Movements of the low back and hip are both anatomically and biomechanically linked with many of the muscles responsible for producing or managing movement at one region producing or controlling movement at the other. Due to this interdependent relationship effective assessment and retraining of movement requires these regions to be considered in concert. It also is becoming increasingly apparent in the literature all functional movement utilises synergistic patterns of recruitment with a varied mix of contribution between one-joint stabiliser and multi-joint mobiliser muscles. Predictable and consistent impairments in the co-ordinated activation of these synergists has been associated with both pain and the site and direction of uncontrolled movement. Changes in the length tension properties of these synergists also alters the efficiency of their ability to produce or control movement
A structured and systematic process of assessment, leading to a diagnosis of movement control impairment, allows for a clinical reasoning approach to prioritise which synergists are more relevant to retrain. Assessing and retraining these muscles so as to manage their length and recruitment deficiencies can help manage pain, recurrence of pain and improve function.
All functional movement utilises synergistic patterns of recruitment between one-joint stabiliser and multi-joint mobiliser muscles. In order to sustain task achievement, and to accommodate changing environments, these patterns typically vary depending on the requirements of a particular task. In ‘normal’ non-fatiguing activities and tasks of postural control, one-joint muscle synergists are normally more active than their multi-joint mobiliser counterparts. During fatiguing high load or high speed activities the more force and range efficient multi-joint mobiliser synergists supply the majority of contribution although there is significant co-contraction with their less force efficient stabiliser partners.
Neurophysiology research has determined that people with pain, a history of previous pain / injury or fatigue, demonstrate aberrant patterns of synergist recruitment in slow, non-fatiguing tasks and movements. These aberrant patterns are related to inhibition or inefficient recruitment of the one-joint stabilisers and increased activation and overactivity of the multi-joint mobiliser synergists. These aberrant patterns appear to be predictable and consistent. These changes in synergist recruitment are related to changes in sensory motor areas of the brain. There appears to be predictable inhibition and central ‘down-regulation’ of the stabiliser synergists, while at the same time there is central ‘up-regulation’ and increased central drive of the mobiliser synergists. Specific global stabiliser muscles of the low back and hip possess an anatomical advantage in providing control of the diagnosed movement control impairments. Cognitive movement control tests have been devised to identify when such impairments are present.
Analysis of the anatomical and biomechanical links between global stabiliser muscles and the diagnosis of the site and direction of movement control impairments allows for clinical prioritisation in both assessment and retraining. Evaluation of the recruitment efficiency of the one-joint global stabiliser muscles and excessive mobiliser substitution throughout range, during non-fatiguing movement testing identifies impairments in these muscles.
Specific recruitment efficiency testing of the global stabiliser muscles and subsequent muscle recruitment retraining strategies seek to restore movement efficiency of the stabiliser synergists of the low back and hip. Specific testing and inhibitory lengthening techniques supply the means to regain extensibility and reduce recruitment overactivity in the mobiliser synergists. Retraining strategies are developed to return optimal movement control, a process allowing for the management of symptoms. Retraining requires an emphasis on progressing cognitive retraining strategies back into function and everyday task achievement. This course will allow you to match the level of retraining required to your patient’s abilities and goals.
- Predictable changes in length and recruitment of global one-joint stabiliser and multi-joint mobiliser synergists are related to pain and impairment of the low back and hip
- Based on a diagnosis of uncontrolled movement of the low back and hip, the anatomical location of stabiliser and mobiliser synergists can be used to prioritise the assessment of recruitment and length of the synergists
- Testing and retraining recruitment efficiency of global stabiliser muscles of the low back and hip is established
- Testing extensibility and inhibitory retraining options of the global mobiliser muscles is presented
- Impairment specific retraining of optimal movement control of the low back and hip is established
At the end of this course the participant should be able to:
- Relate movement and synergistic recruitment patterns and consider how changes to these patterns influence pain, recurrence and function
- Display an enhanced understanding of some physiological changes associated with aberrant synergistic recruitment patterns
- Demonstrate an understanding of the differences and implications of low threshold slow motor unit recruitment and high threshold fast motor unit recruitment
- Demonstrate an awareness of the factors that influence muscle stiffness and discuss how these factors can be used in movement retraining to influence function
- Display an ability to analyse the interactions between restrictions and compensations to maintain function in the low back and hip, from an intra-articular, inter-articular and regional perspective
- Demonstrate the ability to assess the recruitment efficiency of the global stability muscles that control the range of movement at the low back and hip
- Demonstrate the ability to assess for loss of extensibility and aberrant recruitment substitutions of the global mobility muscles that contribute to movement control impairments of the low back and hip
- Display options for movement retraining in addition to acquiring the ability to match the level of retraining to your patient’s abilities and goals
- Looking at muscle synergies
- Review anatomy and function of the muscles of the low back and hip
- The functional roles of these muscles and how these change in the presence of pain and impairment
- Neurophysiological changes associated with aberrant synergistic recruitment patterns
- A movement impairment model
- Factors influencing muscle stiffness and how movement training can help
- Analysis of restriction and compensation inter-relationships at intra-articular, inter-articular and regional levels for the low back and hip
- The process of testing and rating recruitment efficiency of global stabiliser muscles
- Principles of retraining global stabiliser recruitment efficiency throughout range
- Retraining options and progressions for global stabiliser retraining at the low back and hip
- The process of testing and rating extensibility and overactivity of global mobiliser muscles
- Principles of regaining global mobiliser extensibility and inhibiting overactivity
- Retraining options and progressions for global mobiliser extensibility of the low back and hip
- Cognitive recruitment efficiency solutions for movement control impairments of the low back and hip
- Matching recruitment efficiency retraining to the client’s / patient’s goals and priorities
During these courses:
- We’ll look at how changes in muscle recruitment can relate to movement impairments
- You can start to evaluate the recruitment efficiency of the local and global muscle systems
- At this stage you will experience additional practical applications of movement retraining strategies to help restore recruitment efficiency
- You will further develop your skills for cognitive motor learning
- Learn new strategies to recover the ideal recruitment and length of the overactive multi-joint muscles
By the end of the courses you will:
- Have acquired the necessary assessment skills to implement tests to evaluate muscle efficiency
- Developed a better understanding of the relationship between movement impairments and muscle efficiency
- Have at your disposal a range of effective strategies for helping your patients recover ideal recruitment and length of multi-joint global synergists and improve their function
- There will be an opportunity for us to consider the neuroscience underpinning the principles recruitment efficiency, impaired function and recurrence of symptoms
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.