Level 2: Targeting Local Muscle Training

COURSE DETAILS

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Course Introduction

  • Muscles possessing a local stability role are typically the deepest of all muscles, with a biomechanical advantage to control intersegmental displacement (translation) during functional movements. These structures are not efficient at producing or controlling range of motion.
  • All functional movements are seen to create reactive perturbations (displacement) in the spine and proximal motion segments. In normal function, these muscles activate prior to (or simultaneously with) the global muscles in anticipation of this predicted proximal perturbation therefore providing a mechanism of protection against repetitive uncontrolled translation.
  • Research has shown that in the presence of pain (or a recent history of pain) or recurrent pain, the normal timing of this feedforward mechanism can be predictably and consistently delayed.
  • There are indications to suggest that the consistent failure of this feedforward recruitment contributes to a mechanism of insidious symptom recurrence. Retraining these muscles can significantly reduce the high incidence of musculoskeletal pain recurrence following the first episode
  • Clinical tests have been devised to evaluate the recruitment efficiency of these local stabiliser muscles and specific retraining strategies have been developed to recover their recruitment efficiency

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COURSE OUTLINE

  • Muscles that have a local stability role are recruited in all functional movements.
  • They are the deepest of all muscles and are biomechanically advantaged to control intersegmental displacement/translation by being located close to the axis of motion or by generating fascial tension across multiple segments. Biomechanically, these muscles are not efficient at producing or controlling range of motion
  • All functional movements create reactive perturbations (displacement) in the spine and proximal motion segments. In the absence of pain or a history of pain, these muscles activate prior to (or the same time as) the global muscles of range of motion in anticipation of this predicted proximal perturbation to provide a mechanism of protection against repetitive uncontrolled translation. The timing of this anticipatory feedforward recruitment is independent of direction of the force of motion
  • Research has shown that in the presence of pain (or a recent history of pain) or recurrent pain, the normal timing of this feedforward mechanism is predictably delayed. This feedforward failure is also independent of the type or the nature of pain.
  • In a large proportion of people after the first episode of pain, these muscles fail to recover their feedforward recruitment. There are indications to suggest that this consistent failure of the forward recruitment contributes to a mechanism of insidious symptom recurrence.
  • Studies have shown that retraining these local muscles to recover their recruitment physiology and cross-sectional size can significantly reduce the normally high incidence of musculoskeletal pain recurrence after the first episode.
  • Trying to retrain local muscles to recover their recruitment deficiencies have not been shown to be effective in making significant changes to pain in the current episode when applied to non-specific pain populations. However, a ‘washout’ effect appears to contribute to this. Based on clinical observations, the subgroup of patients whose symptoms will respond to local muscle retraining can be identified in order to prioritise the patients who should start with early local muscle training in the rehab process as opposed to those who should leave local muscle training to later in the process
  • Clinical tests have been devised to evaluate the recruitment efficiency of these local stabiliser muscles in the low back, hip, neck and shoulder
  • Specific cognitive retraining strategies have been developed to recover recruitment efficiency so as to improve or correct deficiencies in local stabiliser muscle feedforward recruitment
  • Retraining requires an emphasis on progressing and integrating cognitive retraining into function
  • The course will allow you to match the level of retraining needed to your patient’s abilities and goals

Key Features

  • Consider the predictable and consistent changes in recruitment neurophysiology of the local stabiliser muscles developed in the presence of pain
  • Identify the failure to recover the deficiencies in recruitment of these muscles is strongly linked to pain recurrence
  • Identify the subgroup of patients whose symptoms respond to local muscle training, improving clinical decision-making processes regarding who should start with early local muscle training in rehab
  • Present clinical testing of recruitment efficiency of the local stabiliser muscles of the low back, hip, knee and shoulder regions
  • Consider specific cognitive retraining and integration into function of local muscle recruitment efficiency of the low back and hip

Learning Outcomes

At the end of this course the participant should be able to:
  • Explain the importance of movement in relation to local muscle feedforward recruitment occurring in normal function.
  • Demonstrate an ability to explain the anatomical and neurophysiological differences between local and global muscles
  • Explain the functional implications of the differences in the roles of local muscle vs global muscles
  • Demonstrate an understanding of the neurophysiology and the evidence seen to report on the changes in local stability muscles, related to pain and impairment
  • Explain the differences between disuse atrophy and pain related recruitment inhibition when changes in muscle cross-section are evident.
  • Demonstrate clinical reasoning ability so as to develop appropriate strategies to recover muscle cross-section related to pain inhibition vs recovering muscle bulk associated with disuse atrophy
  • Display an awareness of the reasoning processes behind testing and retraining cognitive recruitment efficiency as a measure of impairment in local stabiliser muscles
  • Demonstrate the ability to discuss the process of clinically assessing local muscles for recruitment efficiency
  • Demonstrate the ability to assess the cognitive recruitment efficiency of the local stability muscles that control intersegmental displacement/translation at the low back, hip, neck and shoulder
  • Demonstrate awareness of a variety of clinical options to regain recruitment efficiency in local stabiliser muscles and to be able to support the most appropriate retraining options with clinical reasoning
  • Demonstrate an understanding of how and when to prioritise assessing and retraining local stabiliser recruitment impairments in movement retraining. Acquire the ability to match the level of retraining to your patient’s abilities and goals

Programme Outline

  • Why movement matters to the local muscle system. Review anticipatory feedforward recruitment of local stabiliser muscles in providing protective control of intersegmental displacement in functional movements
  • Review anatomy and function of the local stabiliser muscles of the low back, hip , neck and shoulder
  • Review the roles of normal local stabiliser muscles and how they change in the presence of pain and impairment.
  • Examine the evidence for impairment of these muscles associated to pain and history of recurrent pain
  • Principles of the clinical evaluation of recruitment efficiency of local stabiliser muscles
  • The process of the testing and rating cognitive recruitment efficiency of local muscles
  • The process of the testing and rating cognitive recruitment efficiency of local muscles
  • Principles and strategies of retraining local stabiliser recruitment efficiency to control intersegmental displacement and segmental translation
  • Clinical testing of cognitive recruitment efficiency of the local stabiliser muscles of the low back, hip , neck and shoulder
  • Identifying optimal retraining strategies and progressions for local stabiliser retraining of the low back, hip , neck and shoulder
  • Applying motor learning strategies for cognitive recruitment efficiency of the local stabiliser muscles of the low back, hip , 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 symptom

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.