Making Rehab More Powerful with Motor Imagery

Connecting Body & Mind with StrongPosture® Protocols

 “All things are created twice, first mentally, then physically.”  Stephen Covey,  the Second Habit of Highly Effective People  

Mental and emotional health are hot topics in rehab and healthcare because overall health is about mind-body as well as body-mind. Which is why when doing just about any sort of rehab for biomechanic or neuromusculoskeletal issues, you should address both…in both directions.

Motor Imagery and Idealized Movement

The mental process of internally conceiving of an action… without actually moving…is called MOTOR IMAGERY^⁠1.  It’s the cognitive process that precedes the motor action; the intention before the action.

This is important in coaching, baseball to ballet, athletes and performers are all coached to visualize idealized movements^⁠2.  There’s a significant bit of neurology at work here: studies show directed motor imagery activates the CNS with functional changes^⁠3 that actually improves performance.^⁠4

Motor imagery is really relevant for the postural back pains at the root cause of most non-specific low back pain (NSLBP refers to pain or discomfort symptoms anywhere in the lower back between the twelfth rib and the top of the legs). Studies by LaTouche^⁠5 and others show people with chronic NSBLP are weaker at mentally visualizing both kinesthetic and motor images.

Degradation of Movement

Think about it like this: When you don’t move something for a while, your body forgets how it’s done… in body as well as mind.  Physical motion patterns shift, and so does your internal perception of how you’re moving. One popular academic theory is that inactivity and lack of motion cause a degradation of the mental image of how you’re moving, training maladaptive changes in the motor cortex and the somatosensory cortex.

A Case for Exercise AND Education

At the latest StrongPosture® Pro Training I mentioned the recent Grande-Alonso study ^⁠6 that looked at how generating kinesthetic and visual motor imagery affects psychological, motor, and somatosensory function. Their secondary objective “was to determine whether an approach based on therapeutic exercise (TE) and therapeutic education (TEd) can improve the ability.

I agree (and the emphasis on and is mine) because blending somatic training of the body and cognitive concepts with proprioception normalizes somatosensory perception towards reality. That’s the essence of the StrongPosture® exercise and education we’ve been teaching doctors around the world since 2003.

From a biopsychosocial perspective, Grande-Alonso’s study supports our work with their conclusion that:

“the most relevant association was found between lower levels of self-efficacy and lower lumbar strength in the group with a lesser ability to generate mental motor imagery.”^⁠7

Their findings also strongly supports the entire StrongPosture® framework and protocols:

“A clinical T(herapeutic) E(xercise) approach, coupled with a T(herapeutic) Ed(action) program, resulted in significant improvement in mental motor imagery (both kinesthetic and visual), reduced pain intensity, increased lumbar strength, reduced disability, and improved psychological variables“^⁠8

Why Does it Matter? 

The dramatic difference in shoulder girdle stabilization patterns we saw in last month’s StrongPosture® Pro Training occurs because when subtle cues target the individuals motion, the individual builds a more accurate motor image. This is why doctors said they were blown away by the videos of three different practitioners teaching StrongPosture® ArmsUP, and observing how subtle, individualized cues made such a big difference! 

Addressing these subtleties is key to effectively targeting subtle compensation patterns of chronic mid back pain and stubborn Upper Cross Syndromes. Making this a crucial step to position people to intelligently incorporate proprioceptive tools to use for self management and StrongPosture® awareness.

What Can You Do?

Communication is in the ears of the listener, which is why integrating exercise with biomechanic education is a must for effective rehab, self-efficacy and clinical engagement.

StrongPosture® concepts such as the 4 PostureZones and 5 Posture Principles^⁠9 provide a global educational framework for just about any NMS rehab or training. Intimately blending these concepts with MUST vs TRY therapeutic motor control exercise creates proprioceptive reinforcement for greater accuracy of somatosensory visualization, leading to greater accuracy of control for movement.

It’s education designed to tell a story, and empower the patient to understand and take control of their body. In other words, functional rehab for pain-free motion in daily life begins with StrongPosture® in body…and mind.

• At-home patient rehab. 7 Steps to StrongPosture® is the online at-home program for patients that integrates education and exercise designed to blend easily into your workflow. Subscribe to offer the program to your patients & clients >>>
• CE Approved online education. Posture and Balance Assessment, Rehabilitation & Motor Control Exercise >>>
• Complete in-office rehab program. Pro Training Manual, Patient Handouts and more >>>

¹ Guillot A, Collet C. Construction of the motor imagery integrative model in sport: A review and theoretical investigation of motor imagery use. Int Review Sport Exercise Psychology 2008; 1:31-44.

² Morris T, Spittle M, Watt AP. Imagery in Sport. Champaign, IL, Human Kinetics, 2005.

³ Dickstein R, Deutsch JE. Motor imagery in physical therapist practice. Phys Ther 2007; 87:942-953.

⁴ Ladda, A. M., Lebon, F., & Lotze, M. (2021). Using motor imagery practice for improving motor performance–A review. Brain and Cognition, 150, 105705.

⁵ La Touche R, Grande-Alonso M, Cuenca- Martínez F, Gónzalez-Ferrero L, Suso- Martí L, Paris-Alemany A. Diminished kinesthetic and visual motor imagery ability in adults with chronic low back pain: Mental task and chronic low back pain. PM R 2018; 18:30311-30313.

⁶ Fisioterapia, C. S. D., La Salle, E. U., Paz, L., La Touche, R., de Estudios, C. S., & La Salle, U. (2020). Influence of the Generation of Motor Mental Images on Physiotherapy Treatment in Patients with Chronic Low Back Pain. Pain Physician, 23, E399-E408.

⁹ Weiniger, S; Stand Taller Live Longer: A Posture and Anti-Aging Strategy, 2008