Level 2: Movement efficiency for the neck and shoulder

COURSE DETAILS

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COURSE INTRODUCTION

Movements of the head, neck and shoulder girdle are both anatomically and biomechanically linked as many of the muscles producing or controlling movement of the neck also produce and control movement of the shoulder. As the neck and shoulder are functionally interdependent it seems clear both should be assessed and retrained together. It is not just these regions that closely interact in the production of efficient movement. All functional movement utilises synergistic patterns of recruitment 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 pain and the site and direction of uncontrolled movement. Changes in their synergies or patterns of recruitment also affects the efficiency of their ability to produce or control movement. Based on a diagnosis of movement control impairment, a clinical reasoning approach can prioritise which synergists are more relevant to test and retrain. Assessing and retraining these muscles to recover their length and recruitment deficiencies can help manage pain, impairment and recurrence.

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COURSE OUTLINE

All functional movement utilises synergistic patterns of recruitment between one-joint stabiliser and multi-joint mobiliser muscles. The proportion of activation and therefore the patterns of synergistic recruitment between these structures varies, depending on the requirements of a particular task. The one-joint muscle synergists are normally more active than their multi-joint mobiliser partners in non-fatiguing ‘normal’ functional activities and postural control tasks. During fatiguing high load or high speed activities the more force and range efficient multi-joint mobiliser synergists contribute the majority of force, with co-contraction of 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. The aberrant patterns appear to be predictable and consistent, and movement tests have been devised to identify when these changes are present. Changes in the contribution of the synergists seems related to changes in sensory motor areas of the brain. This is associated with a 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 in the neck and shoulder do possess an anatomical bias in providing efficient control, a control absent in the presence of movement control impairments. Systematic 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 can identify impairments in these muscles. Specific recruitment efficiency testing of the global stabiliser muscles and subsequent muscle recruitment retraining strategies improve movement efficiency of the neck and shoulder.

Specific testing and inhibitory lengthening techniques can also be employed so as to regain extensibility and reduce recruitment overactivity in the mobiliser synergists of the neck and shoulder. Retraining strategies can be developed to restore optimal movement control to manage symptoms and improve movement. Retraining requires an emphasis on progressing cognitive retraining into function. The course will allow you to match the level of retraining to your patient’s abilities and goals.

KEY FEATURES

  • Predictable changes in length and recruitment of global one-joint stabiliser and multi-joint mobiliser synergists are related to pain and impairment of the neck and shoulder
  • Based on a diagnosis of uncontrolled movement of the neck and shoulder, the anatomical location 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 neck and shoulder is established
  • Testing extensibility and inhibitory retraining options of the global mobiliser muscles is presented
  • Impairment specific retraining of optimal movement control of the neck and shoulder is established

LEARNING OUTCOMES

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

PROGRAMME OUTLINE

  • Why movement matters to the global muscle system
  • Review anatomy and function of the global stabiliser and global mobiliser muscles of the neck and shoulder
  • Functional roles of normal global stabiliser muscles and global mobiliser muscles and how they change in the presence of pain and impairment
  • Review recruitment changes in the patterns of activation of global synergists: evidence and implications for retraining
  • Clinical differentiation of central fatigue versus peripheral fatigue
  • Clinical strategies to facilitate slow motor unit recruitment
  • Analysis of restriction and compensation inter-relationships at intra-articular, inter-articular and regional levels for the neck and shoulder
  • The process of testing and rating recruitment efficiency of global stabiliser muscles
  • Principles of retraining global stabiliser recruitment efficiency throughout range
  • Testing and retraining recruitment efficiency of the global stabiliser muscles of the neck and shoulder
  • Retraining options and progressions for global stabiliser retraining at the neck and shoulder
  • Inhibitory physiology for global mobiliser muscles
  • The process of testing and rating extensibility and overactivity of global mobiliser muscles
  • Principles of regaining global mobiliser extensibility and inhibiting overactivity
  • Testing and retraining the global mobiliser muscles of the neck and shoulder
  • Retraining options and progressions for global mobiliser extensibility of the neck and shoulder
  • Applying motor learning strategies for cognitive recruitment efficiency solutions for movement control impairments of the neck and shoulder
  • 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.