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Performance Matrix
for
Movement Screening
& Risk Analysis
PERFORMANCE STABILITY
The development of realistic and workable risk assessment and screening processes and subsequent
training packages for sport and occupational health has been somewhat of an unattainable dream
amongst exercise, sporting and occupational health professionals for many years. To date, attempts
to do this have been centred on testing joint range, muscle strength (both power and endurance) and
testing muscle extensibility. Some attempts have focused on developing functional tests based on
work specific tasks and sport specific skills. All have been relatively unsuccessful at predicting risk
of injury and have resulted in training programmes being biased towards high load muscle
(strength) training and high force joint and muscle stretching, (which in some cases may be the
cause of injury).
It is well accepted that in todays professional sporting environment that power, endurance and
flexibility are important and are a necessary and integral part of any sports training programme.
However, there is an under representation (if present at all) of low load motor control training in
many of these training programmes.
Contemporary neurophysiological and clinical research into movement dysfunction associated with
musculoskeletal injury, chronicity and recurrence of injury, highlight deficits of low threshold
muscle recruitment and motor control inefficiency (OSullivan et al 1997, Richardson et al 1998,
Jull 2000, Comerford and Mottram 2001 a & b, Gibbons and Comerford 2001a & b, Sahrmann
2002). These deficits are only clinically and functionally identified with very specific tests of low
load recruitment efficiency. Some of these dysfunctions develop prior to the onset of symptoms and
injury and appear to be precursors or contributing factors to the development of injury and
symptoms (Comerford and Mottram 2001b, Sahrmann 2002). There is mounting evidence that
failure of low load recruitment efficiency is the most consistent and reliable predictor of recurrence
(Richardson et al 1998, Hides et al 2001).
benefit of having good stability function of both the local and global stabiliser muscles is in
improved low threshold motor control and in decreasing mechanical musculo-skeletal pain.
o Pass no movement induced pathology and pain free function
o Fail - development of pathology and pain.
STABLE
S T A B IL IT Y
D Y S F U N C T IO N
STRO NG
++
-+
G ood
P e rfo rm a n c e
W EAK
+-
--
Poor
P e rfo rm a n c e
P a in fr e e
P a in fu l
(adapted Silvester & Comerford)
Because the term core stability no longer is used in the way it started off, and it has now achieved
generic status in the exercise and fitness industry it is necessary to redefine or re-label stability
concepts in terms of low and high threshold principles. We suggest that the term motor control
stability may be an appropriate name for the low threshold training. The stability referred so far in
this text is motor control stability and is best defined as central nervous system modulation of
efficient integration and low threshold recruitment of local and global muscles systems. We further
suggest that it may be more accurate and less confusing to refer to high threshold training processes
of the neutral trunk as core strengthening.
There are some defining differences between motor control stability and core strengthening.
MOTOR CONTROL STABILITY
CORE STRENGTHENING
Muscle specific: That is, it can be biased for Muscle non-specific: Because of high load
either a local stabiliser muscle or a global resistance or endurance overload to the point of
stabiliser muscle.
muscles.
Recruitment specific: That is, because all these Recruitment non-specific: Again, because of
exercises use low load or functional normal overload, both slow and fast motor units are
loads then slow motor units are predominately strongly recruited.
recruited
Central nervous system modulated: That is, Regional adaptation to load and demand: The
afferent spindle input influences tonic motor muscle hypertrophy is a response to overload
output.
Low threshold training (CNS modulated)
training.
High threshold training (muscle adapting to
overload demand)
Biased for the local and global stabiliser Biased for the global stabiliser muscles
muscles
Neutral position prevailing (+/- axial plane)
Predominantly isometric and isotonic with Predominantly isometric (also isotonic with
emphasis on eccentric activity
Resistive overload is applied via the limbs while the proximal trunk may be supported or
unsupported. The best example of traditional strength training is gym based weight training
equipment where the weight is lifted concentrically against gravity and where a hinge, axel or cam
controls the direction of the movement to the sagittal (flexion-extension) plane.
The load may be:
Isotonic concentric (shortening against load) or eccentric (lengthening against load) load
controlled with movement range and speed variable
The direction may be limited or controlled (weights machines / equipment) or uncontrolled (free
weights) where axial and coronal movement must be controlled by the subject.
Core
Strengthening:
Trunk
(rotational load)
high
low
low
Muscle Bias
global mobilisers
global stabilisers
global stabilisers
local stabilisers
Position / Plane
of 10 Loading
flexion-extension
plane
rotation plane +
neutral position
rotation plane +
neutral position
neutral position
Type of
Contraction
isotonic
concentric
+/- isometric &
isokinetic
isometric
+/- isotonic
concentric
isometric
(dissociation) &
isotonic eccentric
(through range)
isometric
Training
Threshold
Motor Control
Stability:
Global
Motor Control
Stability:
Local
There are many differing interpretations of stability and stability training. The term core stability
is now generic and used to describe a large range of both low and high load training processes. This
term is now vague and non-specific and is probably best used to refer to stability training processes
in general. With increasing demands on therapists for therapeutic exercise programmes and on
exercise professionals for specific or prescriptive training programmes, it is often difficult to know
where to start. If we at least have a clear understanding of the differences between traditional
strength training, core strength training and motor control stability training we are in a better
position to make a thorough assessment of dysfunction and more reasoned clinical decisions
regarding the appropriate type and level of exercise or movement based intervention.
PERFORMANCE MATRIX
Performance Stability (with its links to the Kinetic Control Movement Dysfunction Courses)
utilises the latest academic and clinical research to develop assessment principles of stability
function and motor control performance to provide a unique, evidence based analysis and training
package for specific client applications. Based on analysis of high incidence sites of injury,
mechanisms of injury, prevalence of certain injuries, previous injuries, and the biomechanics of
sport specific and occupation specific activities that incur higher incidences of injury, a series of
priority risk factors are determined. A series of tests are then produced to best achieve a particular
goal or clients needs. These client specific goals and needs vary but can be tailored towards sport
specific screening, joint specific screening, injury specific screening, technique related risk, general
base screening or elite performance screening.
The priority risk factors are incorporated into Performance Stabilitys concept of a sport specific
Performance Matrix to determine the weak links in the stability and performance chain. These
weak links are identified in terms of the site and direction of musculoskeletal risk and in terms of
the threshold (low or high) of performance failure potential.
This Performance Matrix can be used as a risk analysis protocol and can be used to develop a
training package where sports medicine, occupational health and exercise professionals (doctors,
physios, exercise physiologists, trainers, coaches, ergonomists and work place assessors) can be
taught to implement the tests and identify the weak links or potential risk in the performance
matrix. Different individuals pass or fail different aspects of the testing process so that the
individuals specific profile of performance and stability risks and assets can be determined.
Performance Stability Ltd 2003-2004 all rights reserved
With an individuals performance weak links and potential risks identified, a prescriptive re-training
programme can be developed and implemented. This re-training programme would include
strategies to regain control of the site and direction of performance failure and retrain at the
appropriate threshold of loading. Retraining would use movement and exercise as a tool to:
i.
ii.
iii.
iv.
v.
The performance matrix can also be used to evaluate the effectiveness of any individual retraining
programme.
References
Comerford M J, Mottram S L 2001a Functional stability retraining: Principles & strategies for managing mechanical
dysfunction. Manual Therapy 6(1):3-14
Comerford M J, Mottram S L 2001b Movement and stability dysfunction contemporary developments. Manual
Therapy 6(1):15-26
Gibbons G T, Comerford M J 2001a Strength versus Stability Part I; Concepts and terms. Orthopaedic Division Review
March / April: 21-27
Gibbons G T, Comerford M J 2001b Strength versus Stability Part II; Limitations and benefits. Orthopaedic Division
Review March / April: 28-33
Hides J A, Jull G A, Richardson C A. 2001. Long term effects of specific stabilizing exercises for first episode low
back pain. Spine 26(11):243-8.
Jull G A 2000 Deep cervical flexor muscle dysfunction in whiplash. J Musculoskeletal Pain 8(1/2): 143-154
OSullivan PB, Twomey L, Allison G 1997 Evaluation of specific stabilising exercise in the treatment of chronic low
back pain with radiological diagnosis of spondylosis or spondylolisthesis. Spine 22(24):2959-2967
Richardson C, Jull G, Hodges P, and Hides J 1999 Therapeutic Exercise for Spinal Segmental Stabilization in Low Back
Pain: Scientific Basis and Clinical Approach. Churchill Livingstone
Sahrmann S A 2002 Diagnosis & Treatment of Management Impairment Syndromes. Mosby, USA