There are several ways to progress a patient or client. Sometimes trainers may easily increase the weight, reps, or sets. Or you may increase the rounds or change the work:rest intervals so to modify the intensity. But from a motor control and a functional standpoint how can we be systematic and effective about our progressions?
This is where the 4x4 matrix can assist with proper progression execution:
The above pic entails what is called the 4x4 matrix. Here is an example to show how it works. You can take a patient and potentially start them in a non-weight bearing position (level 1) such as supine or prone (this is first part of the 4x4 matrix) and provide resistance (level 4) with a pattern or movement that you want to improve (this is the second part of the 4x4 matrix). So for this example, the patient would be a 1x4, because they are NWBing x Resistance. If the patient can perform the exercise properly without compensations, high threshold strategies, or abnormal breathing strategies, than you can progress the patient accordingly. For example, into 3x2 which is a tall kneeling position with no resistance, like a hamstring stand. Conversely, if the patient demonstrates difficulty performing the task properly than you can move down to a quadruped alternate arm and leg extension with a towel roll on the back to cue proper core control, or a 2x1. Following the 4x4 matrix allows for proper progression to enhance function and performance.
Another important point to notice above is the abbreviations PA, standing for Pattern Assist. Pattern Assist is defines as any technique to inhibit or facilitate tone, assist a movement or alter a motor control firing sequence during or before a task that is required. An example of PA, would be pulling bands by your side to engage the core as to alter the proper stability needed in this area for a lower extremity movement. A patient should demonstrate appropriate control before progressing to activities with resistance. PA can be added before AROM and Resistive ROM.
The 4x4 Matrix is a valuable concept to follow, allowing for a systematic approach to restoring function and performance. It is important to note that progressing a patient should only accommodate the neurophysiological resets you perform beforehand as to improve proprioceptive awareness and neuromuscular control and/or diminish the protective tone and guarding seen in motor control deficits. Further, the 4x4 matrix should only be performed after biomechanical resets for joint or tissue mobility issues. In other words, make sure you have good mobility first. Reloading with the 4x4 matrix ensures the manual ‘resets’ you perform are sustained.
As I explained it today to an intern, its like our patient is Goldilocks and were trying to make sure the porridge is not too hot (difficult), not too cold (easy), but just right!
As I explained it today to an intern, its like our patient is Goldilocks and were trying to make sure the porridge is not too hot (difficult), not too cold (easy), but just right!
