Don’t worry; in this matrix, you won’t have to choose between the red or blue pill. However, you WILL have to choose which exercises are appropriate for your patients at any given stage of their rehabilitation, which can be just as daunting of a decision.
Why proper exercise progression and regression matters
Functional exercise progression is a dynamic skill that involves an understanding of how we develop movement from as early as birth. It’s safe to say that there has never been a human who has strolled out of their mother’s womb. There’s a natural progression that needs to happen before a person can support his or herself on two feet. Just like this example, your patients need to be able to competently move through beginner movements before they hit the ground running.
“Functional exercises should be prescribed in a logical order of basic patterns that mimic the natural development of human movement” said Michael Voight PT, DHSc, OCS, SCS, ATC, CSCS, FAPTA. “A patient should demonstrate appropriate control before progressing to activities without feedback and definitely before adding resistance, or load.”
It’s no secret that diving into advanced movements too soon can result in pain, discomfort and slower results. Most importantly though, this overzealous behavior can establish improper movement patterns that could potentially result in a re-injury, or injury of another area of the body.
“We want to find that spot for our patient that’s challenging but doable so they’re performing an exercise correctly versus reinforcing bad movement patterns,” said Ashley Campbell PT, DPT, SCS, CSCS, CGFI-2.
The 4×4 Matrix
Drs. Voight and Campbell use the 4×4 Matrix to teach proper exercise prescription, progression and regression in their Scrape, Tape and Move course. The 4×4 Matrix is organized based on the developmental sequence, which includes a general outline of rolling, crawling, transitional movements and upright movements. There are two sides to the matrix: the positional side and the resistance side.
The Positional Side
The left half is based on the neurodevelopmental process and represents the posture the patient will be performing the exercise in:
- Supported: Laying on back or side
- Suspended: Quadruped position
- Stacked: Seated or kneeling
- Standing: Standing upright
The Resistance Side
The right side represents the type of resistance that the patient will be using while performing the exercise:
- Feedback: Without load, only receiving feedback on how to do the movement properly from a tactile cue, instrument, etc.
- No load: Just body weight and gravity without the feedback
- Load with feedback: Adding extra resistance from a tool like the TheraBand CLX, dumbbell or kettlebell with the reintroduction of feedback
- Load: Keeping the load without feedback
How to use The 4×4 Matrix to create, classify, progress and regress exercises
Using this method, exercises are classified as “Position x Resistance.” For example, patients will need to start in position 1, or supported posture. Once they can perform the exercise in the supported posture with feedback (a 1×1 move), they can move on to a supported posture with no load (a 1×2 move), then to a supported posture with load and feedback (a 1×3 move) and finally a supported posture with load only (a 1×4 move).
From here, they would move to position 2, or suspended posture, and work through each resistance level until they can reach a 4×4 level. The method is the same in regression; just work your patients back down the ladder.
Need more clarification? Watch Dr. Campbell dive deeper into The 4×4 Matrix below! Or, better yet, sign up for the Scrape, Tape and Move course to learn how this method can be integrated with diligent movement assessment, instrument assisted soft tissue mobilization tools, kinesiology tape and facilitating proper movement patterns. Find a course near you and earn some CEU’s while you improve yourself and, ultimately, your patient’s outcomes!