Reprinted from The RSI Network - Issue 33 - Nov/Dec'98

Howard Nemerov, CMT
Corte Madera, California
(415) 459-4206


A number of clients who have been treated with Applied Motor Control have said things like: "I had seen conventional physical therapists for three years, trying to resolve pain and tingling in my hands, to no avail. When I started treatment with Howard, the problem went away, and has never returned." (SM, Kentfield, CA) "Howard's work is an integral component of manual therapy. It allows the client to quickly re-establish neural pathways to relax compensating muscles and regain coordinated control of both spinal and extremity motion. My work with Howard has considerably eased my own long-standing neck and arm pain." (Brian Beaudoin, PT, OCS)

These quotes reflect the fact that while other forms of treatment may help, they do not address the underlying neurological problems in the muscle system. These problems arise from repetitive stress, and do not get resolved until they are treated in the detailed, thorough, and orderly way that AMC addresses them.

In this article I will describe some basic concepts of Applied Motor Control, and how it can enhance and hasten your rehabilitation.

What Is Motor Coordination?
For every movement pattern, a unique sequence of muscle actions occurs in order for the movement to be smooth and easy. To take a sip from a cup of tea, you must reach out, grab the handle, lift the cup, and bring it to your lips. If you did these actions out of sequence, you would not achieve the desired action of sipping tea. If you tipped the cup before you got it to your mouth, you might have a surprise! All of these arm and hand muscles must perform their individual jobs, yet within the team context involving the other muscles.

The part of the brain that governs this process of motor coordination is called the Motor Control Center (MCC). The MCC learns and remembers movement. It decides which muscles to use and in what order. Sipping tea from a cup involves dozens of muscles, but you never think about that because the process happens so easily. This ease is a sign that a motor function is efficient. The proper muscles are activating at the proper times, and the desired outcome, drinking from the cup, is accomplished.

How RSI Leads to Dysfunctional Motor Coordination
Smooth, efficient movement is the ideal, but not always the reality. Injuries such as whiplash, sports injuries, and RSI all can cause muscles to overload and "short out," much like an electrical circuit that is drawing too much current. One can easily see how a large impact in an automobile accident could cause such a neurological overload. Heavy strains like these cause dramatic, intense stresses to the muscles, causing them to "short out" in less than a second.

With RSI, small stresses over a much longer period add up to the same type of overload. You can load the muscles with 100% of the force needed to weaken them all at once, or you can give them slight overloads of 1% of that force over 100 days. Either way, you end up with 100%.

Keyboard typing for long periods of time is one way to build up strain gradually. It may seem like a pretty easy activity, but two factors cause it to create RSI.

First of all, the palms-facing-down position is not neutral, and shortens the muscles and tendons in the arms, even if your wrists are straight.

Secondly, when we do any kind of activity without balancing it with rest, stretching, and therapeutic exercise to refresh the muscles, they eventually build up to that critical stress we discussed earlier. When this happens, they begin to hurt, which is the muscle’s way of saying "I’m tired." After a long day of typing, if you notice soreness in your shoulders, arms, or hands, you are experiencing this problem.

Of course, we have deadlines, competition, and the need to perform well at our jobs to avoid being replaced, so we override these signals. After all, what’s a little soreness? It may actually be a badge of courage or a sign that we are tough enough to hang with the best, right? But, as the old margarine commercial went: you can’t fool Mother Nature. If you continually stress your arms and hands, they will eventually break down. Some bodies are more resilient than others. Younger bodies generally recover faster than older bodies. But eventually, something gives.

What happens at this point is extremely interesting. Many times, you don’t even register that your arm functions are breaking down, because after the Motor Control Center sees that you are not going to stop to rest and recuperate your strained muscles, it becomes a trooper and figures out a way to keep going as best as it can. As fatigued muscles weaken and switch off, the MCC looks around for other muscles that it may recruit and substitute. It creates a backup coordination pattern that, while not as efficient as the original pattern, mimics the original enough to allow you to keep at your work. This is also called a compensation pattern.

Compensation patterns put additional stress on the muscles that are recruited, because now they must perform both their original function as well as the compensation pattern. It is very similar to what happens when you are part of a project team. At first, everybody has their assigned responsibilities. If everybody carried these out according to the original plan, the project would be completed with a minimum of stress to each team member. If two people get very sick or quit during the project, the remaining team members often complete the project, forcing them to perform additional duties as well as their original ones. By the end of the project, they are burnt out and cranky. Muscles that have been involved in compensation patterns also get tight and sore, their version of being burnt out and cranky.

Let’s look at the specific activity of typing. You bend your elbows to place your hands on the keyboard. On most of the keyboards in the workplace, unless you are fortunate or rich enough to purchase a top-of-the-line ergonomic keyboard, your wrists are bent back slightly, and your fingers are raised over the keys. This compromises the muscles on the upper side of your forearm by shortening as well as twisting them. To avoid this, you may shrug your shoulders or bend your elbows more, cramping the muscles in the elbow or upper shoulder. Now you begin typing away for hours.

As a result, the muscles that are already shortened become overworked. Usually, this happens in the muscles of the forearm, which support wrist function. The MCC becomes aware of this fact via the painful feedback in the part of the nervous system that connects these muscles to the brain. As a survival response, it decides to back off using the sore muscles. The result is that these muscles begin to lose strength, due to fatigue. But our project is only halfway completed and must be finished. The MCC selects other muscles to compensate for the original muscles in order to keep going. This compensation pattern in turn becomes the new way to type. What you usually notice is tense, sore muscles, usually in the shoulder, upper back, neck, and jaw, as well as painful joints where the muscles are no longer strong and active, usually in the wrist, elbow, and hand.

You have developed dysfunctional motor coordination. Your brain has literally forgotten how to use these muscles in their natural, efficient patterns. The compensation patterns are not as efficient, which strains both the muscles and joints involved. These patterns, or motor programs, must be reprogrammed properly in order to resolve the problem in a timely manner.

How AMC Quickly Resolves the Causes of Pain and Lost Function
In Applied Motor Control, we follow two main principles:

  1. Weak and tight muscles are symptoms of dysfunctional motor coordination. Simply treating these symptoms will not result in quick resolution of the problem. The condition will persist, or may even worsen over time. At the very least, it will take a much longer series of treatments to obtain even minimal permanent improvement in your condition.
  2. The source of a muscle problem resides in the nervous system. It is the quality of the MCC’s connection with each muscle that results in the symptoms of muscular weakness and tension.

Using a gentle form of direct muscle testing, Applied Motor Control engages the MCC in a two-way, kinesthetic conversation. For example, if practitioners wanted to check their clients’ ability to extend their wrists, they would apply a light force of perhaps two pounds against the back of their clients’ hands, while asking the clients to pull their hands back toward their elbows.

Using AMC, the practitioner:

  1. Gains information about which muscles are weakened. If the wrist extensors were weak, the clients would not be able to resist against the pressure.
  2. Determines which muscles are being recruited to compensate for the weak muscles. Using assessment techniques, the practitioner would determine which muscles were tensing up to compensate for the wrist extensors.
  3. Enables the MCC to understand it was compensating and needs reeducation. When the wrist extensors test weak, the MCC is aware that it tried to activate them and failed. This initiates a neurological process called Motor Learning. During this stage, the MCC becomes willing to relearn how to succeed in activating the wrist extensors.
  4. Then takes the MCC through a detailed, step-by step re-education (reprogramming) process whereby it learns once again how to perform each action in the most efficient manner. The practitioner releases the compensating muscles while the Motor Learning process is active, and then tests the wrist extensors again. When they respond better to the muscle test, the MCC interprets this as a successful reeducation process.

Once the reprogramming process is complete, the MCC will remember the regained function. It does this by storing the movement pattern as a "program" in Motor Memory, which is similar to storing a software program on a hard drive, so that the movement can be recalled on demand, much like starting up your favorite word processor.

Now the weak and tight muscles may be treated with any of a variety of soft tissue modalities in order to resolve the physical symptoms of tension and pain. The most rewarding thing for the client is that after reprogramming, the pain and tension are much easier and less painful to treat, and the results are much longer-lasting. Most people who come for treatment already have suffered a certain amount of pain. Why add to it?

When Is AMC Appropriate?
In an ideal world, you would come in for treatment at the onset of symptoms. A new problem is much easier to treat than one that has built up for months. It is much like a weed: if you pull it out when you first notice it, it comes out quite easily. If you let its roots get a deep hold, it is much more difficult to pull out.

The great thing about AMC is that if it is not appropriate for you at the current time, it does not work. This usually means that you need to see a doctor and get specific acute care first. It also means that you do not need to undergo a lengthy series of treatments, hoping you will magically get better. We either see noticeable improvement within the first two or three treatments, or that this isn’t what you need. If AMC is incorporated at the proper time during rehabilitation, you most likely will respond quite well.

You deserve to have your problem resolved as quickly as is reasonably possible. Also, at some point in your rehabilitation you owe it to yourself to help ensure that your suffering does not recur. In my practice, 90% of all clients have their original problem resolved within six AMC treatments.

AMC is also great for maintenance. As work stresses begin to show up as minor aches and pains, you could come in for a "tune-up" and be on your way again for a while. As I said earlier, a recent problem is much easier to work out than one that has had time to settle in. Your car needs regular maintenance, and you take it in without a second thought. Your body is far more complicated than a car engine, and it would appreciate regular maintenance, too!

About the Author
Howard Nemerov developed and teaches Applied Motor Control, and has written a book on the subject. During the course of his research he has developed treatment solutions for injuries to the hands, arms, and shoulders, as well as TMJ and low-back pain. AMC training is available for interested professionals. Corte Madera is in Marin County, about 15 minutes north of the Golden Gate Bridge. Contact him for more information or to arrange a free introductory assessment and consultation.

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Last Updated: 10/21/00