Postural Restoration - Part 3 Ex presc

PROGRAMMING FOR POSTURAL CORRECTION : 

PROGRAMMING FOR POSTURAL CORRECTION Mark McKean

Postural Progression : 

Postural Progression Local control Global tonic control Global phasic control Specific motor pattern control

Local Stability : 

Local Stability Assume correct/required postural position Contract tonic muscles and improve muscle proprioception to demand Use tonic muscles to hold correct/required postural position Load via antigravity or low thresholds

Weak TA : 

Weak TA Teach correct spinal alignment Teach light (5-30% effort) pelvic floor contractions linking with TA & Rectum contraction e.g. 4 x 10s Integrate breathing into position & extend periods of contraction

Global Stability Control : 

Global Stability Control Assume correct/required postural position Teach limb disassociation by Using mobilising muscles to move one joint slowly to limit of strength of local stabilisers Move two or more joints whilst stabilisers maintain position Increase demands on global stabilisers

Global Mobilisers Control : 

Global Mobilisers Control Positional control of specific phases of pattern – isolated positions Motor Program development with controlled speed Motor program developed at specific speed(stop when speed or technique is lost) Motor pattern development – Spend time developing good motor control of the basic day to day movements. Develop postural stability in the patterns and use this to build on for the ensuing phases

Functional Strength : 

Functional Strength Increase strength in mobilising muscles for functional movements under limits of stability system Assess individual muscle weakness and correct as part of the functional movement Develop strength as well as balance, coordination, reflexes, proprioception by selecting movements and activities that utilise these skills

Specific Strength : 

Specific Strength Develop control in isolation of agonist muscles therefore developing role of antagonists to stabilise, and synergist to assist mobilise Develop basic movements in which those muscles work from the trained static or start position Develop complex movements in which they commence from this static positions Develop dynamic stability from free moving positions into and out of controlled positions

Recovery : 

Recovery Unloading/recovery - cycling load to allow adaptation and prepare for next phase. This also allows time to re-establish basic control of posture and correct any motor pattern abnormalities Use recovery to re-establish stability and maintain postural awareness

Skeletal realignment : 

Skeletal realignment Aim to realign skeleton by Strengthening weak muscles Stretching tight muscles Correct phasic/tonic control Learned corrective behaviors daily Progressive and gradual changes

Writing Programs : 

Writing Programs

Plan for 3-6 months : 

Plan for 3-6 months Develop program plan Educate client on need for each stage of plan Know in advance what you hope to lead into with each phase Commit client to daily repetition of the correct positions and movements

Sample : 

Sample

Development Sequence : 

Development Sequence Isometric exercises to strengthen weak local stabilisers first Stretches to release tight muscles second Single joint limb movement activities with correct postural position e.g hip flexion from supine Basic motor pattern correction single joint only e.g hip flexion to step

Slide 15: 

Basic motor patterns with multi joint movements e.g. squat Functional exercises for reinforcement of motor patterns Specific exercises

Programs : 

Programs Activate weak tonic muscles Stretch tight phasic muscles Follow by most difficult patterned movement person is capable of that requires neural system – functional or specific Activities to maintain limited limb disassociation Stability activities next within own limits Tonic control again Stretch tight muscles only if needed

Exercise Selection : 

Exercise Selection What is the movement or position required? How best can that goal be achieved? What machine or movement can used/modified/modeled in order to achieve the goal? Name the exercise in clients terms

Slide 18: 

Exercise Selection POSTURE – Specific demands of the exercise to maintain good posture PROPRIOCEPTION – Specific proprioceptive demands placed on the body from the exercise PATTERN = Complexity of the pattern of movement of the exercise The 3 P’s

Posture : 

1. The exercise requires no effort to hold posture due to assistance of machine or object that support posture 5. The exercise requires dynamic postural free range control in order to perform the movement correctly Posture

Example : 

Example Lying machine chest press – requires little or no postural control suited to persons needs and training history. Increase loads according to biological adaptation rather than any having to learn control Standing cable chest press – requires more stabilisers to be used to control posture of the trunk and scapula to perform the movement more likely to suit level of control the person can sustain – start with light loads and initially increase reps before increasing load to train postural control

Proprioception : 

1. The exercise requires little or no proprioceptive feedback to assist in the performance of the movement 5. The exercise requires a high degree of proprioceptive feedback in order for the exercise to be performed correctly Proprioception

Example : 

Example Lying machine chest press – requires little or no proprioceptive feedback to perform well. can be any range as there is little proprioceptive learning required to improve technique. Can get into more stressful loading patterns quickly. Alt DB Swissball chest press – high demand on proprioceptive feedback to sustain exercise position and balance during the movement. loads needs to be kept low initially until the person learns to read the feedback and control position of exercise and movement.

Pattern : 

1. Exercise consists of one joint movement with the body remaining stationary 5. The exercise consists of multiple joints moving in coordination with the movement of the whole body Pattern

Example : 

Example Rotator cuff drill – single joint movement requiring basic control of scapula whilst moving humerus need to be matched to performance ability but due to low loads and single joint action, the load can be increased as well as number of reps. Specific muscle require volume training initially Throwing a ball – requires coordination of the whole body to initiate power from the legs and deliver this to the trunk and shoulder require repetition to reinforce complex nature of movement – start with light loads and initially increase reps before increasing loading systems

Summary : 

Summary All activity influences posture – good and bad Be prepared to work at it slowly but correctly Integrate into traditional programs Avoid exercises that will contraindicate persons posture