Generating an Interface of Change -

“The Glue” in Resolving a Dysfunctional Movement Pattern

As therapists, we can spot a movement compensation “a mile away” and yet resolving them can certainly feel like an uphill climb and especially within our limited allowable time to care for our patients. Does this vital influence on long term health need to be so difficult?

To answer this question, I would ask you to consider whether your primary emphasis is to address the influencing components or contributory impairments within:

1. The actual production of movement, i.e.

• Pain reduction
• Restrictive joint mobility
• Reduced ROM
• Reduced strength

2. Or is your emphasis targeting more of the influences associated with the preparation of movement, i.e.

• Improving breathing mechanics
• Normalizing sensory input by reducing body bracing such as unnecessary gripping
• Improving anticipatory postural adjustments 
• Encouraging selective muscle activation

3. Or finally, would you say you utilize a mixture and yet still find resolving well established patho-mechanical movement patterns to be a challenge beyond your allowable precious resource of time.

First, if you said #3, I applaud you and would even go further and encourage you to share how you have found the means of integrating your resolution of impairments (our staple delivery as PT’s) within the preparation or rather the initiation of the intention of a particular movement. From my extensive research and 28 years of practice, it is my belief, that yes certainly it is among our vast skill set to efficiently and effectively resolve physical impairments to healthy movement and yet unfortunately we are less equipped to transfer such changes into our patients highly sensitive as well as highly perceptive sensory motor systems.

What we must come to terms with is Movement begins before movement appears.

Compensation is often a prepared solution - - Suppose a person previously experienced shoulder pain. Initially, the compensatory pattern may have been protective:

• increased upper trapezius activity
• reduced serratus anterior contribution
• trunk side bending
• excessive gripping
• reduced thoracic motion
• elbow flexion replacing shoulder elevation

After weeks or months, these strategies cease being emergency responses. Instead, they become the default motor program.

The nervous system begins preparing every reaching movement using this solution before the arm even moves. Consequently, the compensation is no longer merely reactive, it is anticipatory.

The nervous system prefers certainty over efficiency

One of the major purposes of movement preparation is uncertainty reduction.

The brain asks questions such as:

• Where is my body?
• What am I about to do?
• What forces should I expect?
• Which joints require stabilization?
• Which muscles should activate first?

If previous injury taught the nervous system that a movement is unpredictable and therefore to be feared, preparation becomes biased toward stability and pain avoidance.

Typical features include:

• excessive co-contraction
• excessive gripping
• elevated muscle tone
• reduced joint variability
• movement rigidity

Although inefficient, these strategies increase predictability. The nervous system generally values predictability more than efficiency.

To encapsulate this message by looking at why isolated strengthening sometimes fails

A patient may regain:

• full range of motion
• normal strength
• minimal pain

Yet continue moving poorly. Why?

Because strengthening primarily changes what muscles can do.

Preparation determines what muscles the nervous system chooses to do.

Capacity and selection are different problems.

The limiting factor often becomes motor selection rather than muscular strength.

As such, we must be capable of generating for our patients an Interface of Change where the nervous system is provided with a fresh start or novel experience to truly restore.

Rehabilitation is not simply the restoration of tissue—it is the revision of prediction. Motor planning is built upon the nervous system's accumulated expectations about what movements are possible, safe, efficient, and likely to succeed. A novel experience has therapeutic value precisely because it provides evidence that can challenge and update those expectations.

In this sense, resolving compensatory movement patterns is fundamentally an exercise in changing expectations. The visible movement is the final output of a preparatory process that has already integrated prior experience, sensory information, biomechanical constraints, and predicted demands. Lasting recovery occurs when the nervous system learns that it no longer needs to organize the body around protection, but can instead prepare for coordinated, adaptable, and economical action.

Beginning here and progressing in series through 10 innovative measures, you will be provided the means of integrating your most effective efforts of resolving impairment level concerns, with the underlying preparatory circuitry, “the glue” that makes favorable change actually stick.

Read part 1 of the series here.

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