First Principles of Movement's Four Principles
FPM is about principles not methods. As I learned from the Czech Neurologist Dr Karel Lewit "Don't be a slave of methods. The methods should serve the goals." Our goals are determining by identifying WHAT MATTERS to the person we serve.
Trendy & popular methods & systems are all valuable, but we don’t want to be a prisoner of protocols. This is the antithesis of a person-centered Game Plan approach. Protocols & algorithms can become crutches which inhibit our ability to develop problem-solving ability. Current MSK practices are transactional in nature (ie services) instead of being focused on providing ongoing, long-game value (support).
“But man is so addicted to systems and to abstract conclusions that he is prepared deliberately to distort the truth, to close his eyes and ears, but justify his logic at all cost. ”― Fyodor Dostoevsky
FPM’s 4 Principles are simple to follow -
Reassurance - to reconceptualize beliefs about a linear relationship of injury or degeneration & pain to increase recovery hope
Reactivation - to meet the 1st PA Guideline - 150-300m volume of consistent aerobic activity (elevated Heart Rate) via graded exposures to “slow-cook” increased activity tolerance and return to activity
Resilence - to meet the 2nd PA Guideline - 2-3x/week strength training (progressive resistance exercise) with sufficient intensity to cause physiologic adaptation and thus build self-efficacy
Risk Mitigation - Dynamic systems approach with variability to enhance residual adaptation and functional transfer so capacity meets and exceeds demands.
When we have principles we always have Plan B thinking so we can fail forward. Addressing over-protection and under-preparation isn’t a “quick fix” or “cookie cutter”. An agile Game Plan is scalable, can be personalized, and lends itself to problem-solving. All systems & methods can be deployed strategically to offer a person-centered approach designed to enhance an individual’s contextual affordances (functional bandwidth).
Let’s keep an open mind and continue to level up as a community. Our comfort zone is a cage since nothing new grows there. Challenging the status quo is our FPM mission statement since the chasm between science and clinical practice in the MSK field is widening. This is a “super-wicked” crisis that requires we do more than claim to be innovative. Instead, let’s commit to creatively supplant the vested interests of transactional relationships in our present interactions with high-value personalized empowerment for positive health.
Evidence underscores that this long-game mindset is needed to mitigate risk of falls, fractures, frailty, all-causes mortality (CV disease, cancer, etc), and disability due to non-communicable diseases. All of which are an increasing burden in a world where health span hasn’t kept pace with lifespan. In fact, we are older younger as evidenced by the fact that inactivity, obesity, and diabetes are increasing at younger and younger ages.
MSK pain is recurrent and most treatments have minimal effect on an episodes natural history. But, a silver lining of people seeing DPTs, DCs, DOs, and personal trainers for MSK advice is that we can receptualize our collaberations away from us “fixing” problems for people to us supporting their “slow-cooking” their physical exposures and capacity to empower them towards functional independence
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