Module: Muscle Synergies

Managing translation through
local muscle synergists


Course Introduction

This course gives clinicians the ability to identify both exactly when and how to retrain translation control deficits within their patients. It supplies targeted retraining strategies to manage episodes of recurrence at the neck, shoulder, hip and low back. Over the past 20 years large amounts of literature has considered the local/translation control role of a number of muscles. This course supplies the contemporary clinical application of this research, and questions many of the long-held beliefs regarding the assessment, retraining and function of muscles possessing a local stabiliser role. It gives clinicians a systemised framework for the management of recurrence through an evidence based assessment and retraining of multiple local stabiliser muscle synergists. 

The course presents the case of how this approach is not preventative in nature but can significantly impact recurrence when applied within a clinical reasoning framework. It identifies exactly where local stabiliser focussed retraining fits in to the bigger clinical picture for any patient. The course supplies methods to identify how and when to decide to use ‘overflow’ strategies from other local stablisers and supplies a rating system of recruitment efficiency, allowing each patient’s intervention to be highly time efficient. Ultimately, the course considers muscle synergist’s translation control capabilities so as to reduce recurrence and restore confident, sustained pain-free function. Practical skills will be gained in managing these impairments at the hip, shoulder, neck and low back to manage persisting presentations.




Functional movement creates reactive perturbations in the spine and proximal motion segments. In normal function, muscles with a control of translation role, activate to provide protection against repetitive, uncontrolled translation. Yet, due to the acute presence or a history of pain, recruitment of the local control muscles can be delayed. Research suggests consistent failure of this feedforward recruitment contributes to recurrence. However, targeted retraining can significantly reduce the high incidence of musculoskeletal pain recurrence.



This course harnesses the wealth of knowledge and clinical mileage amassed over a number of decades to deliver contemporary clinical tests, evaluating the recruitment efficiency of local stabiliser muscles, in addition to specific retraining strategies to recover their recruitment efficiency. The course explains the reasoning behind why trying to retrain local muscles to recover their recruitment deficiencies is seen not to be effective in making significant changes to pain in the current episode when applied to non-specific pain populations, due to the presence of a ‘washout’ effect within studies. The course identifies how a subgroup of patients whose symptoms will respond to local muscle retraining can be identified allowing for a more effective and time efficient rehab intervention. The course also introduces specific cognitive retraining strategies to change local stabiliser muscle feedforward recruitment, emphasising the need to progress into day to day function. Reducing recurrence and restoring confident, sustained pain-free function through targeted retraining of the local stabiliser system is the underpinning aim of the course.

Key Features

  • Identifies subgroup of patients whose symptoms respond to local muscle retraining, improving clinical decision-making processes regarding who should start with early or late, local muscle training in rehab
  • Supplies a targeted retraining intervention, allowing clinicians to be increasingly time efficient in addressing their patients’ recurrence risk
  • Supplies therapists with the clinical reasoning and skillset to manage the complexities of deficits within local stabiliser synergists 
  • Practical strategies for managing presentations at hip, shoulder, neck and low back
  • Develops skills to successfully use clinical tools and a movement focussed framework to change the mechanisms of movement impairment associated to local stabiliser system
  • Allows for integration of translation control retraining alongside other movement interventions

Learning Outcomes

At the end of this course the participant should be able to:
  • Assess and retrain impairments in the local stabiliser system related to a patient’s risk of recurrence
  • Employ a clinical reasoning framework to identify which patients require this approach and when
  • Display enhanced skills of cueing and facilitation
  • Critically appraise the current employment of local stabiliser assessment and retraining in light of the current body of evidence    

Programme Outline

  • Why movement matters to the local muscle system and vice versa. Review anticipatory feed-forward recruitment of local stabiliser muscles in providing protective control of inter-segmental displacement in functional movements
  • Review anatomy and function of local stabiliser muscles of low back, hip, neck and shoulder
  • Review roles of normal local stabiliser muscles and how they can 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
  • Principles and strategies of retraining local stabiliser recruitment efficiency to control inter-segmental displacement and segmental translation with particular attention to presentations at the hip, shoulder and neck and low back/pelvis
  • Clinical testing of cognitive recruitment efficiency of local stabiliser muscles of low back, hip, neck and shoulder
  • Identifying optimal retraining strategies and progressions for local stabiliser retraining of low back, hip, neck and shoulder
  • Applying motor learning strategies for cognitive recruitment efficiency of the local stabiliser muscles of 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.