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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