SMoC-Wrist: a sensorimotor control-based exercise program for patients with chronic wrist pain

• Published in: Journal of hand therapy Vol. 33; no. 4; pp. 607 - 615
• Main Authors: Lötters, Freek J.B., Schreuders, Ton A.R., Videler, Annemieke J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2020; Elsevier Limited
• Subjects: Chronic pain; Exercise program; Immobilization; Isometric; Kinematics; Kinesthesia; Ligaments; Musculoskeletal system; Pain; Patients; Physical training; Position measurement; Proprioception; Sensorimotor control; Sensorimotor system; Steroids; Wrist; Wrist; Sensorimotor control; Exercise program; Chronic pain
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2018.11.002

This is a narrative review.
Chronic wrist pain is a common disorder that can lead to considerable disability in performing activities in daily living and at work. Patients with nonspecific chronic wrist pain are regularly referred to a physiotherapist/hand therapist. Immobilization, avoiding excessive wrist load, steroid injections, and various physical therapy methods predominantly focus on the pain itself. However, these methods often do not result in a satisfactory long-term pain relief.
In this article, we will describe the principles behind and content of a sensorimotor control–based exercise program as introduced by Videler et al., modified and substantiated by current insights into sensorimotor control training and wrist kinetics.
Both structure and content of the modified exercise program (SMoC-wrist) are substantiated by recent scientific literature.
A clear 4-level exercise model based on sensorimotor principles is presented, that is, proprioceptive level, conscious static/isometric level, conscious dynamic level, and unconscious dynamic level. The content of each level and the transition toward the next level are described in detail.
Besides the substantiation of the exercise program, possible outcome measures for joint position sense and kinesthesia of the wrist are discussed.
We modified and substantiated a widely used exercise program for patients with nonspecific chronic wrist pain based on recent insights into sensorimotor control principles and wrist kinematics. The presented exercise program (SMoC-wrist) is not primarily focused on reducing pain but on functional reeducation and strengthening of the neuromusculoskeletal system on the basis of sensorimotor control principles.
•Sensorimotor control is essential in training patients with chronic wrist pain.•A widely used sensorimotor control-based exercise program is substantiated by literature.•A clear structure in four distinguished levels is described for intensifying the program.