Although the use of the phrase "prescriptive exercise instruction" is not unique to our clinic, we strongly believe that we are unique in how we prescribe corrective exercises.

Prescriptive exercise outcomes are only as good the evaluation performed at identifying the patient's dysfunction and the resulting compensations.

At Ascent Physical Therapy we have the time, knowledge, and experience to correctly identify and treat the functional pathology underlying the structural pathology. By continually reviewing new and insightful research, we have gained a better understanding of how muscle impairments and stability control are influenced by the neuromuscular system. This knowledge allows us to more accurately prescribe the most suitable exercise for a particular dysfunction.

Clinically, the typical pattern of stability dysfunction that is seen is decreased recruitment efficiency in the local system, with compensating recruitment and functional changes in the global system. The loss of ideal local or global control results in abnormal stress or strain on the joint, its supporting soft tissue structures, and related myofascial and neural tissue. Each of these ultimately causes pain.

A new muscle classification system was recently introduced by Mark Comerford and Sarah Mottram. We have adopted this system into our practice. This system classifies muscles into different groups based on their role. The following are descriptions of each of the different muscle types on a functional scale: Function & Characteristics of the local stability muscles:

• muscle stiffness to control segmental motion
• Controls the neutral joint position
• Contraction = no or min. length change, therefore doesn't produce R.O.M.
• Activity is independent of direction of movement
• Continuous activity throughout movement
• Proprioceptive input re: joint position, range and rate of movement

Function & Characteristics of the global stability muscles:

• Generates force to control range of motion
• Contraction = eccentric length change, therefore control throughout range especially inner range ('muscle active = joint passive7) and hyper-mobile outer range
• Low load deceleration of momentum (especially axial plane: rotation)
• Non-continuous activity
• Activity is direction dependent

Function & Characteristics of the global mobilizer muscles:

• Generates torque to produce range of movement
• Contraction = concentric length change, therefore concentric production of movement (rather than eccentric control)
• Concentric acceleration of movement (especially sagittal plane: flexion / extension)
• Shock absorption of load
• Activity is direction dependent
• Non-continuous activity (on: off phasic pattern)

Once the key deficits in the neuromuscular system relevant to the patient's pain have been addressed, then an individualized treatment plan can be initiated. Every individual has a unique clinical presentation, therefore no two treatment programs are the same. Protocol based treatment programs assume that all patients with the same diagnosis have the same etiology, which is rarely the case. If you look at the evidence, individualized treatment programs , give far superior results to generalized ones. This is where the skill and knowledge of the practitioner comes into play.

True physical therapy is about providing patients with the necessary tools to move, be active and exercise in ways that create favorable tissue loading and efficient pain free movement. Exercises should be patient specific (prescriptive) according to their impairment, work and recreation demands. Patients are made aware of how the strategies they have been using are connected to their pain and dysfunction and given simple exercises to correct them. By controlling joint instabilities and changing non-optimal movement patterns, they can return to their normal activities pain free.

Last Updated: February 26, 2010
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