This is the first entry for a blog series discussing the ecological dynamics framework in the context of musculoskeletal rehab and pain management. The aim for part 1 is to introduce underpinning ideas within ecological dynamics, and set the scene to elaborate on the practical application in the parts to follow.

 

Part 1

 

Setting the Scene

 

Traditionally, approaches to musculoskeletal (MSK) pain have involved identifying and treating “root causes” that are heavily (often solely) focused on anatomical injuries or biomechanical dysfunctions. The current body of evidence, however, points practitioners to adhere to much more complexity-friendly models of pain in order to deliver high quality care. Most recently, researchers have advocated for an affordance-based model informed by the philosophical perspective known as enactivism (Vaz et al., 2017, Stilwell and Harman, 2019, Coninx and Stilwell, 2021, Cerritelli and Esteves, 2022, Vaz et al., 2023).

 

The enactivism and affordances-based model focuses on the experiential nature of pain, and places significant considerations on the relationship between the suffering individual as a whole and their respective environment (Stilwell and Harman, 2019, Coninx and Stilwell, 2021). This is different from denying the roles that anatomical, physiological, and biomechanical components could play in the development and recovery from pain and injuries. Instead, it encourages clinicians to zoom out from tissue based rationales and instead, begin to appreciate each person’s unique lived experience around pain, as part of a larger, more complex human-environment system.

 

The aim of this blog article series is to use the concept of affordances to introduce MSK practitioners to the field of ecological dynamics (EcoD) and to provide practical ideas for making the shift towards movement practices that are better aligned with the motor learning and skill acquisition literature. Clinicians reading this may recognize some of the ideas discussed throughout this article to be not exclusively unique to the EcoD approach—same wine in a new bottle, as the saying goes. However, a clearer understanding of the underpinning theories will allow for a more robust and explicit application in practice, and continuous refining of the skills as movement practitioners. Just as we are trying to guide our patients to become adaptable in their own environments outside of the clinic, the goal for us is to be adaptable clinicians as well.

 

Affordances – an opportunity to dive into ecological dynamics

 

To help better capture the experiential nature of pain, the concept of an “affordance” has been gathering attention in pain research. Affordances, adopted from ecological psychology, are described as opportunities for action offered by the environment (Gibson, 1979). Further, these opportunities for action are “constrained”, or shaped, by various factors related to the organism, the environment, and the task at hand (Newell, 1986). Ultimately human movement behavior is described as an emergent result of the self organization of the system’s degrees of freedom, within the boundaries set by these constraints (Davids et al., 2008).

 

The ecological dynamics framework combines the two complementing fields of ecological psychology and dynamical systems theory to provide explanations for complex perceptual-motor behaviors at the level of the organism-environment system. Through this lens, direct effects of pain and injuries such as reduced range of motion, strength, self efficacy, and confidence, increased fear, and heightened internal focus of attention can be explained as alterations to the organism (or individual) constraints. The experiencing person’s field of affordances (Bruineberg and Rietveld, 2014) is affected as a result, and ultimately so are the person’s movement and behavior within their environments.

Affordances in daily life

 

To make these ideas more relatable to the everyday experience, let us consider a person walking up to a box. The box may present lift-ability, push-ability, step-on-ability, walk-around-ability and so on (i.e. various affordances), depending on the person’s current action capabilities, what they are intending to achieve, and the perceptual information available for pick up in that particular moment. An important distinction in the ecological dynamics framework is that perceiving-cognizing-acting are inseparable from each other as this loop is what continuously guides a person’s movement behavior in each unfolding context (Myszka, Yearby, & Davids, 2023b). Now, let us assume that the box needs to be moved elsewhere.

 

In one situation, the box may be made out of light yet sturdy plastic, with handles, resting on a chair in an air-conditioned garage, and the acting individual may be a well rested powerlifter. In another situation, the same person may be experiencing low back pain after having just returned from a long work trip, approaching a flimsy and handleless cardboard box on the floor in a cold and dimly lit basement. In the second scenario, affordances to push the box aside, or ignore it for the time being may be much more attractive, and lift-ability of it (i.e. affordance of lifting) may not be perceived by that person altogether. Even if lifting a box was an option, it would be ignorant to think that the same movement strategy would be (or should be) used in the two scenarios based on two very different sets of constraints surrounding the task. 

 

Reflecting on the underlying assumptions about movement

 

Through a traditional understanding of movement, the action of lifting a box is about having, or not having, the requisite physical qualities such as strength, range of motion, and movement coordination to achieve the task. Rehabilitation approaches underpinned by this organism-centric perspective favor exercises performed in rote repetition with the intent of efficiently addressing physical capacities or practicing and perfecting ideal movement patterns.

 

Now, it is important to consider that the ultimate goal for rehab and pain management should be to guide the person towards flourishing in their own environments, not for them to successfully demonstrate “correct” pain-free movements within the walls of the clinic. However well-intentioned, this is an approach that separates action from perception and the person from the environment. The underlying assumption is that by optimizing the organism part of the system, it will integrate smoothly to the whole system once the person is returned back to more open environments.

 

The ecological perspective calls this exact assumption into question, as it recognizes how vastly different the constraints are between the most typical clinical environment and the performance environment. When the constraints of a person-task-environment system are kept too consistent due to the closed and artificial nature of the clinical environment, the lack of the natural variability or “aliveness” (Myszka, Yearby, & Davids 2023a) may result in a massive gap between the rehab environment and the more open environments outside of the clinic (on the field, or in the society in general).

 

It is highly unlikely that a clinician will be able to anticipate and recreate every possible scenario their patient may encounter. This requires clinicians to shift their aim and focus from simply addressing tissue capacity to designing person-task-environment landscapes in which the person can become a better problem solver (Myska, Yearby, & Davids, 2023b) so that they can learn to flexibly respond to the changes in the environment. Nikolai Bernstein described this “ability to find a motor solution for any external situation, that is, to adequately solve any emerging movement problem correctly, quickly, rationally, and resourcefully” as dexterity (1996).

 

Now, there is no doubt that improving physical capacities would help the person become better prepared for the physical demands of life (or sport). However, by adopting an ecological dynamics framework and expanding the scale of analysis to the organism-environment system, rehabilitation processes can evolve to something much greater than simply restoring patients’ physical capacities and ideal movement patterns. Practitioners can start to seize these incredible opportunities to facilitate movement experiences that promote patients’ adaptability for navigating their own ever-changing environments outside of the clinic.

 

The scene is now set, and the goal of part two of this blog series will be to introduce practical ideas for shifting towards an ecological dynamics-friendly approach to movement in clinical practice, without compromising evidence-based standards of care.

 

In a few weeks’ time, when part 2 is published, I hope that you will accept the affordance to read on…

 

References:

 

Vaz, D. V., Silva, P. L., Mancini, M. C., Carello, C., & Kinsella-Shaw, J. (2017). Towards an ecologically grounded functional practice in rehabilitation. Human movement science, 52, 117–132.https://doi.org/10.1016/j.humov.2017.01.010

Stilwell, P., Harman, K. (2019) An enactive approach to pain: beyond the biopsychosocial model. Phenom Cogn Sci, 18, 637–665. https://doi.org/10.1007/s11097-019-09624-7

Coninx, S., Stilwell, P. (2021). Pain and the field of affordances: an enactive approach to acute and chronic pain. Synthese, 199, 7835–7863. https://doi.org/10.1007/s11229-021-03142-3

Cerritelli F, Esteves J. E. (2022) An Enactive–Ecological Model to Guide Patient-Centered Osteopathic Care. Healthcare, 10(6):1092. https://doi.org/10.3390/healthcare10061092

Vaz, D. V., Stilwell, P., Coninx, S., Low, M., & Liebenson, C. (2023). Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management. Brazilian journal of physical therapy, 27(5), 100554. https://doi.org/10.1016/j.bjpt.2023.100554

Gibson, J. J. (1979). The ecological approach to visual perception. Houghton Mifflin.

Newell, K. M. (1986). Constraints on the development of coordination. In M. G. Wade, & H. T. A. Whiting (Eds.), Motor development in children: Aspects of coordination and control (pp. 341–360). Martinus Nijhoff.

Davids, K., Button, C., Bennett., S. (2008). Dynamics of Skill Acquisition: A Constraints-Led Approach. Human Kinetics.

Bruineberg, J., & Rietveld, E. (2014). Self-organization, free energy minimization, and optimal grip on a field of affordances. Frontiers in Human Neuroscience, 8, 599. https://doi.org/10.3389/fnhum.2014.00599

Davids, K., Glazier, P., Araújo, D., & Bartlett, R. (2003). Movement systems as dynamical systems: The functional role of variability and it’s implications for sports medicine. Sports Medicine, 33(4), 245-260.

Myszka,  S., Yearby, T., & Davids, K. (2023b). (Re)conceptualizing movement behavior in sport as a problem-solving activity. Frontiers in Sports and Active  Living, 5, 1130131. doi:10.3389/fspor.2023.1130131

Myszka, S., Yearby, T., & Davids, K. (2023a). Being water: How key ideas from the practice of Bruce Lee align with contemporary theorizing in movement skill acquisition. Sport, Education and Society, 1–17. doi:10.1080/13573322.2022.2160701

Bernstein, N. A. (1996). On dexterity and its development. In M. L. Latash, & M. T (Eds.), Dexterity and Its development (pp. 1–244). Lawrence Erlbaum Associates.

 

Yuji is a licensed chiropractor and a certified strength and conditioning specialist based in Portland, Oregon. His views on how a musculoskeletal clinician can be most helpful to someone dealing with pain and injuries have been informed by the updated evidence around pain and the ecological dynamics framework for approaching human movement. He currently helps people overcome pain and performance related obstacles through his coaching platform.