Movement disorder syndromes (MIS) are defined as localized painful conditions resulting from irritation of the myofascial, periarticular, or articular tissue.
It was described by Shirley Sahrmann in her book "Diagnosis and Treatment of Movement Impairment Syndromes" in 2001.
Repetitive movements and sustained postures alter tissue properties, ultimately leading to changes in movement patterns and, if these are not ideal, potentially causing impairments. When movements are faulty or strength and flexibility are compromised, negative changes occur in soft tissues and bone structures. The potential consequences of damage to these tissues include musculoskeletal pain or a movement disorder syndrome.
Intrinsic factors, such as the patient's characteristics, and extrinsic factors, such as the type of work and fitness, can contribute to tissue changes.
Hip movement restriction syndromes include:
| Syndrome | Accessory movement | Associated diagnoses |
|---|---|---|
| Anterior femoral gliding | Without rotation | Iliopsoas tendinopathy; bursitis |
| With media rotation | Iliopsoas tendinopathy; bursitis | |
| With lateral rotation | Adductor strain; iliopsoas tendinopathy; groin strain | |
| hip adduction | Without rotation | Overuse of the gluteus medius; trochanteric bursitis |
| With media rotation | Prolonged piriformis syndrome; iliotibial band fasciitis | |
| Hip lengthening | With knee lengthening | Strain of the thigh muscles as a result of insufficient involvement of the gluteal muscle or the quadriceps. |
| With medial rotation of the hip | Thigh muscle strain as a result of insufficient intrinsic involvement of the lateral rotator muscles | |
| Femoral accessories | Early degenerative hip joint disease | |
| Hypermobility | Labrum exercises | |
| Femoral hypomobility | With superior gliding properties | Degenerative hip joint disease |
| Lateral rotation of the hip | Shortened piriformis syndrome | |
| Lateral slippage of the femur | Short-axis distraction | Hip pain; popping hip; subluxation |
Hip movement restriction syndromes
Intervention in these syndromes focuses on correcting muscular imbalances. Adaptively shortened structures are stretched, and weak muscles are strengthened.
The characteristic findings for femoral anterior glide syndrome result from insufficient posterior gliding of the femoral head during hip flexion.
This syndrome is frequently diagnosed as iliopsoas tendinitis because the femoral head exerts pressure on the anterior joint structures, which occurs when the hip is in a hyperextended position. This pressure, combined with reduced posterior gliding of the femur during hip flexion, causes the femur to impinge on the anterior tissue of the joint capsule.
Typically, the patient complains of groin pain, especially when bending the hip, walking, and running.
The consequences of this syndrome are :
Anterior Femoral Glide Syndrome
The characteristic findings for hip extension with knee extension syndrome result from insufficient involvement of the gluteus maximus in hip extension and/or the quadriceps in knee extension.
Typically, the patient complains of pain at the insertion point of the posterior thigh muscles at the ischial tuberosity and along the muscle belly, especially when resisting hip extension, knee flexion, or both.
The consequences of this syndrome are:
The characteristic findings for hypermobility of femoral accessory movement result from early degenerative changes and increased compression at the hip joint due to stretching forces on the rectus femoris and the posterior thigh muscles.
Typically, the patient complains of pain deep in the hip joint and in the anterior groin area, which may spread along the inside and front of the thigh, especially when walking.
The consequences of this syndrome are:
Sahrmann categorizes a number of movement impairment syndromes that can occur in the lumbar spine as a result of an imbalance between flexibility and strength.
The intervention for each of the syndromes involves correcting these imbalances:
Flexion syndrome: This syndrome is characterized by lumbar spine flexion movements that are more flexible than hip flexion movements. The syndrome typically occurs between the ages of 8 and 45 and leads to pain during positions or movements involving lumbar flexion due to adaptive shortening of the gluteus maximus, hamstrings, or rectus abdominis. A: Limited hip flexion with excessive lumbar flexion. B: Good hip flexion with optimal lumbar flexion.
Extension syndrome: This syndrome is characterized by movements of the lumbar spine that are more flexible than movements of the hips. Patients with this syndrome are usually older than 55 years, and the symptoms worsen with positions or movements that involve an increase in lumbar lordosis due to adaptive shortening of the hip flexors and lumbar paraspinal muscles, and weakness of the external
oblique muscles.
Lumbar rotation: This syndrome is characterized by pain that is unilateral or more severe on one side and is exacerbated by rotation to one side. No attempt is made to equate the side of rotation with the side of symptoms. This syndrome is thought to occur when one segment of the lumbar spine rotates, flexes laterally, glides, or dislocates more easily than the segment above or below it. This syndrome is associated with spinal instability and may result from habitual movements or positions involving lateral rotation, leg length discrepancy, or oblique abdominal muscle imbalance. A: The patient's range of rotation is limited. B: Excessive rotation
Lumbar flexion with rotation: This syndrome is characterized by pain that is unilateral or more severe on one side and is exacerbated by the combined movement of flexion and rotation of the lumbar spine. Many of the features of lumbar flexion and rotation syndrome can be applied to this syndrome.
Lumbar extension with rotation: This syndrome is characterized by pain that is unilateral or more severe on one side and is exacerbated by the combined movement of lumbar extension and rotation. Many of the features of lumbar extension and rotation syndrome can be applied to this syndrome. Normal spinal alignment. Lumbo-pelvic alignment.
