By far the most important such perpetuating factor is the presence of faulty movement patterns. Thus, remedial exercise and activity modification advice are the second line of treatment after manipulation. 2 Recent evidence showing the relationship between key stabilizers, such as the multifidus and transverse abdominous and back pain, lends credence to this approach. The goal of treatment is to improve performance of the movement pattern first cortically and then subcortically. This is important because most injuries occur following exposure to unexpected perturbations.
Rehabilitation involves a comprehensive prescription of advice, manipulation and exercise.
The goal of advice is to reduce strain on the locomotor system. Abnormal movement patterns should be viewed as the main perpetuating factor of both segmental movement restriction and myofascial trigger points. Faulty movement patterns are common in our modern society with the prolonged time spent in constrained postures. This static overload causes predictable muscle imbalances and joint overstrain. For instance, we have all observed tight upper trapezius, pectorals, and suboccipital muscles in our patients.