Article

Movement is changed in pain and is the target of clinical interventions. Yet the
understanding of the physiological basis for movement adaptation in pain remains
limited. Contemporary theories are relatively simplistic and fall short of
providing an explanation for the variety of permutations of changes in movement
control identified in clinical and experimental contexts. The link between
current theories and rehabilitation is weak at best. New theories are required
that both account for the breadth of changes in motor control in pain and provide
direction for development and refinement of clinical interventions. This paper
describes an expanded theory of the motor adaptation to pain to address these two
issues. The new theory, based on clinical and experimental data argues that:
activity is redistributed within and between muscles rather than stereotypical
inhibition or excitation of muscles; modifies the mechanical behaviour in a
variable manner with the objective to "protect" the tissues from further pain or
injury, or threatened pain or injury; involves changes at multiple levels of the
motor system that may be complementary, additive or competitive; and has
short-term benefit, but with potential long-term consequences due to factors such
as increased load, decreased movement, and decreased variability. This expanded
theory provides guidance for rehabilitation directed at alleviating a mechanical
contribution to the recurrence and persistence of pain that must be balanced with
other aspects of a multifaceted intervention that includes management of
psychosocial aspects of the pain experience.
CI - Copyright (c) 2011 Elsevier Ltd. All rights reserved.

Langue : ANGLAIS