The

Performance Matrix
for
Movement Screening
& Risk Analysis

Performance Stability Ltd 2003-2004 all rights reserved

PERFORMANCE STABILITY
The development of realistic and workable risk assessment and screening processes and subsequent
training packages for sport and occupational health has been somewhat of an unattainable dream
amongst exercise, sporting and occupational health professionals for many years. To date, attempts
to do this have been centred on testing joint range, muscle strength (both power and endurance) and
testing muscle extensibility. Some attempts have focused on developing functional tests based on
work specific tasks and sport specific skills. All have been relatively unsuccessful at predicting risk
of injury and have resulted in training programmes being biased towards high load muscle
(strength) training and high force joint and muscle stretching, (which in some cases may be the
cause of injury).
It is well accepted that in todays professional sporting environment that power, endurance and
flexibility are important and are a necessary and integral part of any sports training programme.
However, there is an under representation (if present at all) of low load motor control training in
many of these training programmes.
Contemporary neurophysiological and clinical research into movement dysfunction associated with
musculoskeletal injury, chronicity and recurrence of injury, highlight deficits of low threshold
muscle recruitment and motor control inefficiency (OSullivan et al 1997, Richardson et al 1998,
Jull 2000, Comerford and Mottram 2001 a & b, Gibbons and Comerford 2001a & b, Sahrmann
2002). These deficits are only clinically and functionally identified with very specific tests of low
load recruitment efficiency. Some of these dysfunctions develop prior to the onset of symptoms and
injury and appear to be precursors or contributing factors to the development of injury and
symptoms (Comerford and Mottram 2001b, Sahrmann 2002). There is mounting evidence that
failure of low load recruitment efficiency is the most consistent and reliable predictor of recurrence
(Richardson et al 1998, Hides et al 2001).

MUSCLE STABILITY VERSUS STRENGTH

MUSCLE STABILITY FUNCTION:
Assessment of the musculo-skeletal system under low load testing
Muscle stability assessment is based on the accepted and extensive research on muscles like
transversus abdominis. Stability function (or dysfunction) is reliably tested under low load
situations. It is based on the ability to pass or fail a low threshold test of motor recruitment. The

Performance Stability Ltd 2003-2004 all rights reserved

benefit of having good stability function of both the local and global stabiliser muscles is in
improved low threshold motor control and in decreasing mechanical musculo-skeletal pain.
o Pass no movement induced pathology and pain free function
o Fail - development of pathology and pain.

MUSCLE STRENGTH FUNCTION:

Assessment of the musculo-skeletal system under high load testing
Muscle strength is measured as the ability to pass or fail a test of resisting or supporting a high load.
The grading of muscle strength as 1 to 5 with manual muscle testing is an example of muscle
strength testing that physiotherapists are trained to perform. This testing is often performed using
force dynamometers to provide more objective measurements. The benefit of having good strength
is that performance is improved or maintained. Strength training does not demonstrate consistent
improvement in pain and pathology or low threshold motor control function.
o Pass- good power, endurance and high load performance
o Fail - weakness and the loss of performance.

STABLE

S T A B IL IT Y
D Y S F U N C T IO N

STRO NG

++

-+

G ood
P e rfo rm a n c e

W EAK

+-

--

Poor
P e rfo rm a n c e

P a in fr e e

P a in fu l
(adapted Silvester & Comerford)

Performance Stability Ltd 2003-2004 all rights reserved

MOTOR CONTROL STABILITY, CORE STRENGTHENING

& TRADITIONAL STRENGTH TRAINING
Before looking too closely at stability training it is necessary to define basic differences between
strength and stability.

MOTOR CONTROL STABILITY VERSUS CORE STRENGTHENING

The term stability training has gained widespread acceptance in both the therapeutic world and in
the exercise and fitness industry. In the current literature stability is a term used to describe many
different situations and processes.
In particular, the term core stability is now used by many people and is used to describe a large
variety of different types of exercise based training programmes. The term core stability was
originally referred to as low load motor control training of the trunk while progressively adding a
limb load and proprioceptive challenge while maintaining a neutral spine. However, this now
longer seems to the common interpretation. During a literature search of the term core stability in
both the academic literature and in the exercise industry magazines in the popular press, it is
apparent the term is in common use (Gibbons and Comerford 2001a). When used, authors
frequently refer to the low threshold motor control research on muscles like transversus abdominis
and lumbar multifidus but when they go on to describe specific exercise and training regimes the
majority of these articles describe a process of overloading and strengthening (high threshold
training) the proximal trunk and girdle muscles, usually in neutral or mid range positions, using
high load resistance applied via the limbs or at the trunk.
This is strength training of the core muscles of the trunk and results in co-contraction of all
regional muscles (local stabiliser, global stabiliser and global mobiliser muscles). This high load,
core stability training utilises co-contraction rigidity processes rather than low load motor control
stability processes to achieve its observed effects. It may not be appropriate to extrapolate the
research on low threshold dysfunction and training of the local stability muscle system to this high
threshold training process. High load core stability training is an integral part of training to tolerate
loaded activity (including sport) and should be used as part of an integrated strengthening
programme along with traditional strengthening and power training programmes.

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Because the term core stability no longer is used in the way it started off, and it has now achieved
generic status in the exercise and fitness industry it is necessary to redefine or re-label stability
concepts in terms of low and high threshold principles. We suggest that the term motor control
stability may be an appropriate name for the low threshold training. The stability referred so far in
this text is motor control stability and is best defined as central nervous system modulation of
efficient integration and low threshold recruitment of local and global muscles systems. We further
suggest that it may be more accurate and less confusing to refer to high threshold training processes
of the neutral trunk as core strengthening.
There are some defining differences between motor control stability and core strengthening.
MOTOR CONTROL STABILITY
CORE STRENGTHENING
Muscle specific: That is, it can be biased for Muscle non-specific: Because of high load
either a local stabiliser muscle or a global resistance or endurance overload to the point of
stabiliser muscle.

fatigue all relevant synergists are significantly

activated. There is co-contraction of local
stabilisers, global stabiliser and global mobiliser

muscles.
Recruitment specific: That is, because all these Recruitment non-specific: Again, because of
exercises use low load or functional normal overload, both slow and fast motor units are
loads then slow motor units are predominately strongly recruited.
recruited
Central nervous system modulated: That is, Regional adaptation to load and demand: The
afferent spindle input influences tonic motor muscle hypertrophy is a response to overload
output.
Low threshold training (CNS modulated)

training.
High threshold training (muscle adapting to

overload demand)
Biased for the local and global stabiliser Biased for the global stabiliser muscles
muscles
Neutral position prevailing (+/- axial plane)

Neutral position prevailing (+/- axial plane)

Predominantly isometric and isotonic with Predominantly isometric (also isotonic with
emphasis on eccentric activity

emphasis on concentric activity)

TRADITIONAL STRENGTH TRAINING

In contrast, traditional strength training has certain differences and benefits.
Performance Stability Ltd 2003-2004 all rights reserved

High threshold training (muscle adapting to overload demand)

Biased for the global mobiliser muscles

Sagittal plane prevailing (+/- coronal plane)

Predominantly isotonic with emphasis on concentric (also isometric and isokinetic)

Resistive overload is applied via the limbs while the proximal trunk may be supported or
unsupported. The best example of traditional strength training is gym based weight training
equipment where the weight is lifted concentrically against gravity and where a hinge, axel or cam
controls the direction of the movement to the sagittal (flexion-extension) plane.
The load may be:

Isometric movement controlled (no range, no speed) with load variable

Isotonic concentric (shortening against load) or eccentric (lengthening against load) load
controlled with movement range and speed variable

Isokinetic speed controlled with movement range and load variable

The direction may be limited or controlled (weights machines / equipment) or uncontrolled (free
weights) where axial and coronal movement must be controlled by the subject.

CORE STABILITY OVERVIEW

Traditional
Strengthening:
Limbs
(sagittal load)
high

Core
Strengthening:
Trunk
(rotational load)
high

low

low

Muscle Bias

global mobilisers

global stabilisers

global stabilisers

local stabilisers

Position / Plane
of 10 Loading

flexion-extension
plane

rotation plane +
neutral position

rotation plane +
neutral position

neutral position

Type of
Contraction

isotonic
concentric
+/- isometric &
isokinetic

isometric
+/- isotonic
concentric

isometric
(dissociation) &
isotonic eccentric
(through range)

isometric

Training
Threshold

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Motor Control
Stability:
Global

Motor Control
Stability:
Local

There are many differing interpretations of stability and stability training. The term core stability
is now generic and used to describe a large range of both low and high load training processes. This
term is now vague and non-specific and is probably best used to refer to stability training processes
in general. With increasing demands on therapists for therapeutic exercise programmes and on
exercise professionals for specific or prescriptive training programmes, it is often difficult to know
where to start. If we at least have a clear understanding of the differences between traditional
strength training, core strength training and motor control stability training we are in a better
position to make a thorough assessment of dysfunction and more reasoned clinical decisions
regarding the appropriate type and level of exercise or movement based intervention.

PERFORMANCE MATRIX
Performance Stability (with its links to the Kinetic Control Movement Dysfunction Courses)
utilises the latest academic and clinical research to develop assessment principles of stability
function and motor control performance to provide a unique, evidence based analysis and training
package for specific client applications. Based on analysis of high incidence sites of injury,
mechanisms of injury, prevalence of certain injuries, previous injuries, and the biomechanics of
sport specific and occupation specific activities that incur higher incidences of injury, a series of
priority risk factors are determined. A series of tests are then produced to best achieve a particular
goal or clients needs. These client specific goals and needs vary but can be tailored towards sport
specific screening, joint specific screening, injury specific screening, technique related risk, general
base screening or elite performance screening.
The priority risk factors are incorporated into Performance Stabilitys concept of a sport specific
Performance Matrix to determine the weak links in the stability and performance chain. These
weak links are identified in terms of the site and direction of musculoskeletal risk and in terms of
the threshold (low or high) of performance failure potential.
This Performance Matrix can be used as a risk analysis protocol and can be used to develop a
training package where sports medicine, occupational health and exercise professionals (doctors,
physios, exercise physiologists, trainers, coaches, ergonomists and work place assessors) can be
taught to implement the tests and identify the weak links or potential risk in the performance
matrix. Different individuals pass or fail different aspects of the testing process so that the
individuals specific profile of performance and stability risks and assets can be determined.
Performance Stability Ltd 2003-2004 all rights reserved

With an individuals performance weak links and potential risks identified, a prescriptive re-training
programme can be developed and implemented. This re-training programme would include
strategies to regain control of the site and direction of performance failure and retrain at the
appropriate threshold of loading. Retraining would use movement and exercise as a tool to:
i.

Decrease pain (if relevant)

ii.

Increase joint range and muscle extensibility

iii.

Improve joint stability

iv.

Enhance muscle performance

v.

Optimise movement function

The performance matrix can also be used to evaluate the effectiveness of any individual retraining
programme.

References
Comerford M J, Mottram S L 2001a Functional stability retraining: Principles & strategies for managing mechanical
dysfunction. Manual Therapy 6(1):3-14
Comerford M J, Mottram S L 2001b Movement and stability dysfunction contemporary developments. Manual
Therapy 6(1):15-26
Gibbons G T, Comerford M J 2001a Strength versus Stability Part I; Concepts and terms. Orthopaedic Division Review
March / April: 21-27
Gibbons G T, Comerford M J 2001b Strength versus Stability Part II; Limitations and benefits. Orthopaedic Division
Review March / April: 28-33
Hides J A, Jull G A, Richardson C A. 2001. Long term effects of specific stabilizing exercises for first episode low
back pain. Spine 26(11):243-8.
Jull G A 2000 Deep cervical flexor muscle dysfunction in whiplash. J Musculoskeletal Pain 8(1/2): 143-154
OSullivan PB, Twomey L, Allison G 1997 Evaluation of specific stabilising exercise in the treatment of chronic low
back pain with radiological diagnosis of spondylosis or spondylolisthesis. Spine 22(24):2959-2967
Richardson C, Jull G, Hodges P, and Hides J 1999 Therapeutic Exercise for Spinal Segmental Stabilization in Low Back
Pain: Scientific Basis and Clinical Approach. Churchill Livingstone
Sahrmann S A 2002 Diagnosis & Treatment of Management Impairment Syndromes. Mosby, USA

Performance Stability Ltd 2003-2004 all rights reserved