Chapter 9 – Functional Programming for Stability-Mobility and Movement

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    1. Movement
      1. Joint stability: ability to maintain or control joint movement or position
      2. Joint mobility: range of uninhibited movement around a joint or body segment
      3. Arthrokinematics: sensory input and motor output based on neurological and physiological systems, as well as proper joint mechanics
      4. Length-tension relationships
        1. Contractile proteins: actin and myosin
      5. Force-couple relationships
        1. Prime mover
      6. Neural control
        1. Reciprocal inhibition: reflex inhibition of motor neurons of antagonists when agonist muscles are contracted
        2. Synergistic dominance: condition in which the synergist carry out the primary function of a weakened or inhibited prime mover
    2. Phase 1: Stability and Mobility Training – reestablish appropriate levels of stability and mobility within the body
      1. Slow-twitch muscle fibers: enhance stabilizer muscle endurance
        1. Allows muscles to stabilize joints for extended periods of time without fatiguing
      2. Stretching
        1. SMR, static, PNF, dynamic and ballistic
      3. Proximal stability: activating the core
        1. Promote stability of the lumbar spine by improving reflex function of the core musculature
        2. Deep/innermost layer of core
          1. Vertebral bones and disks, spinal ligaments on front and back of spinal column,
        3. 3 stages
          1. Core function
          2. Static balance
          3. Dynamic balance
      4. Proximal stability: core function
        1. Supine drawing-in exercise (centering)
        2. Quadruped drawing-in exercise with extremity movement
      5. Proximal mobility: hips and thoracic spine
        1. Improve mobility of the two joints immediately adjacent to the lumbar spine
        2. Avoid undesirable or compensated movements
        3. Monoarticulate: muscle crosses one joint
        4. Biarticulated: muscle crosses two joints
        5. Exercises –
          1. cat-camel
          2. pelvic tilts
            1. supine bent-knee marches, modified dead bug with reverse knee marches
          3. hip flexor mobility
            1. lying hip flexor stretch
            2. half-kneeling triplanar stretch
          4. hamstring mobility
            1. lying hamstring stretch
          5. hip mobilization with glute activation
            1. shoulder bridge (glute bridge)
            2. supine 90-90hip rotator stretch
          6. thoracic spine (T-spine) mobilization exercises
            1. spinal extension and spinal twists
          7. posterior mobilization
            1. rocking quadrapeds
      6. Proximal stability around the shoulder
        1. Improve stability within the scapulothoracic region during upper-extremity movements (push/pull type movements)
        2. Glenohumeral joint mobility
        3. Promoting stability within the scapulothoracic region requirements
          1. Thoracic mobility
          2. Tissue extensibility (through active and passive structures)
            1. SMR, inferior capsule stretch, posterior capsule stretches, anterior capsule (pecctoralis) stretch, superior capsule stretch
          3. Healthy rotator cuff muscle function
          4. Muscle balance within the parascapular muscles
          5. Ability to resist upward glide and impingement against the coracoacromial arch during deltoid action
          6. Closed-chain kinetic (CKC) movements
            1. Distal segment is more fixed during movement
            2. Load and compress joints
            3. Increase kinesthetic awareness and proprioception
            4. Exercises
              1. Shoulder packing, internal and external humeral rotation, diagonals, reverse flys with supine 90-90, prone arm lifts, CKC weight shifts
      7. Distal mobility
      8. Static balance
        1. Training variables
          1. 2-3 times per week
          2. Do at beginning of workout
          3. 1 set of 2-4 reps, each for 5-10 seconds
        2. Training conditions
          1. Narrow BOS
          2. Raise COG
          3. Shift LOG
          4. Sensory alteration
          5. Sensory removal
      9. Dynamic balance
        1. Body has to react to the changing surface
      10. Single-leg stand patterns
        1. Identifying imbalances
        2. Exercises
          1. Single-leg stands
          2. Static balance on a single leg
    3. Phase 2: Movement training for ADLs
        1. Valgus: internal rotation between femur and tibia, knees move inward
      2. Bend-and-lift
        1. Hip-hinge
        2. Lower-extremity alignment
        3. Figure-4 position
      3.  Single-leg
        1. Half-kneeling lunge rise
        2. Lunges and lunge matrix
      4.  Pushing
        1. Bilateral and unilateral presses
        2. Thoracic matrix
        3. Overhead press
      5.  Pulling
        1. Bilateral and unilateral rows
      6.  Rotational
        1. Wood chops
        2. Hay bailers

     

    Check out our Audio Lectures, Practice Tests and Study Guide for the ACE CPT to see the specific topics that make it onto the ACE CPT Test from this chapter.