Expert Application of the 4x4 Matrix Focus on Progression

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1 Expert Application of the 4x4 Matrix Focus on Progression Phil Plisky, PT, DSc, OCS, ATC, CSCS Phil Plisky 1

2 5 6 Symptoms of Internal Combustion Engine Dysfunction Rough idle Hesitation Engine Misfire Smoke Reduced gas mileage Hard to start Won t start 7 Is adding more gas the solution? 8 Phil Plisky 2

3 What could the problems be? Phil Plisky 3

4 13 14 Functional Training Normalize and Stimulate Sensors & Train the Brain Don t just Train Muscles Is adding more EMG activity the solution? Why do we care which exercise produces the GREATEST EMG activity? 16 Phil Plisky 4

5 Action Point #1 Lab Work on the inputs, not the muscle. Create a sensory rich environment that elicits the movement pattern you want. 18 SFMA Cervical: FN UE: FN Flexion: DN - SMCD Extension: DN no forward weight shift - SMCD Rotation: FN SLS: DN, glut drop, unable to perform eyes closed - SMCD Squat: DN forward lean Segmental Rolling DN - SMCD Every time she does anything, she is in extension 19 Phil Plisky 5

18 SFMA Cervical: FN UE: FN Flexion: DN - SMCD Extension: DN no forward weight shift - SMCD Rotation:

6 FMS SCORING SHEET SCREEN Deep Squat Hurdle Step RAW SCORE R/L 2 2_/_2 FINAL SCORE Corrective Exercises In-Line Lunge Shoulder Mobility Active Straight Leg Raise Trunk Stability Push-Up 3_/_3 3_/_3 3_/_ Adding Sensory Input AND What is the feedback? Rotary Stability 2_/_2 TOTAL General Guidelines Ways to stimulate the sensors for fitness professionals PNF techniques Trigger Point techniques Foam Rolling Stick Work Vibration Manual contact Massage Phil Plisky 6

Therapy Techniques Manipulation 25 26 Clinical Manual Therapy Techniques PNF

7 Clinical Manual Therapy Techniques Manipulation Mobilization PNF techniques Trigger Point techniques ASTYM Active Release Dry Needling Laser Clinical Manual Therapy Techniques Manipulation Clinical Manual Therapy Techniques PNF techniques Clinical Manual Therapy Techniques Trigger Point techniques Phil Plisky 7

Clinical Manual Therapy Techniques Instrument Assisted Soft Tissue Massage Clinical Manual Therapy Techniques Active Release 29 30 Discussions and

8 Clinical Manual Therapy Techniques Instrument Assisted Soft Tissue Massage Clinical Manual Therapy Techniques Active Release Discussions and education about hydration, nutrition sleep quality / quantity / positions, ergonomic positions, driving positions, workout modifications Phil Plisky 8

education about hydration, nutrition sleep quality / quantity / positions,

9 Protection to reduce stress and exacerbations such as footwear, orthotics, bracing, splinting and weight-bearing status Stretching and soft tissue work performed by the patient at home Forms of biofeedback such as leukotape and kinesio tape to provide enhanced perception and input Phil Plisky 9

performed by the patient at home 33 34 Forms of biofeedback such as

10 Don t prescribe strengthening for a motor control problem Do Muscles Have Memory? Rotator Cuff Exercise?? Core Exercise???? Is the best way to learn a new movement pattern to perform an exercise that mimics that movement for 8-10 reps? If your client performs a movement flawlessly during a training session does that mean they will change that same movement in daily life or sport? Phil Plisky 10

??? 37 38 Is the best way to learn a new movement pattern to perform an exercise that mimics that

11 As long as the client can perform the movement properly, they are training the right thing? When providing feedback to your client it is best to provide it as frequent, immediate, and as informative as possible? Recommended Reading Motor Programs are Different than Cognitive Skills Retention of motor skills is better and more enduring than factual information H.M Phil Plisky 11

12 What Research Says About Muscle Memory Motor Programs are planned in advance and executed without many changes when triggered into action (Wadman et al.) What Research Says About Muscle Memory Motor Programs are planned in advance and executed without many changes when triggered into action (Wadman et al.) So What s the Best Way to Train for the Brain? Block Training Do one exercise for a certain number of repetitions per set Each rep has the same movement No stopping between reps Focus on form Random Training Do multiple exercises per set and one rep of each Each rep has some different movement Take time with each rep Focus on feel 47 Blocked vs. Random Practice Jerky Form Blocked Smooth Random Practice Shea & Morgan, Phil Plisky 12

Block Training Do one exercise for a certain number of repetitions per set Each rep has the same movement No stopping between reps Focus on form Random Training Do multiple exercises per

13 Blocked vs. Random Practice Jerky Blocked vs. Random Practice Jerky Form Random Form Random Smooth Blocked Practice Retention Smooth Blocked Practice Retention Jerky Illusions of Learning Jerky Illusions of Learning Form Random Form Random Predicted Actual Smooth Practice Blocked Retention Simon & Bjork, Smooth Practice Blocked Retention 52 Phil Plisky 13

Blocked Practice Retention 49 50 Jerky Illusions of Learning Jerky Illusions of Learning

14 Illusions of Learning Functional Movement Training Jerky Train the Brain Not the Muscles Actual Form Random Predicted Smooth Practice Blocked Retention Functional Training Action Point #2 Train Randomly Reduce Block Training Train randomly for optimal adaptation of movement skill. 55 Phil Plisky 14

53 54 Functional Training Action Point #2 Train Randomly Reduce Block

Tracking (Cervical) Limb Movements Rolling Crawling Transitional Movements Upright

15 SFMA s 4 x 4 Matrix Remember the Neuro-Developmental Perspective Functional Exercise Progressions Movement was Learned in Stages Breathing Gripping Head-Eye Tracking (Cervical) Limb Movements Rolling Crawling Transitional Movements Upright Movements 59 Functional Exercise Positions Non-Weight Bearing Supine Prone 60 Phil Plisky 15

Functional Exercise Positions Quadruped Functional Exercise Positions Kneeling 61 62

Non-Weight Bearing 2 - Quadruped 1 - No-Resistance - PA PA = Pattern Assistance 2 - No

16 Functional Exercise Positions Quadruped Functional Exercise Positions Kneeling Functional Exercise Positions Standing Functional Exercise Progressions The 4X4 Matrix 1 - Non-Weight Bearing 2 - Quadruped 1 - No-Resistance - PA PA = Pattern Assistance 2 - No Resistance 3 - Kneeling 3 - Resistance - PA PA = Pattern Assistance 4 - Standing 4 - Resistance Phil Plisky 16

17 Pattern Assistance Functional Exercise Progressions The 4X4 Matrix Timing vs. Firing High Threshold vs. Low Threshold Strategy Stabilizers vs. Mobilizers 1 - Non-Weight Bearing 2 - Quadruped 3 - Kneeling 1 - No-Resistance - PA PA = Pattern Assistance 2 - No Resistance 3 - Resistance - PA PA = Pattern Assistance 4 - Standing 4 - Resistance Functional Exercise Resistance No Resistance With Pattern Assistance (PA) Functional Exercise Resistance No Resistance With Pattern Assistance (PA) Phil Plisky 17

Mobilizers 1 - Non-Weight Bearing 2 - Quadruped 3 - Kneeling 1 - No-Resistance - PA PA = Pattern Assistance 2 - No Resistance 3

69 70 Functional Exercise Resistance Resistance Example: Kettlebell

18 Functional Exercise Resistance No Resistance Except: Gravity Body Weight Functional Exercise Resistance Resistance With Pattern Assistance (PA) Functional Exercise Resistance Resistance Example: Kettlebell Swings 4 x 4 Patterns (Flx, Ext, Sqt) Standing Resistance Phil Plisky 18

19 Turkish Get Up Supine Quadruped Kneeling - Standing Resistance Functional Exercise Progressions The 4X4 Matrix 1 - Non-Weight Bearing 2 - Quadruped 1 - No-Resistance - PA PA = Pattern Assistance 2 - No Resistance 3 - Kneeling 3 - Resistance - PA PA = Pattern Assistance 4 - Standing 4 - Resistance 1X4 2X4 3X4 4X Action Point #3 Place person in posture and position where it can only be done correctly Practical Implementation Work on the inputs, not the muscle Create a sensory rich environment the elicits the movement pattern you want Higher level postures (standing) can hide dysfunction Train randomly for optimal adaptation of movement skill Don t rely on verbal coaching 76 Phil Plisky 19

posture and position where it can only be done correctly Practical Implementation Work on the inputs, not the muscle Create a sensory rich environment the elicits the movement

Practical Implementation Higher level postures (standing) can hide dysfunction Work in the lowest level posture that is challenging Place person in posture & position where it can only be done

20 Practical Implementation Higher level postures (standing) can hide dysfunction Work in the lowest level posture that is challenging Place person in posture & position where it can only be done correctly Don t rely on verbal coaching philplisky@gmail.com For the latest movement assessment and injury prevention research Functional Movement Systems Follow Like 79 Phil Plisky, PT, DSc, OCS, ATC, CSCS 80 Phil Plisky 20

rely on verbal coaching philplisky@gmail.

Current Concepts of Low Back Pain. Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS

Current Concepts of Low Back Pain Terry L. Grindstaff, PhD, PT, ATC, SCS, CSCS 28% population reports LBP in past 3 months (CDC 2010) 60% recurrence rate (Turner et al, 1992) Low Back Pain Low Back Pain