FOOTNOTES from "What is M.A.T. ?" 1. The sciences behind MAT, and the understanding and application of these sciences are what make MAT unique as a baseline assessment tool for joint function. Biomechanically a muscle loses its ability to contract as it reaches its shortest position due to a decreased force angle and loss of moment arm. In this position a muscle is relatively ineffective at producing torque as compared to more mechanically advantageous positions at different points in the range. Neurologically when a muscle is in the shortened position the muscle spindle is under slack, resulting in diminished proprioceptive feedback from the central nervous system. This loss of neural communication creates a reduction in potential force production. Physiologically when a muscle is in its shortened position there is a loss of active tension or diminished capacity for developing tension because there is less overlap between the actin and myosin filaments and consequently fewer possibilities for crossbridge formations to exist. It is the combination of these scientific factors and the emphasis on the shortened muscle position that is the foundation for Muscle Activation Techniques. 2. The cause of limited motion, positions of instability, reduced performance and/or pain, when not related to a structural issue, is most often related to muscular imbalances. A muscle must be capable of performing its job throughout the joints entire range of motion (ROM) in response to forces applied to the joints. Muscles with a fully functioning feedback loop [both afferent and efferent] will be able to support a joint through a full ROM. Muscles having a diminished feedback loop will not perform optimally, resulting in instability, limited motion, compensation and/or pain. The primary focus of MAT is to locate muscles that are neurologically inhibited and restore the communication loop. It is generally in positions of extreme and particularly in the shortened range, for reasons mentioned previously, that inhibition is detected. These are positions of extreme vulnerability and the positions where an injury is likely to occur. Most injuries do not occur with joint positions near neutral. 3. Weak links occur in the body when joints lose the components of mobility and stability. Muscles serve a mobility function by producing or controlling the movement of a bony lever around a joint axis; they serve a stability function by resisting movement of joint surfaces and through approximation of joint surfaces. Since muscles control joint movement, they must have optimal neural input in order for normal joint function to occur. Without proper neural input into the supporting muscles, joint stability and mobility will be compromised. When stability/mobility is lost at one joint, the body attempts to compensate at a joint proximal and/or distal to the dysfunctional joint. This places additional and uneven stress on the contact surfaces and connective tissues of other joints in the system and interferes with the timing of muscular participation. Under these circumstances, activities or exercises will only contribute to this compensatory motion. Although concentric exercises are often prescribed to strengthen muscles, they are ineffective and perhaps detrimental to muscles that have diminished neural input. Due to the unloading of the muscle spindle and subsequent stretch lag time as the muscle moves into the shortened position, strength will be improved where propioception exists, but will not improve where it is needed most. In this scenario, concentric exercise would contribute to positions of vulnerability, not help to resolve them. 4. Muscles Activation Techniques uses a comprehensive 2-Step process. The 1st Step in the evaluation is a joint specific range of motion (ROM) exam designed to identify asymmetric limitations in motion. MAT recognizes these limits in range of motion to be the result of neural inhibition♠ of the muscle that is responsible for moving the joint into the position of restriction (agonist), NOT tightness in the opposing muscle (antagonist). Once the limits in ROM are identified through the examination process, the muscle or muscles that are responsible for moving the joint into position will be evaluated. * Loss of neural input to a muscle can occur due to: Chemical stress - medications, vitamins, environmental, nutritional Emotional stress– career, finances, family, relationships Physical stress– surgery, aggressive passive stretching, trauma, over use, inappropriate use, under use (or a combination of any or all of the above) The 2nd Step in the MAT process is a strength test of the muscles showing weakness revealed by restricted motion in Step 1. The strength test reveals whether or not a muscle has sufficient neural input to fully support its corresponding joint(s). A muscle that fails the strength test is a muscle that cannot withstand the forces of day-to-day living. This sets off a chain reaction of muscular compensation. MAT has altered the traditional components of a strength test to create a neuroproprioceptive response test. The purpose of the MAT muscle test is to determine if a muscle will contract on demand, rather than measuring contractile strength. MAT has altered the traditional strength test in the following ways. The muscle is tested in the shortened position because the slack in the muscle spindle, disadvantaged mechanics and reduced overlap in the actin and myocin contribute to make the shortened position the most likely place to reveal inhibition. Pressure and timing are only hard enough and long enough to determine if the muscle will contract on demand in the designated position. The tests are not intended as break tests. Some muscles have more than one division therefore, there may be several tests for one muscle. The direction of the applied force and the joint position is critical to retrieving accurate information. Once the ROM exam and neuroproprioceptive response tests are completed, the goal of MAT is to restore neural communication to the inhibited muscle. 5. There are two forms of treatment used to increase the neural input sent through the Central Nervous System to the inhibited muscle. Precision manual palpation of the attachment points of the inhibited muscle directly stimulates the sensory nerve endings increasing proprioception. Isometric contractions can also be used to stimulate communication and may be used independently or in conjunction with manual palpation. The isometric contraction and its use in increasing the sensitivity of the muscle spindle in an inhibited muscle are based on the principles of gamma biasing. Concentric contractions are ineffective for increasing neural input because as a muscle reaches its shortened length there is an unloading effect and stretch lag in the muscle spindle limiting potential contractile output, thereby reinforcing the receptive part of the muscle, but keeping the weak range weak. An isometric contraction, performed in the shortened range, eliminates the unloading effect and stretch lag on the muscle spindle making it more responsive to tension. The muscle relies on a continuous feedback loop from the brain to the muscle through the muscle spindle. Feedback is interrupted when the spindle has slack, therefore it needs to be under tension to deliver communication, which the isometric contraction provides. It is the specific positioning and intensity of the isometric contraction that allows the MAT certified specialist to effectively increase neural input to an inhibited muscle. 6. There are many treatment options and exercise protocols that address muscle tightness. The theory is to restore normal joint function by loosening or releasing the tight muscle via massage, heat, pressure points, stretching, manipulation of fascia, vibration, energy flow, postural awareness techniques, etc. However, tightness represents only half of the muscular imbalance equation and is a symptom, not the cause. The other half of the equation is recognizing, looking for and when necessary, restoring proper neural input to inhibited muscles. An inhibited muscle cannot provide optimal support and control at the joint. The brain detects this instability and sends a motor command to tighten muscles to create the necessary support. Releasing the tight muscle is not the solution. Restoring function to the inhibited muscle solves the problem and immediately removes the need for muscle tightness. When mobility is increased and is not accompanied by strength and control, tightness will return in an attempt to provide stability and protection. MAT provides a checks and balance system that insures increases in range of motion are accompanied by strength and control within the new range. 7. When limits in motion and/or pain are a result of muscular imbalances, the cause is not always located at the site of pain. When the feedback loop of information from the brain through the Central Nervous System to the muscle is reduced, joints become unstable and information to supporting muscles may be altered. This will shift forces to other joints in the body, contribute to compensatory motor patterns and order of motor recruitment. Over time muscles required to perform their function plus attempting to compensate for another muscle will become over worked. These overworked muscles may become the site of the pain, but they are not the cause of the underlying problem. Restoring normal joint function, in many cases, reduces or eliminates pain that has been transferred by compensation. Through a foundation of biomechanics MAT examines the interrelationships between the joints and recognizes that abnormal mechanics in one joint may affect motion at another joint. 8. MAT is the missing link between rehabilitation and Progressive Exercise Mechanics. It is generally accepted that muscle imbalances play a major role in contributing to injury and pain. There are many therapies that address muscle tightness, but when it comes to weakness, the other half of the equation, most therapies encourage strength training. What is missing is an acknowledgment for the need of a specific neuromuscular component, followed by an evaluation and treatment plan. Strength training before neuromuscular integrity has been established will reinforce the pathways that are receptive however; those with limited proprioception will stay relatively weak. For this reason corrective and functional exercises would be a poor prescription for dealing with the neurological weakness component of muscular imbalances. MAT provides the neuromuscular missing link. Once MAT has identified and eliminated the weak links, a progression of exercises can begin. Although most exercise programs claim to be customized, they rarely take into consideration an individual’s structure, anatomical limitations, physical tolerances, skill level, conditioning and whether or not their muscular system is capable of generating the forces necessary to support their joints and limbs. The human body has a tremendous ability to adapt (increased muscle size, strength, endurance, flexibility, performance, weight loss, etc.) and withstand increases in force, but there is always a limit to what it can tolerate at any given time. When the limit is exceeded the body responds negatively (muscle soreness, tendonitis, damage to connective tissue, bone degeneration, mechanical wear, osteoarthritis, bone spurs, bursitis etc) and we are usually at a loss as to why these conditions appear and in many cases become chronic. This means exercise, which includes everything that involves body movement from weight training to yoga, has equal potential for benefit and harm. Exercise is a combination of force, movement or prevention of movement, time and internal muscular effort. If these components are applied haphazardly with no consideration as to the potential effects they may have on a specific individual for each exercise, there is an increased risk that the tissues of the body (cartilage, ligaments, tendons, muscle) will not be prepared to tolerate the demand, generating a negative response. When they are applied appropriately and progressed systematically, the tissues adapt to tolerate increased demand and health and fitness goals can be reached with a decreased risk for injury. In order to achieve results and keep the risks to a minimum, exercise prescription must consider neuro-muscular integrity first. Followed by the individual’s structure and how far an exercise deviates from the joint(s) intended function. The frequency and duration of an exercise must also be considered as well as the amount of added load and speed of movement. The single most important factor in appropriate exercise may be how well an individual prepares, both short and long term, to perform an exercise, sport or motion. Knowing how and when to alter, add, eliminate or intensify these factors to create strategic variation and manipulate challenge is the key to injury prevention and long-term joint health. 9. The fitness industry standard for assessment consists of a variety of tests designed to create a baseline for an exercise program. The method of testing, qualifications and influence of the tester, accuracy of the information and how that information is applied to an individual has long been the subject of disagreement within the fitness industry. Heart Rate – A resting heart rate is used in formulas to determine level of expenditure for cardiovascular activities. Resting Heart Rate is the fewest number of beats per minute, which can only be accurately measured upon wakening, not at an information intake session in a fitness facility. Blood pressure – This may not be a very accurate tool, at the initial assessment, given the potential anxiety/excitement level of a first session. If blood pressure is taken during exercise it should not be used as a baseline measurement because it (like resting heart rate) is also an elevated reading. Taking circumferences – Due to bulky clothes, variability of test site locations and reliability of the tester, these measurements may not be accurate. A solution to these variables would be to have the individual pick an article of clothing that fits at the time of the assessment and monitor changes in body measurements relative to the clothing. Body Composition – There are several ways to determine body fat composition, but the degree of accuracy depends on the method of testing (hydrostatic weighing 1-1.5% + or – error factor, skin fold caliper 3-3.5% + or – error factor) and reliability of the tester. For these reasons the inaccuracy of the test make them inappropriate for absolutes or relative change. Postural/functional assessments performed in a fitness setting are crude and misleading. Visually assessing standing posture (on one or both legs) or compound movements such as a squatting motion may reveal deviations from what the observer perceives to be normal, but in no way do they indicate a musculoskeletal problem and they certainly do not reveal the source or location. Imposing forces on an individual in the form of “Stretch and strengthen” corrective exercises based on this information often contributes to the muscular dysfunction the fitness trainer is attempting to correct. Concerns with visual or computerized assessment: •Any form of active movement before neuromuscular integrity has been addressed is inappropriate. • The skill required to perform the test may be beyond the ability of the individual being assessed or the skill of an individual may be advanced enough to hide compensations. How does the observer/computer program distinguish between: 1. limited skill and muscular imbalances 2. de-conditioned muscles and neurologically inhibited muscles 3. global and/or local instability 4. structural/anatomical vs. muscular limitations 5. focused attention to the task and disinterest, non-focused, insecure • If the client passes the assessment and everything looks normal, is it assumed that neuromuscular integrity and orthopedic health are optimal? • At best the observer is seeing motor patterns and compensations, not the causes of them. • Who determines normal movement and alignment and how skilled is the observer at assessing them through clothes, skin and tissue? • How do anatomical differences, such as bone length and rib cage thickness, alter the test/assessment results? Using visual or computerized, postural or functional assessments as a screening tool for exercise prescription is the equivalent of having a mechanic watch you drive into the repair shop, visually inspect the exterior of your vehicle and write up a work order and bill without ever checking the mechanical systems under the hood. Sit and Reach Test – The Sit and Reach Test has been used as an industry standard to assess flexibility for years, but the test position, information gained and applicability of that information has also been debated for years. The Sit and Reach Test requires motion at the ankle, knee, hip, spine, shoulder and neck. Questions about the Sit & Reach Test that need to be asked and answered are: What joint(s) is/are being evaluated? How is joint motion being measured? How is the shifting axis in rotation of some joints being calculated? Is the spine being measured at each segment OR is it overall spinal flexion, in which case where is the axis of rotation? What is considered “normal” flexibility? Can flexibility be altered by an anatomical limitation, neural inhibition, surgical procedure, body mass and/or an inadequate warm-up? How does the tester know if these factors are present? How qualified is the individual gathering this information? How are the results of the Sit & Reach test being applied to exercise perscription? Uncontrolled forward flexion is a position that is typically avoided by medical and fitness professionals, so why is it OK for a standardized test? Step Test – is designed to determine an individual’s current level of cardiovascular fitness. Asking a client to exert significant effort at the initial session to determine where to start the exercise process makes absolutely no sense. A beginner pilot is not initially asked to land a plane to give the instructor an idea where to start flying lessons. Additionally, asking an individual to move before their joint health has been assessed is inappropriate. The combination of sciences and the precise method of assessment and correction make Muscle Activation Techniques stand out as a much needed missing link in the fitness profession. By acknowledging and addressing the need for a neuro- mechanical baseline, MAT in combination with Progressive Exercise Mechanics is able to promote long-term orthopedic health. |
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