In the previous article, the question was asked “How often today do PTs, OTs and other providers asses a person’s ability to stand up from a seated position as poor and then make the conclusion that what is needed is more lower extremity strength?” In a problems solving structure, the clinical decision making lead to exercises prescribed to improve strength. It would likely include some open kinetic chain exercises as well as some generalized strengthening for the core. If the reader attempted the suggested exercise of sitting in a chair place your feet forward such that the knees are flexed and attempting to stand, then the experience was had that it was not a question leg strength and the treatment intervention would be of very little impact. Each change effort will include exercises as intensification of function movement. In this way, the actions are directed at supporting the COG BOS relationship.
Returning to our change effort, a distinction is necessary to understand the values that are underlying the structured motion approach. As the approach values a client’s full participation in a life that matters to them and the development of change efforts to promote this level of function, then we begin and end with functional movement. We use change efforts to promote and intensification of functional movement to create the stimulus for change in the body, whether that is increased flexibility, increased strength, improved coordination, rhythm or timing between muscle groups. The intensification’s are found in the definitions of the critical tasks, and as they are the basis of functional movement, include movement in all three planes.
This is not based on pattern reduction and repetition. A pattern may not include the critical task that is required to support the COG BOS relationship. A squat pattern can be inferred in the wall squats exercise. However there is nothing functional about this exercise. Why? Simply because it lacks the anterior weight shift of the COG into the BOS. Marching in place is another favorite that appears at first to be of value. Patients are positioned to hold on to surface and then instructed to lift one knee then repeat with the opposite side. Observation of this movement would include recognizing a lateral weight shift to the stance lower extremity. Not bad, but that lateral weight shift only begins at the initiation of ambulation from a symmetrical standing position. What is really going to impact the patients function, namely ambulation ability in this case, is the practicing of the single limb pattern from an asymmetrical stance. In this way, the diagonal motion of the COG through the asymmetrical BOS is promoted that supports the positioning of the COG over the single limb BOS. It seems a small thing, but if the goal here is to support functional movement, tri-planar motion is required and exercises will be intensification of the critical tasks associated with the change in the COG BOS relationship.
We can use patterns a nomenclature, as a method of organizing observations and changes. Patterns also are useful categorizations to link similar exercise groups together. Corrective exercises can be categorized in terms of specific impacts that it has on a pattern of movement. However the pattern is an abstract. The human mind does not use patterns. Instead it reacts to the COG BOS relationship and seeks to organize the neuromuscular system to complete critical tasks that control the COG BOS relationship.
The BOS will give rise to tendencies of movement, however in human form, it is not the BOS that is dominate, it is the COG position that determines the use of anterior or posterior chains. The question then becomes what are the critical tasks and what body positions support the critical tasks. These will be explored in the upcoming installments as we move to completion of the introduction of Structured Motion as an approach to improving function and sports performance.