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Prescriptive Exercises

Dynamic stabilisation exercises refer to exercises to correct faulty posture and movement. This is related to muscle imbalances and faulty muscle recruitment and activation sequences, which results in non-ideal positioning of joints, loss of joint and segmental stability. This results in increased strain and likelihood of injury.

Postural balance is a state of least muscle activity to maintain an upright posture or performance of a particular activity. This is determined by:

• Structure - Congenital or acquired asymmetry, for example short leg or scoliosis.
• Pattern of use - The balance between opposing muscles (agonist and antagonist) and joint position from occupational, recreational and emotional influences. Certain activities preferentially use particular muscles which can cause shortening and malpositioning of joints for example weight lifters may develop protracted shoulders and stooped posture.
• Deconditioning - injury or inactivity weakens selected muscles leading to altered joint position. This results in changes to the balance of forces acting on opposing muscles with preferential use of force generating muscles as oppose to stabilising muscles. This leads to changes not only in joint positions but also in altering the pattern and timing of muscle activation, resulting in recruitment of extra muscles in a compensatory and less efficient manner. This alters not only posture at rest (static posture) but also posture during movement (dynamic posture).
• Developmental - There is evidence to suggest up to 30% of infants develop faulty movement patterns during development of locomotion, for reasons which are not fully understood. This group uses substitute non-ideal muscle patterns to achieve stages of turning, rolling, crawling and upright stance and finally walking. This leads to development of weak core and poor peripheral stability, faulty joint positioning and faulty muscle recruitment and firing (non ideal muscle activation pattern). This will also result in altered posture during development for example uneven pelvis and shoulders and chest wall asymmetries.

The focus of dynamic stabilisation exercises is to achieve dynamic stability and functional fitness for the musculoskeletal system to improve efficiency of movement and reduce risk of injury. To achieve this task, we at Northside adopt a program which focuses on the following:

• A thorough musculoskeletal assessment by our doctors to determine the individual's pattern of dysfunction and to identify the cause.
• Manual treatment of pain triggers for symptom relief.
• Teaching an individualised program of home exercises targeting stretches to achieve muscle balance, restoration of a more ideal joint alignment and corrective muscle activation pattern to change habitual maladjusted muscle recruitment sequence.
• Identification of possible breathing dysfunction (see breathing dysfunction) and core instability (see core stability) and initiate a program of corrective exercises.
• Identify poor stabilisation in the peripheral system, for example poor shoulder stability causing rotator cuff injury and pain, and address the identified problem with corrective exercises.
• The integration of peripheral and core stability into global full body activities of daily living, in order to achieve postural balance with minimal strains. This requires supervised exercises initially in a static position by our doctors and then progressing to movement activities under supervision by our exercise physiologist.
• Attainment of this stage will enable patients then to participate in their choice of exercises to achieve functional fitness without risk of further injury.

The above program is personalised to address the individual's musculoskeletal dysfunctions. It involves one on one instructions and supervision of exercises to ensure the correct muscle activation pattern is taking place before gradual upgrading of tasks.

At all stages of training the essential task of learning body awareness is emphasised and needs to be achieved to allow patients to become self aware of non-ideal postures and faulty muscle activation patterns. This awareness and performance of corrective exercise empowers patients for self-care and self-correction in the ongoing task of healthy maintenance of the musculoskeletal system.