To describe the Movement Improvement difference, let’s use an example of a client presenting with a knee complaint. The knee is, essentially, a hinge joint and therefore operates in one motion (bending and straightening). However, the knee is only one component of many within your entire body system. If we consider your leg as a whole, the hip and foot/ankle also play a large role in assisting ideal movement of the knee. If your foot ‘rolls in’ too much or your hip cannot absorb your body weight correctly, this can force the knee to operate outside of its permitted hinge joint movements. This can disperse weight incorrectly on any of the structures in the knee, including muscle, ligament, cartilage or bone. Therefore, you may present with a knee complaint, but is it your knee that is the problem?
So, what's the problem?
The hip, foot or something else? Let’s use the hip as an example.
Why doesn’t my hip absorb loading correctly? Quite typically, it is because your butt muscles are not firing as they should. As Movement Improvement physiotherapists, we then ask ourselves; why aren’t the butt muscles firing appropriately? This is when our philosophy of “think locally, but act globally” becomes prominent. Sure, we can give you specific exercises to ensure that your butt muscles are firing (and you may get some benefit out of this), but more commonly, there is a deeper reason as to why they do not activate appropriately.
Unique to Movement Improvement, our physiotherapists emphasise the importance of the deep muscle stabilising system for ensuring ideal movement patterns. This system has a ‘feed-forward mechanism’, which means that the brain triggers this system to automatically activate prior to any movement. If this system is not functioning as it should, this compromises any movement that you purposefully make. A simple way to explain it is to ask the question; which one of the following is the easiest to do? Standing on dry land watching a boat crash over waves? Or standing on that boat without holding on? If your deep muscle stabilising system is not functioning, you are the one struggling to stay upright on the boat because you cannot achieve a stable base for your body.
So, what is our deep muscle stabilising system? And how does this relate to my knee complaint?
Our Body's Muscular Systems
A very common approach to achieving a stable base is to strengthen your ‘core’. Typically the exercises that are given for this target your more ‘superficial’ abdominal muscles such as, rectus abdominus (6-pack), obliques and erector spinae (back muscles). From a Movement Improvement perspective, we refer to them as ‘beach’ muscles as they offer no use if your deep muscle stabilising system is not active. In essence, we do not attempt to improve your ‘core strength’. It is like trying to isolate your butt muscles; you will only achieve limited improvement. You need the facilitation of your deep muscle stabilising system to achieve an improved global movement pattern.
Your global movement patterns are controlled by three separate layers of muscle; your deep muscles, steering muscles and power producing muscles. If your deep muscle stabilising system is not functioning appropriately, it cannot set the foundation for the steering muscles. The steering muscles are responsible for controlling the position of each joint. A simple example of these muscles is the rotator cuff in the shoulder. The rotator cuff is vital for keeping the arm centred in the shoulder to provide essential movement. On that note, the power producing muscles, like your quads and pectoral muscles need the deep and steering layers to set the foundation for efficient power production. Pain and/or dysfunction occurs when these power producing muscles are required to perform the steering layer’s role because the deep muscles are not providing the stable base required for the movement. This scenario is very common in people that present to Movement Improvement. As a generalisation, our first task is to ensure that the deep muscle stabilising system is setting an appropriate foundation for each of these layers to function synergistically.
The deep muscle stabilising system is characterised by the integration of five groups of muscles:
- Short intersegmental spinal muscles (multifidi)
- Deep neck flexors
- Abdominal wall and
- Pelvic floor.
In essence, the deep muscle stabilising system controls the displacement and amount of intra-abdominal pressure to provide a stable base. From musculoskeletal standpoint, maintaining an ideal level of pressure within your abdominal cavity is essential for spinal and pelvic stabilisation. If this is achieved, then global movement patterns can occur without interrupting the normal movements of limbs, joints and soft tissues. The key word within this is pressure. It is not about ‘tensing’ your muscles to achieve this, it is about your brain sending the correct signal to the correct muscle groups to ensure an ideal amount of intra-abdominal pressure is achieved. If your brain has been deconditioned by poor occupational postures, lots of stationary positioning (sitting), incorrect technique in sport or poor development progression as a child, then we need to re-train your brain to initiate the correct sequence of muscle firing again.
For example, imagine your abdomen is a sealed canned drink. When the seal is maintained, the can is quite firm, i.e. it is very hard to crush/squeeze it by hand. However, if you undo the seal or drill a hole in the side of the can, it becomes increasingly easier for you to manipulate the can in your hands. This is not dissimilar to how your deep muscle stabilising system works. Initially, you have a stable base with the co-activation of all of the deep muscle stabilising system to keep the abdomen firm. However, when one aspect of the system fails it makes it much harder to distribute an appropriate amount of intra-abdominal pressure. This forces you to either change your posture and/or movement patterns to accommodate for this. From our perspective then, we must target the part/s of the deep muscle stabilising system that are not receiving the correct message from the brain to regain a more functional distribution of intra-abdominal pressure and therefore, provide the body with a stable base.
Linking it Together
Therefore, based upon our philosophy of “think locally, but act globally” we have now established that your knee complaint could be primarily caused by a poorly functioning aspect of the deep muscle stabilising system. From here, we give you the tools that will allow you to train whichever aspect/s needs the most attention. Once a more stable base is established, it will then be much easier for you to control your hip movement. Now that your hip has the potential to accept load more effectively, the structures that were under increased stress in your knee can now be allowed to recover and therefore, you have begun the journey to eliminate your knee complaint permanently.
Essentially, it is Movement Improvement’s philosophy, assessment, knowledge of human movement and intervention choices that set us apart from other allied health professionals.
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