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Movement Retraining

Expanding a person's movement strategies to reduce pain and meet their goals

What is movement retraining?

Movement retraining helps to improve a client's movement strategies, which can reduce pain and fatigue and improve performance1. It starts with assessing movement quality and then prescribing exercises to address the limiting factors that are identified.

Assessing movement quality2

Process Worked example
1 Collect patient history, presenting concern, goals, limitations, ADLs Left knee pain (4/10) on knee flexion, limiting kapa haka.
2 Select tasks from ADLs + goals Wide (kapa haka) squat.
3 Qualitative observation Left knee wobble and pain at depth.
4 Hypothesise limiting factors & test Limiting factors could be reduced hip/ankle ROM, hip strength, or control. On testing: hip PROM normal; left ankle dorsiflexion reduced; left hip abductors strength reduced, quadriceps strength normal. Reduced left dorsiflexion and hip abduction are the likely limiting factors.
5 Address limiting factors
& re-assess		 Modify squat to add band around knees, reduce depth/elevate heels, increase depth to progress. Stretching / eccentric loading of calf.

Limiting factors & exercise prescription1,2

ROM deficit

Test: PROM testing

Address: eccentric loading3, stretching

Force (strength)

Test: MMT, isolated strength tests

Address: isometric activation, isolated strengthening exercises

Energy (endurance)

Test: movement quality at higher repetition ranges or over longer periods

Address: higher repetitions, aerobic conditioning, education about pacing

Control (including confidence / fear)

Test: change task and/or environment, e.g. add cognitive load, balance: does the limiting factor persist?

Address: regress the exercise, change environment, add external cues

Safety, load management & referral triggers
  • Must respect tissue healing timeframes and surgeon restrictions.
  • Monitor movement quality and pain response during exercise.
  • Monitor pain response in the 48 hours post-exercise, and reduce/regress load if pain is 4–5/10 or lasts for more than 24 hours.
  • Stop and refer if: pain ≥ 6/10 or impacting sleep; new or worsening neurological symptoms; sudden loss of function; signs of infection; chest pain, unexplained syncope, or sudden shortness of breath.

Acronyms: ADLs Activities of Daily Living; ROM Range of Motion; PROM Passive ROM; MMT Manual Muscle Testing.

References

  1. Bennett, H., Arnold, J., & Davison, K. (2021). Exercising to improve movement quality: Why and how. ACSM’s Health & Fitness Journal, 25(3), 20–27. https://doi.org/10.1249/FIT.0000000000000669
  2. McClure, P., Tevald, M., Zarzycki, R., Kantak, S., Malloy, P., Day, K., Shah, K., Miller, A., & Mangione, K. (2021). The 4-element movement system model to guide physical therapist education, practice, and movement-related research. Physical Therapy, 101(3), Article pzab024. https://doi.org/10.1093/ptj/pzab024
  3. Weiss, S., Kreuzer, M., Brunschmid, C., Kern, B., Lohkamp, M., & Diermayr, G. (2026). Eccentric training modalities to affect range of motion in the rehabilitation of lower limb musculoskeletal disorders: A scoping review. Physical Therapy Reviews, 31(1), 17–30. https://doi.org/10.1080/10833196.2025.2530295