Personally written by Dr. Milan Lassiter, Laser Sport & Spine, 1303 W. Main St, Richmond, VA 23220. He can be reached by calling (804) 254-5765.
The idea of core stabilization is different than that of core strength. Often (especially with athletes) we have sufficient strength. After an injury, however, core stabilizer muscles can fail to fire appropriately, causing atrophy and, ultimately, failure to regain their function to stabilize the spine. Muscles will fire with different patterns depending on if there’s pain or not. These abnormal nervous system patterns can’t be corrected with core strengthening exercises.
Core stabilizer muscles are very deep and wrap very closely around the spine. When the spine is injured, there’s a loss of stability. The larger muscles that are not designed to stabilize the spine get recruited. This is a guarding, defensive mechanism to prevent instability (everything tightens up).
Traditional core strengthening exercises contradict the basic principles of motor learning and motor training. Following are three of the basic principles for re-training motor/movement patterns:
• Similarity and specificity principles – You have to practice the same movement in the same position that you’re having a problem. If your restriction is that you can’t bend forward, doing a crunch or plank does not put you in a similar position as that movement restriction (floor exercises are not in the same position as being upright and weight bearing).
• Internal vs. external principle – In real life, we think of what goal we want to accomplish (external), not what muscles we need to internally use to accomplish that goal. For example, you don’t think about what muscles you need to use in order to bend forward to wash your face, you just think of the end goal (which is to wash your face). In other words, when you have a pain pattern when bending forward, you don’t need to strengthen the muscles that bend you forward. You have to change the way the nervous system is automatically firing the different muscles involved with bending you forward.
• Economy of motion – The brain is always trying to optimize motor patterns to avoid pain and to sequence the least amount of muscle movements. The ATM2 uses a belting system to reposition and compress the spine into a stable position. This allows an optimized, pain-free sequence of movements to be learned. When you’re in pain and you’re using regular floor exercises, you’re just re-affirming a dysfunctional movement pattern (one that’s already painful).
How do we change how people move? Instead of looking at pain and movement problems as being caused by local injury and dysfunction of an area, another important aspect is to look at how the body has “learned” how to move. These abnormal patterns are deeply ingrained habits that the body has adopted over time as a preferred movement strategy. Deficits in strength and mobility still need to be addressed (ie: through exercise and chiropractic adjustments), but they can’t be expected to correct the abnormally learned movement pattern. The body has to be re-taught how to coordinate movement with more appropriate patterns.
Traditional core stabilization exercises are performed on the ground (ie: a crunch or a plank). Muscles are activated differently in a standing, weight-bearing position than they are when you’re doing floor exercises. This is why the ATM2 puts the patient into an upright, weight-bearing posture.
With Active Therapeutic Movement, we’re also looking to treat a specific movement impairment (the specific movement that causes pain and limited range of motion). Core stabilization is movement specific. For example, a patient may be able to bend backwards and sideways just fine, but there’s a lot of pain and limitation when bending forward. With the ATM2, we’re working on a specific movement impairment. We need to restore that specific, painful movement impairment, but we need to eliminate the pain first.
The active therapeutic movement concept has 4 Phases:
1) Exam – What movement is painful and impaired?
2) Set-up – Stabilize the restricted movement to make it pain-free by using belts to compress and re-position the area.
3) Intervention – Isometric exercises, in a specific direction, are performed to make the nervous system memorize the pain-free movement pattern. This is where the nervous system says “aha, this is the position in which I can fire my muscles correctly and not have pain…so I’ll remember it.”
4) Re-exam – Re-test the movement impairment; There should be 50-100% reduction in pain and improvement in movement.
The ATM2 gives you the capability to alter the way the brain activates the muscles, teaching the brain a different and non-painful way to execute a movement. As a person does the ATM2 exercises, now their central nervous system is training and learning a new firing pattern per their condition. The ATM2 changes the way the nervous system acts to fire muscles. You can’t change this firing pattern by doing floor exercises or by thinking about it; It has to happen automatically by the brain. The ATM2 does not use exercises to strengthen an area, it uses exercises to change the way your nervous system is activating a movement to occur.
