Friends & ‘Enemies’

Basketball Analogy

 

It’s NBA basketball playoff time, and (when it’s not a foul-fest) I enjoy watching the most graceful athletes in the world do their thing. One of the most spectacular plays in basketball is the alley-oop dunk, where one player passes the ball up near the rim while the other player jumps, catches the ball and flushes the ball through the hoop, all in one movement.

Most commonly, this play happens off a ‘pick and roll’ play, where one player sets a pick (positioning oneself on the court to block an opposing player that is guarding the person with the ball), then immediately runs (rolls) toward the basket. The person with the ball then passes to the roller for the dunk.

This is a play that requires exquisite timing – when to roll, when and where to pass, when to jump and how to coordinate a nearly simultaneous catch and jam. It is a play that needs to be practiced over and over and over again – with a goal of making it spontaneous or second nature. Obviously, both  of the offensive players need to be on the court at the same time to practice this.

 

Agonist Cooperation

 

Similarly, in an integrated motor system, muscle synergists need to be coordinated and timed to work together – on the same ‘court’ and applied to a specific functional context. And this basic ‘rule’ of motor control exercise (rehab related exercise done for postural, gross motor or arthrokinematic optimization) is summarized by neurophysiologist Donald Hobb

 

• • • Neurons that fire together wire together.

• • • • We want to create/encourage automaticity between relevant muscle synergists.
      • This is accomplished through both axonal sprouting and reduction of the excitation threshold across the relevant synapses.

• • • Neurons that fail to sync together fail to link together.

• • • • In order for muscle synergists to ‘wire together’, they need to be timed or synchronized.
      • We can’t do one exercise for one muscle and another exercise for another muscle, any more than we can have one player practice a pass near one basket while the other player practices dunking on another basket.

 

Antagonist Cooperation

 

Perhaps not as obvious, but the two offensive players in a pick and roll/alley-oop also need two defensive players to simulate game conditions. ‘Practice the way you play’ is a basic athletic axiom, but could just as easily be applied to rehab. In basketball, the two defensive players are not cooperative, but antagonistic – they are trying to prevent the play from happening.

Within the body, and when doing rehab-related exercise for motor control purposes, the action of the muscle antagonists is just as important as the action of the agonists. We call them antagonists, but they are not actually trying to prevent the action of the agonists (ideally):

 

• • • Antagonist musculature needs to be inhibited and allowed to lengthen as the agonists are excited and shortened (in an anti-gravity situation).
    • Therefore, we can say that all four ‘players’ are working cooperatively toward a common goal and for the common good.

 

Rehab Implications

 

When doing exercise for motor control purposes, our traditional roots or common thought processes has implied that:

 

• • • ‘The purpose of this exercise is to strengthen this or that muscle’.
    • ‘If I strengthen all the muscles involved in a particular movement, they will automatically improve the quality of the targeted function’.
    • ‘Optimal muscle engagement for any particular function is primarily a result of the objective strength of the individual muscles’.

 

This approach is not scientific – it is wishful thinking. Instead, we might expand our exercise paradigm to think to ourselves:

 

• • • ‘I am prescribing this exercise to train optimization of this or that particular function’.
    • ‘I know I need to simultaneously coordinate and time the various synergists involved in that function’.
    • ‘I want to train the engagement of these muscle synergists within a specific functional context – train how you play’.
    • ‘I am cognizant of the role of the antagonists while training and coordinating the agonists’.

 

• • • • I need to ensure accurate antagonist inhibition – making sure they are not working unnecessarily against resistance or ‘driving with their brakes on’.
      • I acknowledge the duality of all meaningful movement – the positive/go and negative/stop aspect of each movement.

 

Thus, motor control exercise is not simple or easy – it does not lend itself well to pictures or simplified drawings on a flash card or exercise sheet. And while evaluation and manual therapy are high level skills for the rehab professional, so is movement training/exercise prescription, correction, teaching techniques and appropriate progressions. Exercise is not a low level skill to be passed off to aides or untrained exercise techs.