ACE CPT Chapter 9 – Functional Programming for Stability-Mobility and Movement

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Movement

  • Joint stability – The ability of a person to control and maintain the joint position or movement
  • Joint mobility – This is the amount (range) of uninhibited movement around a body segment or joint
  • Arthrokinematics – This is motor output and sensory input based on physiological and neurological systems. It also includes joint mechanics.
  • The length/tension relationship
    1. Actin and myosin as contractile proteins
  • The force/couple relationship
    1. The prime movers
  • Neural control
    1. Reciprocal inhibition: This is the reflex inhibition of antagonistic motor neurons during the time that agonist muscles are contracting.
    2. Synergistic dominance: This happens when synergistic muscles carry out the primary movements/functions of an inhibited/weakened prime mover

The first phase: Stability and mobility training

  • The first phase is meant to restore good levels of mobility and stability within the client’s body
  • Slow twitch muscle fibers: Improve the muscular endurance of stabilizer muscles
    1. Allows joint stabilization for prolonged periods of time with minimal fatigue
  • Stretching
    1. Static stretching, self-myofascial release (SMR), PNF, dynamic and ballistic stretching
  • Proximal stability (core activation)
    1. Help to promote lumbar spine stability by bettering the core musculature reflex function
    2. The innermost layer of core
      • The vertebral discs/bones and ligaments of the spine on both the back and front of the spinal column
  • The three stages
    1. Core function
    2. Static balance
    3. Dynamic balance
  • The proximal stability (core function)
    1. The supine draw in exercise (centering)
    2. The quadrupled draw in exercise with added movement of the extremities
  • Proximal mobility (thoracic spine and hips)
    1. Helps to improve the mobility of both the joints that are adjacent to the lumbar spine
    2. Helps in avoiding compensated or undesirable movement patterns
    3. Monoarticulate: When muscle crosses one joint
    4. Biarticulated: When a muscle crosses to joints
    5. Different exercises:
      • Pelvic Tilts
        1. Modified dead bug + reverse knee marches, supine bent knee marches
      • Cat/camel
      • Mobility for hip flexors
        1. The half kneeling triplanar stretch
        2. hip flexor stretch (lying)
      • Hamstring mobility exercises
        1. Lying hamstring stretch
      • Hip mobilization + glute activation
        1. Glue to bridge/shoulder bridge
        2. Supine 90/90 hip rotator stretch
      • T-spine (thoracic) mobilization exercises
        1. Spinal twists and spinal extension
      • Posterior mobilization
        1. Rocking quadriceps
  • Proximal stability (around the shoulder)
    1. For bettering the stability in the scapulothoracic area during pushing and pulling type movements
    2. Glenohumeral joint mobility
    3. Requirements for improving stability in the scapulothoracic area
      • Thoracic mobility
      • Extensibility of tissue by passive and active structures
        1. Self-myofascial release, posterior capsule stretches, inferior capsule stretch, superior capsule stretch and anterior capsule stretch (for pecs).
      • Healthy muscle functions of the rotator cuffs
      • Good muscle balance in the parascapular muscles
      • The ability to resist an upward gliding motion and impingement of the coracoacromial arch during shoulder movements
      • CKC (closed chain kinetic) movements
        1. The distal segment stays more fixed while moving
        2. Compress and load joints
        3. Increased proprioception and kinesthetic awareness
        4. Exercises
          • External and internal humeral rotation, shoulder packing, reverse flies with 90/90, diagonals, CKC weight shifts, prone arm lifts
  • Distal mobility
  • Static balance
    1. The variables of training
      • 2 to 3 sessions per week
      • Perform at the beginning of the routine
      • One set of between two and four repetitions. Each for between five and 10 seconds
    2. Training conditions
      • Narrow BOS
      • Raise COG
      • Shift LOG
      • Sensory alteration
      • Sensory removal
  • Dynamic balance:
    1. When one’s body needs to react to a changing surface
  • Standing patterns on one leg
    1. Imbalance identification
    2. Exercises
      • Single leg static balance
      • Single leg stands

The second phase: Movement training for ADL’s

  • Valgus – This is an internal rotation between the tibia and femur where the knees move inward
  • Bend and lift
    1. The hip hinge
    2. The alignment of the lower extremity
    3. Figure 4 position
  • Single Leg
    1. Half kneeling lunge rise
    2. The lunge matrix and lunges
  • Pushing
    1. Unilateral and bilateral pressing
    2. Thoracic matrix
    3. The overhead press
  • Pulling
    1. Unilateral and bilateral rowing
  • Rotational exercises
    1. Hay bailers
    2. Wood shops