Motor Programming: How To Correct Faulty Motor Patterns

Motor Programming is now advocated as an exercise rehabilitation tool by many of the leading experts in the field of personal training and rehabilitation (Chek, 1999; Sahrmann, 2002; Richardson, Hodges & Hides, 2005; McGill, 2006; Lee, 2007). The premises is that if the client has a faulty motor pattern which has been caused by repeated activity, pain, tight musculature or weakness then this can predispose them to further injury or result in poor recovery. All human movement is patterned and organized. It has predictable, repeatable elements such as those we see in gait (Woodruff,2005), unless something changes that pattern. This article aims to outline the process of how to correct faulty motor patterns.

Faulty Motor Patterns

Imagine if someone fractures and ankle, the leg is immobilised for a period of time, the fracture heals and rehabilitation has come to an end. There is no pain and the client now has a full range of motion and full power but, the patient is still limping and weight bearing more on the uninjured side. The client may now think;

1. It’s my imagination and I’m just not thinking the right thoughts.
2. I’m doing this to myself—punishing myself for getting injured, or malingering to avoid my responsibilities, or to get sympathy.
3. Something is seriously wrong and they’re not telling me.

“But if I’m not limping because I want to or need to, why am I limping? It’s all in my head, isn’t it?” The clients habit of limping is a movement pattern. These patterns are stored in the central nervous system, so the problem really is in his/her head (and spine). But it’s not about imagining things. By having pain or even fearing pain we construct adaptive patterns so that when we move, it hurts less. In this way, we teach the nervous system a different way of moving (e.g., limping), which the CNS remembers even when the reason for limping is gone. The CNS is goal oriented. It is designed to answer a need: the mover’s intention. Whenever we want to do something, the CNS is there for us directing our muscles and joints. However, if there is a barrier, such as pain, the CNS fulfils our intention by choosing alternative muscle use. Unfortunately, the pattern is not necessarily efficient, normal or pain-free, but it keeps us on our feet. The client may have limped but they got around, all because of this goal-oriented aspect of the CNS. To improve the limp the client is required to work on changing his/her motor programme to change the motor pattern so he/she would require walking re-education.

The same could be said for the spine, if a client has pain he/she will move away from that pain and/or move towards the area of strength. In the same way a breathing motor pattern problem could cause poor posture, the client could have an inverted breathing pattern (1/3rs diaphramatic breath 2/3rd accessory muscles) Chek (1998). This would mean that they are using more of their accessory muscles such as the scalenes and the sternoceidomastoid, which could cause forward head posture and therefore further injury.

Teaching Motor Programmes

A Motor programme can be defined as: “ A set of motor commands that is pre-structured at the executive level and that defines the essential details of a skilled action ” (Schmidt & Wrisberg 2000). Teaching motion / motor patterns and therefore movement patterns, like any other skill is a progressive process. Whether an elite performer is re-grooving motor patterns, or an adult is engaged in the rehabilitation process a similar process can be used. A foundation of basic movements must be developed long before any special skills are grooved. Consider the most basic skills for locomotion or simply moving from one place to the other. Then consider basic manipulation skills where objects are moved with the hands and feet. On top of these skills are the proprioception awareness and sensory awareness of skills of vision, auditory and tactile awareness and processing which must be challenged to optimise reaction time, body position etc. Spatial and joint position awareness together with processing of vestibular information assists in ensuring balance so that subsequent optimal force can be developed and optimally directed. Returning astronauts are a poignant example of what happens when the constant challenge of training motor skills is neglected for a short period of time. They have difficulty walking and balancing. While there is much evidence about the best time to develop each of these skills in developing children, they still must be continually re-affirmed in adults.

As with astronauts clients could have a poor motor programme, your goal will be to correct this dysfunction. Once the nervous system is engrained with a programme it is difficult to correct. While is takes 300-350 reps to build a motor engram, it takes 3000-5000 reps to rebuild (Schmidt, 1991) Don’t forget they can also create faulty ones so always remember to follow the form principle.

The Form Principle – “Train only with correct form. Stop exercise 1 or 2 repetitions before form breaks to avoid reinforcing faulty motor patterns and to prevent injury”

Primal Patterns

According to Schmidt (1999) everyone has generalised motor programmes that share common invariant characteristics and provides the basis for controlling a specific action within the class of actions. All movement can be broken down into 7 fundamental movement patterns (McGill, 2006) which can be known as Primal Patterns (Chek ,1999), these are:

1. Squatting
2. Lunging
3. Bending
4. Pushing
5. Pulling
6. Twisting
7. Locomotion

Primal Patterns and 3 levels of Ascent and Descent

Teaching each Stage of a Motor Pattern or Motor Skills

The stages of learning a motor skill / pattern are (McGill 2006) ; Albernethy 2005):

Verbal / Cognitive Stage:

• Individuals use environmental cues, and past experiences.
• Individuals trying to learn a new skill
• Old habits are shaped into new patterns
• Visual verbal clues are more important than proprioception cues.
• Coaching is continually needed to highlight differences between new and old skill.

Motor Stage / Associative Phase:

• Effective movement is obtained which becomes constant.
• Individuals are able to identify their own mistakes.
• Proprioception feedback is more important than visual feedback.
• Individuals fine tune new movement pattern.

Autonomic Stage:

• Movement “happens” on its own.
• Movements become independent of the attention demands.

How to utilise the knowledge of the stages to be the most effective therapist.

Cognitive Stage:

• Use your hands to place the client in position.
• Have them use their own hands.
• Remember that you cannot activate what you cannot feel.
• Repeat until they can achieve optimal positioning on their own.

Motor Stage:

• Once the client can find their own optimal position then practice and more practice to groove the new pattern.
• Have the client perform the exercise and movements at home and don’t forget the FORM principle.

Motor Programme Exercise

As these patterns are in the pelvic and spinal neutral, the question is when and how do we start to intergrate patterns that enable us to flex our spine and therefore train our ligaments? This may be important as when we come out of our comfort zone e.g. a child falls and you reach down to catch him you will then incorperate flexion into your spine. In most textbooks it is stated that lumbo-pelvic rhythm exists and there is spinal flexion during the first 60 degrees of a forward bend followed by flexion of the hips. McGill refutes this suggestion and states that the spine and hips don’t move independantly and that the opposite is true in olympic lifters, who rotate about their hips, as a guide no one should go to full flexion where possible. As a guide Chek recommends that when you can lift a weight 20 times with no pain in a neutral position then you can start training your ligaments and flexing your spine.

Conclusion

As we can see if a client has a faulty motor pattern this can predispose them to injury or reduce their improvements in rehabilitation due to muscular imbalances and faulty muscle recruitment. It is imperative that early in the rehabilitation stage that this be identified and correct motor patterns introduced and grooved so that the client has less chance of further muscle imbalances and therefore injury. It can be beneficially to start the clients day with motor pattern exercise and then follow up with mobilty exercises if necessary.

References:

• Albernethy, A. Hanrahan, A.J. Kipper, V. Mackinnon, L.T. Pandy, G.M. (2005) The Biophysical Foundations of Human Movement, 2nd Edition. Human Kinetics; Australia.
• Chek, P. (1999). Advanced Programme design, Correspondence Course.
• Chek, P.(2002) Scientific Back Training.
• Chek, P.(1998) Scientific Core Training. Correspondence Course.
• Feldenkrais, M.(1990) Awareness Through Movement. Harper-Collins, New York.
• Lee, D.(2007) Who Owns Low Back pain? Symposium and Debate. Royal Geographical society, London 210307.
• McGill, S. (2006) Ultimate, Back Fitness and Performance. Canada.
• Richardson. C., Hodges. P. Hides. J. (2005) Therapeutic Exercises for Lumbopelvic Stabilization. A Motor Control Approach for the Treatment and prevention of Low Back Pain. Churchhill Livingstone.
• Sahrmann, S.A. (2002). Movement Impairment Syndromes. USA.
• Schmidt, R, A. (1991) Motor Learning and Performance. Human Kinetics; USA.
• Schmidt, R, A. Wrisberg, C.A. (2000) Motor Learning and Performance. Human Kinetics; USA.
• Woodruff, D.(2005) Movement Patterns, www.ptonthenet.com accessed on 200307.