JEMS® has been developed over a period of 25 years and draws from biomechanical, neuromuscular, sensory, psychological and behavioural domains of inquiry to create a holistic, individualised framework for restoring confident, effective, efficient movement.
JEMS®’ roots lie in dynamical systems theory (DST).This theory proposes that movement is produced from the interaction of multiple sub-systems within the person, task and environment (Thelen, 1989). These sub-systems integrate and interact in a specific way, to produce the most efficient movement solution for each specific task (Thelen, 1989). DST also proposes that all sub-systems have a role in this process, without the predominance of one system over another (Thelen, Kelso, & Fogel, 1987). Thus, clinicians need to consider and evaluate all aspects of the task, person, and environment when considering rehabilitation.
Dynamical systems theory starts to make sense of the accumulating evidence that a disproportionate focus on one sub system does not necessarily lead to effective functional transference in the patient. Recently, manual therapy has suffered criticism due to lack of sufficient support in the literature for this very reason (Jull and Moore, 2012; Rubinstein 2011, 2012), and this is an excellent example of the challenge faced by the modern clinician who seeks to work in an evidence informed manner. In the clinical context, manual therapy in isolation is not well supported, but it can play a relevant role in the early stages of the rehabilitation process as part of a coherent mix of interactions and techniques to meet the individual patient’s needs, and when applied with careful consideration of the accompanying messages delivered to the patient.
In the field of rehabilitation, stability programmes have been heavily weighted over the past fifteen years, yet systematic reviews of their effectiveness do not yield convincing results (Lim et al, 2011; Pereira et al, 2012; Rockwitz et al, 2006), despite a general belief amongst rehabilitation professionals that this approach is evidence based. While there are many papers which confirm that specific “stabilising” muscles can be facilitated through motor control exercise, there are far fewer which indicate that such behaviour transfers to functional movement, as demonstrated in papers such as those by Critchley et al, 2011 and Vasseljen et al, 2012.
Where once stability and strength were predominant themes in rehabilitation, further research indicates that excessive co-contraction, i.e. too much stabilisation and insufficient neuromuscular variability are evident in populations with poor outcomes (Grenier and McGill, 2008; Lamoth et al, 2006; Tsai et al, 2012), whereas balance and proprioception training can enhance function and postural control while reducing excessive co contraction (Nagai et al, 2012). It is through dynamical systems theory that neuromuscular programmes yield much more positive results e.g. Barendarecht et al, 2011, as they provide a mixture of stimuli, including high and low threshold activities, perturbation tasks and proprioceptive challenges.
Furthermore, the effect of emotional response and psychological state are increasingly being identified as key influences in the outcomes for non specific low back pain (O’Sullivan P, 2012) requiring clinicians to acquire a greater understanding of how these factors influence movement and postural responses, as well as learning effective coaching strategies which empower their patients.
In understanding dynamical systems theory, it is possible to appreciate the shortcomings of a reductionist application of research findings to clinical practice. Research by nature must narrow its field of inquiry in order to ascertain the answer to a specific research question, and such results contribute to our understanding of discrete factors involving the patient experience. However the patient in reality represents an amalgam of many factors, and the clinician must be able to assess and treat in a way that accounts for the interplay of these factors.
Examining the current research arising from a broad array of subject areas enables JEMS® to identify functionally relevant connections in the field of human movement. By using the Holistic Functional Model, clinicians are able to consider the patient in context, connecting the presenting issue to the body’s global functional relationships, the functional tasks which they must perform, the environment within which they must function, and the influences of arousal i.e. their physiological and behavioural responses to emotion and beliefs. By understanding key principles within the model, they are able to determine which of these domains is initially of most significance, taking this as their start point, while also establishing a clear goal to guide progression.
JEMS® provides a structured framework and progressive education which guides clinicians to develop their ability to integrate the available research into a systematic, patient centred approach. Given that pathology has not been shown to necessarily be the determining feature of a patient’s presentation and progress, this approach is a practical method for implementing contemporary rehabilitation and pain research. Through analysis of movement and patient response, clinicians learn to identify the effects of common neuromuscular dysfunctions and link them to patient presentation, effectively moving them on from identifying “where” the site of pain experience is to “why” and “how” it has arisen.
In order to achieve the desired effects from specific techniques, the clinician must learn to manage the entire interpersonal interaction and structure of the session in order to achieve meaningful progress. Fostering independence and increasing patient confidence in their own context and environment are JEMS® key aims, and as such, management of the therapist/patient interaction to promote self efficacy development is prioritised. This is delivered through setting up mastery experiences (Bandura, 1994) and through the content and timing of feedback in order to emphasise process over outcome (Zimmerman and Kitsantas, 1997). Communicating in this way enables the patient to develop a sense of control and ability to problem solve for themselves, which is critical for them to meet the numerous and varying challenges of their own lives as well as the successful implementation of a movement programme.
Similarly, JEMS® draws from the motor learning literature to develop more effective skills and greater clinician self awareness when offering augmented feedback in order to foster independent learning in the patient (Butki and Hoffman, 2003).
JEMS® is principle based, rather than protocol based. This provides the clinician with a flexible, responsive approach, which creates space for creativity yet still provides the security of an evidence informed foundation upon which to base their choices. This requires development of the clinician’s own clinical skills, and an enhanced degree of self awareness and self regulation. By focusing on development of critical thought, clinical reasoning and skilled application, clinicians are able to avoid prescriptive routines, instead responding to the individual patient by identifying a choice of routes by which they can proceed, modifications to enable success, teaching methodology, and facilitation and cuing techniques to promote the learning process. In doing so, they learn to problem solve and address a wide variety of presentations presentation with a high degree of functional specificity, using simple but systematic techniques.
JEMS® is therefore a framework which,although it also provides it’s own library of unique and original movement experiences and exercises, is a coherent model which integrates a clinician’s existing skill base into the broader context, connecting the different techniques and approaches that they have acquired, rather than replacing them.
Course participants thus regularly report that “JEMS® is the glue that brings everything together”.
Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.),Encyclopedia of human behavior (Vol. 4, pp. 71-81). New York: Academic Press. (Reprinted in H. Friedman [Ed.], Encyclopedia of mental health. San Diego: Academic Press, 1998).
Butki BD, Hoffman SJ.2003 Effects of reducing frequency of intrinsic knowledge of results on the learning of a motor skill. Percept Mot Skills. 97(2):569-80.
Critchley D, Pierson Z and Battersby G (2011) Effect of pilates mat exercises and conventional exercise programmes on transversus abdominis and obliquus internus abdominis activity: Pilot randomized trial. Manual Therapy 16: 183-189
Jull G, Moore A. 2012. Hands on, hands off? The swings in musculoskeletal physiotherapy practice. Man Ther. 17(3):199-200
Lim EC, Poh RL, Low AY and Wong WP (2011) Effects of Pilates- based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. J Orthop Sports Phys Ther 41(2): 70-80
Nagai K, Yamada M, Tanaka B, Uemura K, Mori S, Aoyama T, Ichihashi N, Tsuboyama T. 2012 Effects of balance training on muscle coactivation during postural control in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2012 Aug;67(8):882-9.
O’Sullivan, P. 2012 It’s time for change with the management of non-specific chronic low back pain Br J Sports Med March 46 (4) doi: 10.1136/bjsm.2010.081638
Pereira LM, Obara K, Dias JM, Menacho MO, Guariglia DA, Schiavoni D, Pereira HM and Cardoso JR (2012) Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta- analysis. Clin Rehabil 26(1): 10-20
Reeves NP, Narendra KS and Cholewicki J (2007) Spine stability: the six blind men and the elephant. Clin Biomechs 22(3): 266-74
Rockwitz B, de Bie R, Limm H, von Garnier K, Ewert T and Stucki G (2006) Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin Rehabil 20(7): 553-67
Rubinstein SM1, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. 2012. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 12;(9):CD008880
Rubinstein SM1, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW. 2011. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 16;(2):CD008112
Thelen, E (1989). The (re)discovery of motor development: Learning new things from an old field. Developmental Psychology, 25(6), 946-949.
Thelen, E., Kelso, J. A. S., & Fogel, A. (1987). Self-organizing systems and infant motor development. Developmental Review, 7, 39-65
Tsai LC, McLean S, Colletti PM, Powers CM. (2012) Greater muscle co-contraction results in increased tibiofemoral compressive forces in females who have undergone anterior cruciate ligament reconstruction. J Orthop Res. 2012 Dec;30(12):2007-14
Vasseljen O, Unsgaard-Tøndel M, Westad C, and Mork PJ (2012) Effect of core stability exercises on feed-forward activation of deep abdominal muscles in chronic low back pain: a randomized controlled trial. Spine 37(13): 1101-8
Zimmerman, B. J., & Kitsantas, A. (1997). Developmental phases in self-regulation: Shifting from process to outcome goals. Journal of Educational Psychology, 89, 29- 36.