A POLITE Method for Proprioception
Written by Editor   
Monday, March 06, 2017 12:48 PM

News bite: Using the acronym POLITE can help remind the practitioner of the things to cover when planning rehabilitation.

When a patient’s symptoms are overwhelming here is a system using the acronym POLITE as a reminder of the things I may need to discuss, check or perform with my patient:

P is prevention, plan, posture, proprioception.
OL is optimal loading.
I is instrumentation, ice.
T is taping, technology.

E is education, eating, exercise, ergonomics.

The treatment process often begins by:

  1. discussing my plan and prevention strategies, making the patient aware of poor postures and showing or assisting him into full range of motion or correcting a dysfunctional movement pattern (proprioception)

  2. showing  the patient how to resist the planes of motion in a variety of mediums to develop more integrated skills so that we change the brain’s perception of the movement system (OL – optimal loading)

  3. recommending ice, or heat, or other instruments

  4. taping methods and technology; and

  5. improving the patient’s eating, exercise, and ergonomics, and of course all the while educating the patient.

The POLITE acronym works. 

The chronic pain patient’s history usually reveals prior injuries, excess or prolonged sitting, poor postures or repetitive movements over time that have led to movement inefficiency and dysfunction in natural movement patterns. Do these factors really relate to the current symptoms? I would say, yes. Previous injury in the same muscle does play a part in recurrent muscle injury (McCall).

Examination involves posture analysis, range of motion, orthopedic testing and movement screens, but the screen depends on the patient’s complaints. Movement analysis can inform us about the patient’s movement system. The only way I know if movement patterns are compromised is to ask the patient to move. I observe if the patient can do what I request, then I ask, “Was there normal range of motion? Was there control of motion in the various planes?” I am lookng for movement quality, synergies of muscle activation and coordination with other muscles. I am looking at proprioception. It’s about fluidity, balance, timing, symmetry or asymmetry of motion. Look for dysfunctions that can arise during function.

Restoring pain-free range of movement is a starting place for functional improvement in work, home, school and recreational activities. Insurance companies are demanding we document this information.  

Utilization of manipulation/adjustments and exercise movement therapy will improve flexibility, range of motion, strength, soft tissue issues and ultimately gait. One of the missing links in rehab treatment of movement-control dysfunctions is proprioceptive training (e.g., wobble boards, roller boards, disks, physioballs). Proprioception identifies our sense of position, location, orientation and movement of body parts in relation to each other. It feels weight and tells us if we are stationary or moving, what direction we are moving, what range we are moving through and how fast we are travelling through it. Movement outcomes are determined by sensory input from mechanoreceptors, located in joints, tendons, muscles and ligaments. These receptors provide the CNS with real-time information and constantly update the status of the body’s biomechanical and spatial properties.

Past trauma and acute injuries to the body can cause an alteration in the muscles trying to support our body's movement. Assessments of functional movements would show that the wrong structures are working, negatively affecting how well we move. 

Read examples of implementing POLITE at the source link below.

If you are interested in learning current rehab methods, please join the ACA Rehab Council in Orlando, Fla., March 30-April 2, 2017, for our annual symposium. 

Visit www.CCPTR.org for registration information.

Source: https://www.acatoday.org/News-Publications-News/ArtMID/6595/ArticleID/239/A-POLITE-Method-for-Proprioception