Are we Training Transitions?
From a rehab perspective, we previously discussed the merits of retraining and progressing a patient while utilizing the ‘4x4 matrix’. This ensures that the patient is challenged at their most difficult, yet most appropriate level as to not allow for compensations during the exercise. Generally, a patient progresses from unloaded to loaded positions with the 4x4 matrix.
However, what's the point of performing corrective exercises and reloading the patient into more challenging positions if we’re not immediately retraining authentic and dynamic movement? In other words we can’t skip the simplicity and importance of training the transitions between each position as part of our programming.
For example, performing half kneeling chops and lifts are improving the patient/clients motor control in several patterns and in several movement ‘chains’. But what's that motor control for? Hopefully for improved durability, efficiency, and capacity with movement! Movement in or out of that respective position. Therefore the patient needs to follow reloading of the 4x4 with retraining movement, like 1/2 kneeling to stand. Performing several reps, with weight/resistance, or pattern assistance. Challenging them dynamically is much more functional than any static work we can give them. Let’s not forget all these transitions from the ground up our fundamental in how we learned to stand and walk. Probably worth practicing then...
Its super super exciting to see patients who are fearful (TKA) of half kneeling (or quad, or fill in the blank), or unable to get into that position on their own, or unable without directly causing pain, be able to perform several reps with good form with proper exercise progression and practice. Patients need to have a plethora of proper transitioning skills for work around the home. Further, quality transitions for the athlete will build a solid movement foundation for performance, skill, and athletic enhancement.
Don't underestimate the difficulty this is for most people (even atheltes). Take someone who can perform quadruped resisted alternate ue/le (resisted bird dog) and have them perform 10-15reps or quadruped to half kneeling and watch the amount of difficulty they may have.
Transitioning also allows us to assess for aberrant motion and make sure we don't reload them too quickly. Lets say a patient has a real tough time going from half kneeling to stand even with pattern assist, than they will likely compensate and cheat in standing so we may want to spend more time in half kneeling training motor control. Before transitioning training, ensure that the patient has worked in both positions beforehand. Conversely working in reverse can be a powerful neuromuscular re-ed strategy. This way a patient can feel the proper load and stability needed.
This is why the Turkish Get Up (TGU) is such a powerful training tool, it works people through each transition from the ground to fully loaded! “The get up can also be used, as Brett Jones says, as a “save document” function. If you perform some corrective work (Resets and 4x4 matrix reloading) then TGUs, you tie it all together. Load creates motor patterns and with the get up involving so many different muscles and movements (and transitioning), it reinforces the corrective work just done” Andrew Read.
