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Prerequisites

Concepts Course

Course Highlights

  • Make a diagnosis of the site and direction uncontrolled movement in the lumbar spine and relate this to symptoms, functional disability and recurrence of symptoms
  • Identify dysfunction in the local and global muscle systems and relate this to uncontrolled segmental movement and range of movement

Testimonials

'I thoroughly enjoyed the course - I will definately recommend it to colleagues.'

'The concept of identifying the site and direction will really help underpin my assessment.'

'I was familiar with the exercises - now I can use them in the right context'

'A new way of thinking about movement...progression from static stability ideas and tranversus work.'


“We really enjoyed the course and found James to be an excellent and enthusiastic tutor”
 
Rob Hillman BSc (Hons), SRP, MCSP, MMACP
European Tour Physio Unit Director

 

Low Back

Kinetic Control: Managing Movement - Solutions for the Low Back

Mechanical back pain, and the underlying movement dysfunctions that contribute to its development, often seem complex and confusing, especially when clinical decisions are based upon diagnosing pathology and tissue injury.


This is a 4 day course. However we occasionally run it in three parts of two day courses (click on a course name to find out more):

Course Outline

Articular or myofascial restrictions of functional movement are common and part of everyday life. The body normally maintains function by subtly increasing motion elsewhere to compensate for many of these restrictions. If these compensations are effectively controlled, then the body adapts well and stays symptom free. However, if there is inefficient control of compensatory motion, uncontrolled movement develops which can result in symptoms recurrence of symptoms and disability. A subgroup classification of the low back pain population is identified using a recently developed system of assessment of motor control recruitment efficiency.

The diagnosis of uncontrolled movement is based on movement control tests to identify uncontrolled movement in the sagittal, coronal and/or axial planes (Flexion, Extension and Asymmetry). The development of client specific rehab programmes are detailed based on the diagnosis of the site and direction of uncontrolled movement. The course highlights practical integration of the local and global stability muscles to control directional load and strain in the lumbar spine.

Contemporary research has highlighted the importance of the local muscle system’s contribution to maintaining control and function of the lumbo-pelvic region. The assessment and retraining of these muscles is an ongoing source of confusion and debate amongst manual therapists. These muscles provide subtle, though important, fine motor control of the spinal and pelvic stability. There is continuing debate regarding the effectiveness of these muscles in treating low back pain and in the prevention of chronicity and recurrence of musculoskeletal pain. The ‘real’ function of these muscles is gradually becoming clear.

This course examines motor control of trunk stability based on the concept of the local muscles of the trunk creating a dynamic core cylinder. The cylinder concept is developed around local muscle motor control of intersegmental motion. These local muscles which control the cylinder ‘inner core’ include

  • Transversus Abdominis
  • Segmental Lumbar Multifidus
  • Posterior Fasciculus Psoas Major
  • Pelvic Floor
  • Respiratory Diaphragm


If the cylinder model is valid, then these muscles must have efficient recruitment and sophisticated integration processes. If any one of these muscles becomes dysfunctional, the stability of the cylinder will be compromised. This course details assessment of these muscles for motor control dysfunction and presents a variety of retraining strategies to improve recruitment efficiency. These strategies, which are supported by up to date research and clinical evidence, include highly specific motor recruitment facilitation along with more functional low threshold co-activation. Options for integrating this specific local muscle training into ‘normal’ function are presented. This course also uses a pressure biofeedback unit to objectively assess the effectiveness of the integrated co-activation of this local ‘inner core’ cylinder.

Recent academic and clinical evidence highlights the strong link between chronic and recurrent musculo-skeletal pain and altered patterns of recruitment between one joint stabiliser muscles and their multi-joint mobiliser synergists. Restrictions of normal motion are common, and the body normally compensates for these restrictions by increasing motion elsewhere to maintain function. This is a normal adaptive process. In normal functional movement, the brain and CNS are able to utilise a variety of strategies to perform any functional task or movement. Ideally, the brain and CNS will determine the most appropriate strategy for the demands of the functional task.

Although it is accepted that it is normal to compensate for acquired restrictions in order to maintain function, several questions are often asked: “How much compensation is normal?” “When does compensation become abnormal?” “What defines dysfunction?” Increased range of joint motion or compensation is frequently observed but this hypermobile range does not necessarily constitute a stability dysfunction. Stability dysfunction requires a demonstrable lack of neuro-muscular control of joint motion.

As long as the trajectory or path of compensatory motion is well controlled by a balance of forces in the stabiliser and mobiliser synergists, the movement system will cope well. If the recruitment strategy is abnormal, the compensatory motions are not adequately controlled and maladaptive motion results.

This course will help you to identify these altered recruitment patterns, and apply effective management strategies to regain previously restricted motion and to re-establish effective control of maladaptive motion.
The course will review the functional anatomy of the lumbar spine. This course is based on up to date academic and clinical evidence. Movement assessment will be linked to other physiotherapy concepts and modalities. A ‘hands on' practical approach will consolidate learning using patient examples where possible.

Key Features

Course content will include:

  • Presentation of a process to indentify uncontrolled movement at the lumbar spine
  • Strategies to assess for and retrain the direction of uncontrolled movement in the lumbar spine
  • Strategies to assess for and retrain motor control dysfunction of the local stability muscles influencing the lumbar spine
  • Strategies to assess for and retrain motor control dysfunction of the global stability muscles influencing the lumbar spine
  • Review of functional anatomy
  • A clinical reasoning framework to develop and guide a management programme

 

Learning Outcomes

At the end of this course the student should be able to:

 

  • Make a diagnosis of the site and direction uncontrolled movement in the lumbar spine - flexion, extension and asymmetry and relate this to symptoms, functional disability and recurrence of symptoms
  • Identify dysfunction in the local and global muscle systems and relate this to uncontrolled segmental movement and range of movement
  • Use a rating system to record the dysfunction, and as re-assessment tools to guide the rate of progression of an individual patient through their rehab programme
  • Use clinical reasoning framework to prioritise management and plan a progression of rehab
  • Develop an evidence based management plan to improve functional control
  • Apply motor control retraining for uncontrolled movement and influence symptoms, function and recurrence
  • Link movement assessment to other physiotherapy concepts and modalities

 

Programme Outline

Review of uncontrolled movement


Review of functional anatomy of the lumbar spine


Myofascial influences on postural alignment and postural adaptation


Review of postural types


Alignment assessment: [practical]


Kinaesthetic repositioning


Principles and practice of dynamic movement assessment and correction

  • Control of direction
  • Control of translation
  • Control of imbalance – through range control
  • Control of imbalance - extensibility


Clinical decision making and integration of local and global stabiliser recruitment into normal function

  • Rehabilitation strategies
  • Integration of flow chart strategies to develop a framework for dynamic stability progression
  • Strategies and priorities for rehabilitation progression

 

Course Requirements

Kinetic Control courses are designed for medical health professionals such as physiotherapists, osteopaths, chiropractors, podiatrists etc registered with the HPC. In exceptional circumstances experienced non medical health professionals may be allowed to attend Kinetic Control courses but these participants MUST be able demonstrate that the course material is within their scope of practice and that they have appropriate professional liability insurance to cover them for their attendance at the course and the course content.

This course has both theortical and practical elements. Please come prepared for the practical work.

Pre-course Preparation

 

Comerford MJ, Mottram SL. 2001

Functional stability re-training: principles and strategies for managing mechanical dysfunction. Manual Therapy 6:3-14

 

Comerford MJ, Mottram SL. 2001

Movement and stability dysfunction – contemporary developments. Manual Therapy 6:15-26

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