation for Neck Pain Patients (message me and I’ll send it to you) outlines stereotypical patterns of movement system dysfunction which may be affecting the cervical spine. Any functional evaluation should be performed in deference to this principle of functional interdependency.ĭr. Given the fact that we as humans develop our movement system from a genetically predetermined neurodevelopmental process, dysfunctions in the motor system occur in predictable patterns.įunctional movement impairments that result in neck pain are affected by the sensory system, mastication, respiration, cervical spine, upper extremities, and trunk. This model attributes degeneration, pain, and limited function to stereotypical patterns of movement dysfunction. Professor Sahrmann’s first textbook regarding functional impairments explains the kinesiopathologic model rehabilitation. To effectively treat the pain, one must look outside of the neck to assess the function of the entire movement system. The majority of neck pain cases are due to a failure of the movement system.
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