Muscle PTSD, Predictive Processing, and Reinforcement Learning: Reimagining and Treating Non-Specific Musculoskeletal Disorders as Mind/Body Conditions

Even following apparent recovery, musculoskeletal pain and injury patients frequently exhibit persistent muscle weakness (Mw), compromising occupational and athletic performance and increasing risks of ongoing pain, osteoarthritis, and repetitive stress injuries. Current clinical approaches undervalue Mw, inadequately testing for, treating, and explaining the phenomenon. Maladaptive learning (neuroplasticity) is pro-posed as a mechanism for central (pain) sensitization. With separate biomechanical contributions to chronic pain, a "muscle, movement, or motor post-traumatic stress disorder" (mPTSD) Model proposes that persistent Mw also stems from maladaptive neuroplasticity. The model suggests that Mw is induced by predictive processing and/or single-trial, two-stage passive avoidance learning, mechanisms potentially re-lying on cerebellar forward modeling. Affected muscles fail to adapt to incoming force—a binary pathology (present or absent) reflected in similarly binary manual muscle testing (MMT) results, as demonstrated by objective analyses. Preliminary evidence suggests that memory reconsolidation disruption can immediately normalize muscle function by eliminating muscle-pain/trauma associations. Like psychoneuroimmunology, which explores conditioning effects on immune function, this suggests "psychoneurokinesiology": studying conditioning's influence on movement. This neuropsychological reconceptualization may establish a new clinical paradigm for non-specific musculoskeletal disorders while potentially addressing unexplored associations to kinesiophobia and functional weakness.