Therapeutic Exercise Prescription III

Motor control

Ability to regulate or direct the mechanisms essential to movement, need to consider role of cns, peripheral sensory and motor nervous systems, environment and individual

Stability in a closed predictable environment

Sitting or standing on a non moving surface

Stability in an open unpredictable environment

Sitting or standing on foam or a rocker board

Mobility in a closed predictable environment

Walking or a non moving surface

Mobility in an open unpredictable environment

Walking on an uneven surface

Core stability

Ability to control position and motion of trunk over the pelvic to allow optimum production, transfer and control of force and motion

Local muscles

Insert onto vertebral column, provide joint stability, optimise postural control, work in background of all movements, minimal torque, usually one joint muscles

Global muscles

Insert onto pelvic or ribcage, control of spinal orientation

One joint global muscles

Predominantly responsible for joint support and protection

Multi joint global muscles

Non weight bearing, torque producers, high load large range or high speed role, optimises rapid acceleration movement and production of high force and power, recruited as required

Characteristics of local muscles

Stabilisers, tonic activation, type one fibres, often deep and placed close to joints, activation does not interfere with movements, minimal torque production role, minimises force generated by torque producers 

Characteristics of global muscles

Mobilisers, voluntary control, phasic activation, type two b fibres, placed further from axis of rotation, significant length change with different activities, increased torque production role

Characteristics of one joint global muscles

Stabilisers, combine elements of both - rotator cuff and deep hip external rotators

Tests for assessing trunk strength, endurance and control

Need patient to maintain neutral spine, require efficient integration of local and global muscle activation

Functional tests

Not specific to a particular muscle, assess technique and capability of patient to perform task

Motor control tests

Involves low to medium loads, often performed with a pressure biofeedback tool

Considerations for targeting local or global muscles - variability

Core stability is not stiff spine, movement of spine important for spinal health, need lumbo pelvic contribution to rom, need control in variety of trunk and limb positions

Recruitment of spinal muscles

Local stabilisers recruited before large global muscles, exercises to improve neurovascular control of local stabilisers

Characteristics needs to understand whether local or global are recruited

Weight bearing or nwb, static or dynamic, high or low load, high or low speed, eccentric or concentric, inner or outer rom

Dosage of balance exercises

Daily, three hours per week required to reduce risk of fall, low load and good quality, rest as required but often 

ACSM for children

60 minutes or more of moderate to vigorous activity daily, vigorous intensity at least three days a week, include muscle strengthening physical activity on at least three days a week, include bone strengthening physical activity on at least three days a week