Joints and their associated soft tissues need unrestricted movement for the body to function properly. These tissues include muscles, tendons, ligaments, fascia (connective tissue) and skin. A restriction or “barrier” to movement is an area for assessment. Clinical findings often include changes in joint mobility, tissue texture, tenderness and muscle tone.
Historically, chiropractors referred to these restrictions or barriers to movement as subluxations, and the European manual medicine community calls them “joint blockages”. Common to the manual therapy schools is the diagnosis of the barrier to movement by manual methods, with the aim of reducing joint and soft tissue restriction using mobilisation, manipulation or adjustment techniques.
The barrier concept also includes neuromuscular barriers, such as muscle imbalances and poor coordination, and psychosocial barriers, such as avoiding movement or physical activity for fear of aggravating an injury. Neuromuscular barriers can contribute to joint overload and instability in the core and spine. Psychosocial barriers can contribute to deconditioning.
A functional examination assesses neuromuscular barriers by looking at the quality of muscle activation. It checks whether a muscle is inhibited or overused during movements such as squatting or raising an arm. Questionnaires called “outcome measures” assess psychosocial barriers and track progress. Examples include the OMPQ score for musculoskeletal pain and the DASH score for the upper limb.
Addressing all of these barriers means care is tailored to the patient, so that chiropractic care and more active methods of rehabilitation (e.g. DNS, sensorimotor training) can be integrated.
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