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

• Actin and myosin as contractile proteins

The force/couple relationship

• The prime movers

Neural control

• Reciprocal inhibition: This is the reflex inhibition of antagonistic motor neurons when the agonist’s muscles are contracting.
• 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

• Allows joint stabilization for prolonged periods of time with minimal fatigue

Stretching

• Static stretching, self-myofascial release (SMR), PNF, dynamic and ballistic stretching

Proximal stability (core activation)

• Help to promote lumbar spine stability by bettering the core musculature reflex function
• 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

• Core function
• Static balance
• Dynamic balance

The proximal stability (core function)

• The supine draw-in exercise (centering)
• The quadrupled draw-in exercise with the added movement of the extremities

Proximal mobility (thoracic spine and hips)

Helps to improve the mobility of both the joints that are adjacent to the lumbar spine

Helps in avoiding compensated or undesirable movement patterns

Monoarticulate: When muscle crosses one joint

Biarticulated: When a muscle crosses two joints

Different exercises:

Pelvic Tilts

• Modified dead bug + reverse knee marches, supine bent knee marches

Cat/camel

Mobility for hip flexors

• The half kneeling tri-planar stretch
• hip flexor stretch (lying)

Hamstring mobility exercises

• Lying hamstring stretch

Hip mobilization + glute activation

• Glue to bridge/shoulder bridge
• Supine 90/90 hip rotator stretch

T-spine (thoracic) mobilization exercises

• Spinal twists and spinal extension

Posterior mobilization

• Rocking quadriceps

Proximal stability (around the shoulder)

For bettering the stability in the scapulothoracic area during pushing and pulling type movements

Glenohumeral joint mobility

Requirements for improving stability in the scapulothoracic area

• Thoracic mobility
• Extensibility of tissue by passive and active structures
• 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 periscapular muscles
• The ability to resist an upward gliding motion and impingement of the coracoacromial arch during shoulder movements

CKC (closed chain kinetic) movements

• The distal segment stays more fixed while moving
• Compress and load joints
• Increased proprioception and kinesthetic awareness
• Exercises:

• External and internal humeral rotation, shoulder packing, reverse flies with 90/90, diagonals, CKC weight shifts, prone arm lifts

Distal mobility

Static balance

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

Training conditions:

• Narrow BOS
• Raise COG
• Shift LOG
• Sensory alteration
• Sensory removal

Dynamic balance

When one’s body needs to react to a changing surface

Standing patterns on one leg

Imbalance identification

Exercises

• Single leg static balance
• Single leg stands

The second phase: Movement training for ADLs

Valgus – This is an internal rotation between the tibia and femur where the knees move inward.

Bend and lift

The hip hinge

The alignment of the lower extremity

Figure 4 position

Single Leg

Half kneeling lunge rise

The lunge matrix and lunges

Pushing

Unilateral and bilateral pressing

Thoracic matrix

The overhead press

Pulling

Unilateral and bilateral rowing

Rotational exercises

Hay bailers

Wood shops

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