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Progressing any exercise programme smartly requires considerations above and beyond basic muscle physiology. As detailed in the article Getting Smarter with Exercise Progression, a good practitioner will also consider, among others, autonomic nervous system physiology, motor control physiology and hormonal axis physiology. This article outlines a practical approach to the delivery of a key exercise considering motor control physiology, outlining the case of a recent client.

 

Mr Smith was referred by his rheumatologist, and presenting with what had been diagnosed as a form of arthritis secondary to a bacterial infection. Mr. Smith had received 2 recent courses of cortisone medication, and although he had improved was still experiencing significant levels of hip pain. Mr. Smith’s rheumatologist felt that there may be a mechanical contributor to his hip pain, and that a structured and individualised exercise programme was Mr. Smith’s best option for ongoing management of his (dis)ease.

An initial assessment detailed (amongst other things) the following key points:

· Significant Iliotibial band, tensor facia latae and psoas tightness

· Significant weakness of both left and right psoas musculature

· Significant inefficiencies through biomechanical chain while walking

· A history of difficulty learning and retaining new exercises and movement patterns when working with physiotherapists and personal trainers in the past

· Significantly high stress levels, poor dietary habits and very poor sleep hygiene

A comprehensive programme, considering a range of physiological factors was developed, the first, and most important phase implemented was the motor control considerations.

 

Physiological Consideration	Goal
Autonomic Nervous System	· Teach Mr. Smith to elicit a relaxation response with movement on a regular basis to reduce systemic stress, inflammation and to improve sleep hygiene
Nutritional Considerations	· Improve nutritional habits and implement the use of anti-inflammatory foods to reduce systemic inflammation
Muscle Physiology	· Improve hip stability via strengthening medial glutes and improving psoas contribution to hip stability. · Reduce muscle tension through TFL and ITB
Hormonal Axis	· Improve Cortisol:DHEA ratio through improved nutritional habits and sleep hygiene to reduce systemic inflammation
Motor Control	· Improve intrinsic awareness and movement pattern retention with a goal of improving sling mechanism contribution to gait

 

This article will elaborate on one of the early phase techniques used to progress Mr. Smith’s motor control ability through exercise.

Phase 1: Motor Sensory mapping: Supine Walk

The purpose of this exercise is to help the motor cortex ‘map’ the important muscles involved in hip stability while walking. Muscles involved are not worked in isolation, rather in the same pattern that we are trying to improve and make more efficient (in this case gait).

Exercise Cues

1. Position yourself on floor with knees bent and feet flat on floor

2. Push one foot lightly into floor. Focus on which muscles you feel working when you do this. You should feel your butt muscles and the muscles in the backs of your leg wake up when you do this. This is a regressed version of the ‘stance phase’ in gait.

3. Take the weight off your other foot, but keep the foot on the floor. You should feel the muscles on the inside of your hip wake up when you do this. If you feel the outside hip muscles wake up, try lightly ‘sucking’ your hip joint into itself before you take the weight off your foot. This is a regressed version of the ‘swing phase’ in gait.

4. Now alternate sides. Notice whether you feel the same muscles working once you’ve alternated sides.

5. Alternate sides again. As you are doing this, feeling what is happening with the muscles in your hips, imagine that you are walking.

This exercise is done as often as possible daily, progressing from a slow alternating exercise (slow walking speed) to one at faster levels (normal walking speed).

Stability musculature are meant to work at a subconscious level, if we try to consciously ‘activate’ these muscles, the increased signals from the nervous system will not allow them to work the way they should. The goal here is not to get a hard work out of the stability muscles, or to consciously change the way the muscles are firing (conscious override), but to improve Mr. Smith’s awareness of the muscles that could be working in the hip. This will result in improved motor sensory awareness and improved subconscious activation of these important stability muscles.

Try this exercise yourself, and then follow it up by going for a short walk. Notice how this changes your awareness of how the muscles through your hip are working while you walk; notice how it changes your stability, your power and your interaction with the ground.

The Early Phase Holistic Exercise Workshop will explore this and many other ‘outside the box’ exercise techniques to help you modify your exercise prescription to truly meet your clients’ needs.

By the way, Mr. Smith noticed a full resolution in hip pain only after one week of doing this exercise, and continues to progress through his holistic programme to address the other significant needs outlined above.