When using Kinetic Control exercises you should be familiar with the principles of stability rehabilitation. Comerford and Mottram (2001) have written an excellent article on the subject and we have summarised some of the principles briefly for you to remember when producing exercise handouts with PhysioTools. Also movement dysfunction rehabilitation as aquatic therapy is briefly introduced.
According to Comerford et al. (2001) movement dysfunction can present at segmental or at multi-segmental level. Multi-segmental dysfunction occurs at multi-segmental level in functional movements and is related to changes (under-activity i.e. give, loss of extensibility i.e. restriction) in myofascial system. Segmental dysfunction can present as articular hypermobility (give) or hypomobility (restriction). Mechanical movement dysfunction can be a combination of segmental and multi-segmental dysfunctions1.
When training the local stability system the aim is to increase muscle stiffness and retrain ability to control the neutral joint position. Ability to produce low force contraction that is consistent is essential. Activation should be incorporated into functional activities and throughout the joint range1.
- low effort tonic activation,
- no fatigue,
- no substitution,
- no pain,
- local stability muscles dominate, however low-load, low-threshold co-activation from global stabilizers1.
When training the global stability system the aim is to train dynamic control (control of direction), to control the ‘give’ and to move the ‘restriction’, and especially retrain the control in the pain provocative movements1.
- 15-20 slow low-effort repetitions,
- only move the adjacent joint/segment through range were the dysfunctional segment/region is dynamically controlled,
- continue until feels natural1.
The ability to actively control the full available range of motion, and especially control rotational forces is important for global stabilizers1.
- 10 times 10 second low-effort contractions,
- in muscles shortened position,
- controlled eccentric return1.
The retraining of global and local stability systems ought to be done simultaneously. Training the control of neutral joint position and the control of direction are usually established as early as possible and they are often trained simultaneously.
If there is lack of extensibility (restriction) in two joint global mobility muscles due to adaptive shortening or excessive use (overuse), compensation may occur elsewhere in the kinetic chain. Extensibility exercises (active inhibitory re-stabilization lengthening techniques (AIR)) and stretches aim to regain extensibility and inhibit over activity of the multi-joint global mobiliser muscles1.
- gently and slowly,
- lengthening until a small failure in maintaining proximal stability is felt due to resistance,
- the loss in stability should be corrected and the position then maintained for 20-30 seconds,
- 3-5 repetitions1.
Extensibility becomes a training priority usually after the underlying problem is under control. Finally integration into functional movements is essential.
Mark Comerford has designed Kinetic Control Cervical Spine, Lumbar Spine, Lumbo-Pelvic and Upper Quadrant modules for PhysioTools. These modules have been compiled to help the therapist provide clear, precise and detailed instruction for the client on movement control retraining to treat musculo-skeletal pain and uncontrolled movement (UCM). The exercises are based on principles and recruitment retraining strategies that were briefly explained above based on the article by Comerford and Mottram on Functional stability retraining.
Aquatic therapy and movement dysfunction
Unique properties of water, in particular buoyancy and drag as well as the metacentric effects, can be utilized also in movement dysfunction retraining.
Aquatic Therapy module by Benjamin Waller (MSc, PT: University of Jyväskylä, Finland) provides an up to date and dynamic set of therapeutic aquatic exercises with specific focus on correction of movement disorders and core stability. Although primarily developed with musculoskeletal problems, sports injuries and postoperative situations in mind, these exercises can be applied to a wide range of groups.
The exercises utilise different water depths, positions and a wide variety of aquatic equipment. In addition to core stability and functional movements the module includes joint mobilising, stretching and strengthening exercises. Different aquatic running techniques are also included with video to assist in client instruction.
PhysioTools modules concerning movement dysfunction
The modules concerning movement dysfunction retraining are Cervical Spine Dynamic Stability/Kinetic Control, Lumbo-Pelvic Dynamic Stability/Kinetic Control, Lumbar Spine Dynamic Stability/Kinetic Control, Upper Quadrant Stability/Kinetic Control, Movement Impairment Correction Exercises (Sahrmann) and Aquatic Therapy (Waller).
1) Comerford MJ, Mottram SL. Masterclass: Functional stability re-training: principles and strategies for managing mechanical dysfunction. Manual Therapy 2001, 6(1):3–14.