Bridging the Gap- Part 3- Psychomotor Control

In the last post we discussed the concept of the Pain Generator and the importance of the entire Motion Segment as it relates to Bridging the Gap.

In this post we’ll touch on Psychomotor Control, Biopsychosocial Considerations and Somatosensory Control.

Psychomotor Control
In reviewing psychomotor control, we are concerned with the right tissue firing at the right time as muscles and other tissues do their jobs. Prime movers must remain prime movers. Synergists must be synergists. Stabilizers must be stabilizers.

When a stabilizer such as lumbar musculature becomes a synergist to hip extension, or a synergist like the hamstrings becomes a prime mover or a prime mover like a glute decreases its activity because another muscle is doing its job, the body gets angry—the body will produce pain.

Just as in a factory, the body has individual parts responsible for a job. When people in a factory start doing jobs they were not intended to do, the entire line gets thrown off. One job has too many workers, while another has no one focusing on it. Chaos ensues, and in our example, pain is created in the body.

Neuromuscular control of the body is the fine-tuning we use to ensure proper movement. Of course, the body will figure things out if needed and will compensate its way through a less-than-ideal motor pattern. That newly created motor pattern certainly has the potential to be efficient; however, biomechanical stresses caused during these compensations can cause damage if left unattended.

Over time, this compensation can lead to pain or asymmetries in flexibility and strength, and will further exacerbate the issue. The compensatory pattern will become the default pattern once the brain myelinates this new workaround.

There are many schools of thought in psychomotor control to pull from, including Dynamic Neuromuscular Stabilization® (DNS), Postural Restoration Institute® (PRI), MAT, dry needling, FMS, SFMA, Shirley Saharmann’s work in Movement System Impairments and Pilates, to name a few. We use whatever aligns best with our specific training and practice.

Biopsychosocial Considerations
The biopsychosocial model was introduced in 1977 by psychiatrist George Engel. In this model, he suggests that the person’s biology, psychology and social aspects of life have an influence on each other and the human as a whole being. These three things in combination will dictate pain, suffering and response to treatment interventions.

The psychological stress of an injury can increase stress hormones and inflammatory markers, making a somatic injury difficult to heal. Social activities such as drinking and smoking all impact a person’s overall health and wellbeing. Lack of support from family and friends can increase depression, impacting a person’s biology. It can also lead to unhealthy lifestyle behaviors such as substance abuse, interrupted sleep or poor eating habits, thereby impacting the biological ability to heal.

In fact, biopsychosocial factors could be argued as the number-one element that will impact your patients’ ability to heal and return to play.

We have all had experiences when we had two people who play the same sport walk in the door with the same diagnosis, and later have two very different outcomes. Biopsychosocial factors that are individual to each person are most likely at play when that happens.

When dealing with any athlete, we must recognize that the injury impacts the psychological wellbeing of that person. How a person deals with the trauma will be dictated by social support and techniques used to cope with the stresses of injury. These stresses will impact biology and the person’s ability to heal.

Somatosensory Control
The somatosensory system is a system of nerve receptors and cells that sense and react to alterations in a body’s internal state. We could not have a motor system without a sensory system. Our input gives us our output. Bad input equals bad output.

If we continually type the wrong command into a computer keyboard, we keep getting the wrong output. We have to give the computer the correct commands for it to work properly. The same goes for our bodies. If we send faulty information, our motor responses will be wrong and potentially inefficient. When we are dealing with somatosensory control, we are addressing vestibular balance, postural sway, reflexes, visual system and proprioceptive awareness.

This phase of moving from rehabilitation to performance centers on reestablishing balance and postural reflexes and creating better sensory input for improved motor output. Here, concepts of motor learning and motor control are of use, and we might apply techniques from DNS, PRI, yoga or Pilates to assist the client with balance, proprioception and reflexive responses.

We cannot ignore these factors when bridging the gap from rehab to performance . . . and there’s more to consider. Part 4 of this series of posts will focus on the performance segments of Organizational System: Fundamental Performance, Fundamental Advancement and Advanced Performance.

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