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Pathokinesiology vs. kinesiopathology vs. kinesiophysiology

Does tissue damage lead to motor impairment, does insufficient motor activity lead to musculoskeletal tissue damage (injury), or does motor activity lead to better musculoskeletal tissue function? in all cases!

The pathokinesiological model describes the change in motor function as a result of pathological changes in the tissues of the musculoskeletal system that lead to dysfunction and/or pain. Although a connection may exist, this need not always be the case. Radiologically proven abnormalities of the spine or a joint such as "herniated disc", "supraspinatus syndrome" or "arthrogenic abnormalities" are broad, ambiguous, and non-specific and do not necessarily lead to motor changes. Moreover, they do not lead to treatable magnitudes. And also because a causal relationship between clinical symptoms and these diagnoses has never been established, treatments are often ineffective.  
Specific pathologies (e.g. paralysis due to brain injury) or injuries (e.g. cruciate knee ligament injuries) obviously lead to motor impairments. Functional impairments of hip or shoulder joints (e.g. due to inactivity) also lead to motor disorders via arthromyogenic inhibition (pathokinesiology), which in turn can lead to incorrect loading of other joints (kinesiopathology). See here the interaction between pathology and kinesiology.

A good understanding of pathokinesiology can identify a possible risk of injury at an early stage. This is because more and more studies are showing a link between reduced joint loading capacity (reduced neuromuscular control) and an increased risk of musculoskeletal complaints. For example, scapular dyskinesia, reduced external rotation strength of the shoulder, and a rapid increase in training load in a group of 679 elite youth handball players led to an increased risk of shoulder injuries (Möller et al. 2017). And minor motor asymptomatic abnormalities (less strength, lower mobility) hang together with lower load capacity and may pose a greater risk of injury (Windt et al. 2017).

The kinesiopathologicalmodel is based on the thesis that incorrect or incorrect dosed movement can lead to disorders of the tissues of the musculoskeletal system. In particular, forms of movement that do not take into account the biomechanical properties and thus the load-bearing capacity of these tissues can lead to pain and functional impairment. Motor activities that are correctly dosed and adapted to the joints' load-bearing capacity rarely lead to musculoskeletal diseases. 

The Kinesiophysiological model includes motor interventions that lead to a better motor function of joints and so to clinical outcomes and specific training programs that aim to improve motor skills and lead to a lower risk of injury.

However, this complex relationship between movement, pathology, and musculoskeletal health is far from conclusive. There is sometimes an interaction between the pathokinesiological, kinesiopathological, and kinesiophysiological models. Degeneration of hip or shoulder joints leads directly to reduced neuromotor control of the joints (pathokinesiology) and indirectly to overuse of spinal joints such as the sacroiliac, lumbosacral and cervical joints (kinesiopathology). Correct or properly dosed movement of these joints (kinesiophysiological) leads to improved joint function and thus to a reduction in musculoskeletal symptoms.

Given the enormous variability of human motor abilities, there are no clearly defined standards for healthy, "ideal" motor abilities and thus no "one size fits it all" motor treatment strategy. An effective distinction between pathological and healthy motor abilities, however abnormal, can only be made on the basis of clinical symptoms. Correct motor examination of joint function and loading capacity is the only way to diagnose musculoskeletal symptoms correctly. A correct assessment of the individual environmental and task-specific context (work, sport) is crucial for correct clinical decision-making.