Pieter de Smidt, PT, DPT, Cert. MDT, MTC, FMS-C, shares his thoughts on the concept and application of movement-based therapy.
For many years, physical therapy treatment was primarily directed by a medical diagnosis. Often, protocols were created regardless of the presentation of the patient. Movement-based therapy, on the other hand, uses a comprehensive movement evaluation to develop treatment plans specific to each individual patient, regardless of their diagnosis.
What is movement-based therapy?
“We’re using a movement screening to dictate the type of treatment we will provide,” says Pieter de Smidt, PT, DPT, Cert. MDT, MTC, FMS-C. “We don’t base our treatment plan solely on the medical diagnosis or the results of imaging.”
For example, an individual who presents with back pain might have a diagnosis like lumbar stenosis, lumbar HNP, or even just LBP. In movement-based therapy, the focus switches to how the individual moves.
In cases like this, a physical therapist might ask: Which movements are most painful? Which movements are most restricted? Which movements relieve pain? Is the patient’s movement screen consistent with their difficulties performing daily activities?
Physical therapists then prioritize these different movements and use soft-tissue treatments, joint mobilization, and exercise therapy as indicated by the patient’s presentation.
“If somebody responds to flexion, or needs more flexion mobility, we might use IASTM and cupping to improve flexion, combined with joint mobilization to improve flexion prior to progressive exercises to address mobility, stability, strength, and endurance with an emphasis on flexion,” de Smidt explains. “The movement directs the treatment focus. Once flexion is improving we move on to the next movement.”
A physical therapist practicing movement-based therapy should evaluate all movements and base treatment on how the patient can and cannot move. For example, patients with stenosis do not automatically need flexion-directed treatment. A lumbar radiculopathy does not always respond to extension.
The emphasis of this approach is exercise programming: mobility exercises, motor control activities and, most importantly, strength training necessary for positive long-term outcomes. The ‘back-to-basics’ approach can be used for any patient regardless if there is an acute or a chronic presentation.
“Consistency of the movement screen is an important indicator to determine whether the emphasis needs to be on mobility or motor control as a starting point for your treatment,” says de Smidt. “You evaluate loaded versus unloaded movements. You assess AROM versus PROM. The more consistent the presentation, the more likely it is that this patient might need joint mobilizations to help with their mobility problem. Patients that are able to move passively, or unloaded, might need more emphasis on motor control and stabilization-type exercises.”
“It comes down to your evaluation dictating your treatment, regardless of the diagnosis. You are focused on what they can or cannot do.”
IASTM and cupping
Instrument-Assisted Soft Tissue Mobilization (IASTM) and/or cupping can offer quicker results when compared to traditional soft tissue therapy. “It’s a rapid means of producing changes,” explains Dr. de Smidt. “[These modalities] can help reduce pain and muscle guarding, which is essential in helping patients to move better. IASTM is an adjunct to exercise in that it makes it easier for the patient to perform each exercise. IASTM and cupping are treatment accelerators.”
Dr. de Smidt prefers combining IASTM or Cupping with movement. For example, if the individual is having difficulty with overhead reaching, the therapist can recommend using exercises that improve flexion, making the patient less guarded and able to progress to more advanced exercises afterwards.
Recent research has shown the importance of strength training in gaining mobility. Many therapists haven’t evaluated patients or athletes who regularly lift weights. They may not be familiar or comfortable with using strength training in attaining the desired long-term outcomes. Given the popularity of CrossFit and other intense training programs, many patients want to be able to return to at least some level of strength training exercises after injury.
“Some physical therapists aren’t comfortable evaluating a deadlift or a squat,” explains Dr. de Smidt. “Part of movement-based therapy is the belief that strength training is very important. If you want to incorporate that into your treatment philosophy, you need to expand knowledge in that subject.”
“As a part of movement-based therapy,” he says, “we spend a good portion of our time looking at the movements involved in traditional weight lifting, and the corrections you can offer. Loading the body leads to resilience, which patients need for long term results.”
Benefits for patients and therapists
Dr. de Smidt recommends movement-based therapy for any therapist interested in expanding their knowledge or becoming an expert in orthopedics, as well as those interested in expanding their abilities to treat athletes. But movement-based therapy training holds value for anyone from new grads to experienced practitioners.
“The longer you’re a physical therapist, the more different techniques and different approaches you’re going to learn along the way,” he explains. “Movement-based therapy is about getting back to the basics, the most critical elements of helping people get better and move better.”
Pieter de Smidt, PT, DPT, Cert. MDT, MTC, FMS-C, is the owner and operator of Reset-Wellness Physical Therapy in Houston, specializing in manual therapy via an evidence-based approach. Pieter has written numerous courses for Elite Learning, including Orthopedic Manual Therapy of the Upper Body, Orthopedic Manual Therapy of the Lower Body, and Orthopedic Manual Therapy of the Cervical Spine.