Top 5 Fridays! 5 Ways to Facilitate Motor Control | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

Top 5 Fridays! 5 Ways to Facilitate Motor Control

Thanks to blog reader Jean Michael Comier for the topic! After taking SFMA level 1, both he and I were left wondering, how do we facilitate motor control/stability issues?

I have not taken either FMS or SFMA level 2, where you get more into the 4x4 Corrective Exercise Matrix by Dr. Greg Rose. So here are 5 Ways I Facilitate Motor Control

You know it's a motor control issue and not motion dysfunction (I do not differentiate between capsular and "issues in the tissues") when

  • active motion is painful and/or limited
  • passive motion is significantly greater than active testing, and not painful or less painful
  • their "tightness" or limited ROM comes and goes
  • they have been "stretching" an area for a while and it stays "tight"

Here are 5 ways I improve motor control

1) Light manual resistance into the pattern
  • it's sad that PNF is taught in neuro class and not as part of orthopaedics or even that these courses are compartmentalized in the first place
  • using your hands to facilitate movement is powerful
  • give light resistance in the direction of difficult movement
  • start with very light resistance to facilitate recruitment and as they are able to increase force output in the inhibited direction, gradually increase your resistance
  • this is also a way I test for real weakness, a 3/5 MMT often becomes a 5/5 with some cuing
  • example: patient has a DN or DP for right shoulder MRE (functional scratch IR) testing
    • cue the right lower trap lightly by having them push down with their right scapula into your webspace
    • grade your resistance and as they are able to set their scapula, have them hold this resistance and see if the MRE test becomes FN or FP - a significant increase in ROM means it's a  motor control issue, not tightness
2) agonist reversals in and out of the pattern
  • my favorite PNF cue for rolling pattern difficulty
  • often patients will have a sticking point in their rolling pattern
  • if in upper body rolling supine to prone, lightly pace one hand on the anterior chest wall and the other on posterior scapula
  • at their sticking point, perform agonist reversals for 10 degrees or so of trunk rotation into the rolling pattern and back to starting direction for several minutes or as tolerated
  • often the rolling pattern will go from DN to FN with this simple PNF treatment
  • try the same thing on the pelvis for lower body rolling pattern difficulty
  • this also works great for scapula elevation/depression with motor control issues for shoulder movement
3) IASTM to the agonist
  • the input that the body needs to feel and move better can be easily accomplished with some light skin stimulation
  • it sounds generic, but if an area is inhibited, with IASTM it becomes facilitated, and if facilitated, it becomes inhibited
  • when someone gets a DN on the SFMA cervical rotation/flexion test (rotate and touch chin to clavicle without opening your mouth or elevating the clavicle) AND passively in NWB they can easily touch, this is a motor control issue
    • light IASTM to the cervical paraspinal and upper trap patterns, 30-60 seconds on each, then retest active motion, it is often now FN or at least improved, painlessly
4) Functional release to common tonic muscle groups
  • shoulder motor control issues? - pec minor release
  • hip motor control issues? - psoas and QL release
    • these days, my releases are pain free, normally just lightly holding a hypertonic area, then having the patient take several diaphragmatic breaths, often this will rapidly decrease the tone
    • if that does not work, have them actively contract the antagonist, to reciprocally inhibit the agonist for 4-5 seconds, lengthen the agonist, then repeat until reaching end range, as in the end of this video
  • cervical motor control issues? - upper trap release
    • have patient contract lower trap to inhibit upper trap, while you pin a tonic area with one hand and ask the patient to rotate/SB away to functionally lengthen the trap in an inhibited state
5) Pattern Isolation with Assistance
  • after the above manual techniques restore motion, it's up to the patient's homework to keep it
  • a great way to keep cervical, SLR, shoulder disassociation is to have the movement pattern assisted with resistance in another pattern
  • this is a SFMA level 2 concept, so forgive me if I am watering it down but the 4x4 is only limited by you imagination
    • cervical disassociation
      • have the patient lie supine
      • use a band, like say... The Gray Cook Band, to give them resistance one arm pulling into shoulder extension, the other overhead into flexion
      • this fires the posterior chain giving some proximal stability
      • then the patient actively rotates the head to the left and right, keeping the trunk stable
      • they may also perform the rotation/flexion movement pattern or what ever went from DN to FN
    • active SLR
      • often difficult due to "tight hamstrings"
      • perform some IASTM to the quads, psoas release
      • then have them perform the same crossed UE pattern as above, or even self generated resistance as in this HEP I wrote previously
  • you will find that for many patients who had limited/painful motion, once you cue some proximal stability (or is it distraction) that the motor control returns to the DP area and it becomes FP or even FN 
Keeping it Eclectic....

PS. If any of you are attending Charlie Weingroff's Training = Rehab 1 day Seminar in my hometown of Buffalo, NY tomorrow, please say hello! I will be assisting all day!

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