Essentials of Integrated Training - Part 1

The health and fitness industry is overwhelmed with information on training, fitness, nutrition and rehabilitation. In the face of this information, how does the health and fitness professional tell the difference between gym science and sound scientific training principles? The answer is simple: Integrated Training. Integrated training enables the health and fitness professional to make intelligent choices with regard to training, reconditioning and rehabilitation. The purpose of this article is to provide the reader with a foundational overview of the following integrated training concepts and principles:

• Section I. The Kinetic Chain
• Section II. Integrated Training Concepts
• Section III. Integrated Training Principles
• Section IV. Integrated Training
• Section V. Article Summary

Across the country, there is a shift toward functional training. In fact, functional training has become a buzzword in clinics, gyms, and academic institutions. To stay on the cutting edge of research, exercise science and practical application, the health and fitness professional must understand function.

Function is integrated, multi-planar movement that involves acceleration, deceleration and stabilization. Typically, most strength and conditioning programs involve uniplanar (sagittal plane) force production. Very little time is dedicated to neuromuscular stabilization training, core stabilization training and eccentric training in all three planes of motion (sagittal, frontal and transverse).

Most people perform strength training programs on machines that have been designed based on a lack of understanding of functional anatomy, functional biomechanics and human movement science. Machines provide artificial stabilization and only allow isolated, uni-planar training. This form of training is effective for hypertrophy, but does very little to improve function and prevent injury. New machines have emerged on the scene to help create a solution for this problem. For example, the Free Motion line of equipment allows for multi-planar and multi-dimensional training.

Integrated Training Defined

Integrated training is a comprehensive training approach that strives to improve all components necessary to allow a client to achieve optimum performance. These components include the following:

Core Stabilization Training

• Neuromuscular Stabilization Training
• Reactive Neuromuscular Training
• Integrated Strength Training
• Integrated Flexibility Training
• Integrated Speed Training

The health and fitness professional must thoroughly understand the kinetic chain, functional anatomy, human movement science, total kinetic chain assessment and integrated training principles in order to effectively and consistently improve their client’s performance. These integrated training principles include:

Integrated Training Paradigm

• Integrated Training Continuum
• Multi-Planar Training
• Training with Optimum Posture
• Training for Optimum Muscle Balance
• Training for Optimum Muscle Function
• Training the Complete Muscle Contraction Spectrum.899

Section I. The Kinetic Chain

It is important that the health and fitness professional view the kinetic chain as an integrated functional unit. The kinetic chain is made up of the soft tissue system (muscle, ligament, tendon and fascia), neural system, and articular system. Each of these systems works interdependently to allow structural and functional efficiency. If any of the systems do not work efficiently, compensations and adaptations occur in the other systems. These compensations and adaptations lead to tissue overload, decreased performance, and predictable patterns of injury. Health and fitness professionals must understand the integration and synergy of the kinetic chain in order to develop an effective integrated training program.

Section II. Integrated Training Concepts

Integrated training is a comprehensive approach to training, reconditioning, and rehabilitation that involves several fundamental components. Each of these components are necessary to achieve optimum physical, physiological and performance related goals for your client.

Core Stabilization

Core stabilization is the foundation upon which all other aspects of integrated training are based. The core is considered the lumbo-pelvic-hip complex, thoracic spine and cervical spine. The core operates as an integrated functional unit to dynamically stabilize the kinetic chain during functional movements. Many clients have developed strength, power, neuromuscular control and endurance in their prime movers, but few individuals have developed adequate core stabilization to allow optimum performance and injury prevention. The kinetic chain’s stabilization system has to function optimally to effectively utilize the strength and power in the primemovers. A strong and stable core enables your client to train with heavier loads, which increases gains in the rest of their body.

Neuromuscular Stabilization Training

Neuromuscular efficiency is the ability of the neuromuscular system to enable agonists, antagonists, synergists, stabilizers and neutralizers to work synergistically to produce force, reduce force and dynamically stabilize the entire kinetic chain in all three planes of motion. When designing a training program, the health and fitness professional typically thinks of developing morphological changes in the muscle (muscle hypertrophy). However, integrated training — in a proprioceptively enriched environment — enables optimum neural adaptations. This process improves muscle hypertrophy and function more effectively than isolated training alone. High levels of neuromuscular efficiency yield greater recruitment of the agonist and less neural inhibition from the antagonist. This results in greater force production and greater hypertrophy.

Reactive Neuromuscular Training

The imposed demands during training must reflect those incurred during functional activities. Enhanced performance in most activities is directly related to the rate of force production. The speed of muscular exertion during functional movements is limited by the neuromuscular system. This means that the kinetic chain will only move within a set range of speed set by the Central Nervous System (CNS). The neuromuscular system must react quickly following an eccentric contraction to produce a concentric contraction and impart the necessary force and acceleration in the proper direction. Reactive neuromuscular training utilizes the stretch-shortening cycle to enhance neuromuscular efficiency, rate of force production, and reduced neuromuscular inhibition. Reactive neuromuscular training heightens the excitability of the central nervous system, which improves performance. RNT training is important for every client. The concepts of training do not change only the application of the concept. For example, if a 75-year-old person steps off from a curb and loses their balance, they had better have worked on rate of force production so that they can re-establish their base of support under their rapidly changing center of gravity. This doesn’t mean that you are going to have your grandmother doing box jumps or throwing a 5kg medicine ball over her head. It means that you will begin implementing an integrated, systematic training methodology that progressively challenges each of your clients based on their needs and their goals.

Integrated Strength Training

Strength is the ability of the neuromuscular system to exert force against resistance. There are many types of strength including maximal strength, absolute strength, relative strength, strength endurance, speed strength, stabilization strength and functional strength. Each type of strength is explained in more detail in an upcoming article. An integrated strength training program utilizes the principles of integrated training to achieve consistent results (training in multiple planes of motion, at different speeds with varying modes of resistance, utilizing various body positions, and always focusing on training for muscular balance).

Integrated Flexibility Training

Muscle imbalances and poor flexibility decrease performance and lead to injury. Flexibility is the ability of the neuromuscular system to allow optimum extensibility of the appropriate tissues in the right range of motion, while providing optimum neuromuscular control throughout that range of motion. Flexibility training is a key component to all integrated training programs. Optimum flexibility and muscle balance ensures optimum performance and decreases the chance for injury. All functional movements occur in all three planes of motion. Therefore, flexibility must be established in all three planes of motion to ensure optimum tissue extensibility during functional movements. Neuromuscular control must be established concomitantly in the new range of motion to prevent injury. According to the Integrated Flexibility Continuum, flexibility training occurs on a continuum from Corrective to Active to Functional. Each type of flexibility training is discussed in an upcoming article.

Section III. Integrated Training Principles

The Integrated Performance Paradigm

The INTEGRATED performance paradigm explains the concept that force reduction precedes all force production. For example, when taking a step, all of our muscles must eccentrically contract to decelerate gravity, ground reaction forces and momentum. Stabilization strength, core strength, and neuromuscular efficiency control the time between the eccentric contraction and the preceding concentric contraction. The greater your client’s eccentric strength, neuromuscular efficiency and stabilization strength, the greater their concentric force production will be without any increase in hypertrophy (morphological changes). If the health and fitness professional fully understands this concept, eccentric neuromuscular control and stabilization strength exercises should begin to make up a larger portion of their client’s training program. Improving your client’s eccentric strength provides the ability to handle heavier loads without creating overuse in the connective tissue. If your client can handle heavier loads for a prescribed intensity and repetition spectrum, they will improve their muscle hypertrophy and improve their performance.

The Integrated Training Continuum

Most strength and conditioning programs focus on isolated, uniplanar exercises to elicit maximal morphological changes (muscle hypertrophy). However, the central nervous system is designed to optimize the selection of muscle synergies to perform integrated movement patterns in all three planes of motion.) Therefore, if the body is designed to move in all three planes of motion in an integrated environment, isolated training does little to improve functional ability. Isolated training is primarily open kinetic chain movements. These exercises are primarily uniplanar (sagittal plane). They have a very low neuromuscular demand because they are performed primarily with the kinetic chain artificially stabilized on stabile pieces of equipment. When training in an isolated, uniplanar, artificially stabilized environment the kinetic chain is not being prepared to deal with the imposed demands of normal daily activities (walking up/down stairs, getting groceries out of the trunk, etc). When your clients utilize functional movement patterns, they develop high levels of core strength, neuromuscular control, dynamic flexibility and functional strength. In addition, your clients can develop similar or higher levels of hypertrophy. This is secondary to improved motor unit recruitment. Training integrated, functional movement patterns targets synergistic muscles to produce force, reduce force and dynamically stabilize in all three planes of motion. This creates maximal motor unit recruitment, which facilitates a greater overall training response.

Multi-Planar Training

Although functional activities occur in all three planes of motion (sagittal, frontal and transverse), an activity may be one plane dominant (walking - sagittal plane), but the other two planes of motion must be stable to perform the activity efficiently. Research demonstrates that most injuries occur in the transverse plane during eccentric muscle contractions. However, most exercises are sagittal plane dominant and concentrate primarily on force production. With this in mind, it is clear that health and fitness professionals must train their clients in all planes of motion and utilize the entire muscle contraction spectrum (concentric, eccentric and isometric contractions) to most efficiently improve function. Eccentric contractions produce the greatest tension development in the muscle, followed by isometric contractions, then concentric contractions. If eccentric and isometric contractions increase tension development greater than concentric contractions, they should be more often incorporated in training programs. Training in multiple planes of motion elicits greater motor unit recruitment from agonists, synergists, stabilizers, and neutralizers. Also, if a muscle is primarily one plane dominant (gluteus maximus - transverse plane) and other muscles (gluteus medius - frontal plane) are dominant in other planes of motion, then the health and fitness professional must develop a multi-planar training program. This ensures optimum development of all muscles of the kinetic chain in the plane of motion they are the most efficient in. Training primarily in the sagittal plane may not allow complete recruitment of certain muscles that are frontal or transverse plane dominant.

Training with Optimum Posture

Posture is a dynamic controlling quality. Optimum alignment of each segment of the kinetic chain is a cornerstone to any integrated training program. If one component of the kinetic chain is out of alignment, other components must compensate. This decreases neuromuscular efficiency and increases the chance of injury. Poor posture during training and activities of daily living such as sitting, standing, sleeping and driving lead to muscle imbalances, joint dysfunctions and postural distortion patterns (upper extremity, lumbo-pelvic-hip complex and lower extremity postural distortion patterns).

A Postural DistortionPattern is the state in which the functional and structural integrity of the kinetic chain is altered and in which compensations and adaptations occur. This process is explained more thoroughly in an upcoming article. Training with proper posture ensures optimum results and decreases the risk of developing muscle imbalances, joint dysfunctions and tissue overload. For example, allowing an individual to perform overhead lifting with poor cervical and lumbar posture will result in the development of muscle imbalances and possible injury. The integrated training program requires a client to perform exercises correctly while executing proper postural control throughout the entire movement. This will ensure maintenance of structural integrity throughout the kinetic chain.

Training for Optimum Muscle Balance

Muscles function optimally from a pre-determined length, thus an optimum length-tension relationship. If a muscle is too short or too long, then the length-tension relationships are altered. This decreases force production and alters force couple relationships and joint kinematics. Muscle imbalances result from poor posture, pattern overload (same exercise performed repetitively in the same plane of motion, with the same weight, at the same speed, with the same ROM), injury and decreased neuromuscular efficiency. Muscle tightness can cause reciprocal inhibition and synergistic dominance. Reciprocal inhibition is the process whereby a tight muscle, the Psoas for example, causes decreased neural drive in its functional antagonist (Gluteus Maximus).

This process results in decreased force production by the prime mover, and leads to compensations by the synergists (Synergistic Dominance). Synergistic dominance is the process whereby synergists compensate for a weak or inhibited prime mover in attempts to maintain force production and functional movement patterns. This process leads to altered movement patterns and decreased neuromuscular control. Therefore, all integrated training programs should be well balanced to ensure the development of optimum muscle balance. This will, in turn, ensure maintenance of the structural integrity of the kinetic chain. These concepts will be explained in more detail in an upcoming article.

Training for Optimum Muscle Function

Since muscles function eccentrically, isometrically and concentrically in all three planes of motion, it is imperative for the health and fitness professional to completely understand functional anatomy. The greater the understanding of functional anatomy, the better the health and fitness professional can design a functional training program. For example, the hamstring works eccentrically to decelerate knee extension, hip flexion and tibial internal rotation. The hamstring also works concentrically to assist in hip extension. Typically, to strengthen the hamstring, health and fitness professionals will lay clients prone on the hamstring curl machine and perform isolated, stabilized contractions without integration from the rest of the kinetic chain. It is important to remember that when training an isolated muscle, the health and fitness professional must completely integrate the entire kinetic chain for improved function. Muscles have anatomical individuality, but they lack functional individuality. Movement is a complex event that is controlled by the central nervous system. The central nervous system calls for pre-programmed patterns of movements that can be modified in countless ways to react appropriately to gravity, ground reaction forces and momentum. Integrated training requires a thorough understanding of functional anatomy. Functional anatomy will be reviewed thoroughly in an upcoming article.

Training the Complete Muscle Contraction Spectrum

All muscles function eccentrically to decelerate the kinetic chain, isometrically to dynamically stabilize the kinetic chain, and concentrically to accelerate the kinetic chain. Therefore, an integrated training program must focus on all types of muscle contractions. Different methods of training are utilized to maximally train each type of muscle action.

Section IV. Integrated Training

The goal of an integrated functional training program is to prevent injury, decrease body fat and increase lean muscle mass, strength, endurance, flexibility and performance in some specific activity. All integrated, functional training programs must be multi-planar, multi-joint, multi-dimensional, proprioceptively enriched and activity specific.

Integrated Performance Training

The health and fitness professional must follow an organized, systematic approach when designing an integrated training program. The health and fitness professional must take into consideration the following:

• Activity demand analysis profile
• Postural assessment
• Flexibility assessment
• Functional movement assessment
• Core strength assessment
• Neuromuscular control assessment
• Functional strength assessment
• Body fat assessment
• Nutritional assessment

It is imperative to have baseline information on your client to determine how to most efficiently assist your client in achieving their goals.

Integrated Training Guidelines

Each training program must be based on current research, basic science and empirical results. All integrated training programs must be progressive, systematic, challenging and dynamic. All programs should focus on neural adaptations before morphological adaptations to ensure long term training success.

Training Variation

The training program should be varied regularly to force constant adaptation. Program variables that can be changed include the following: plane of motion, range of motion, mode of resistance, body position, speed of movement, rest period, sets, repetitions, intensity, tempo, duration and frequency. These variables will all be covered at more depth in a future articles in this series, so stay tuned!

References

1. Brittenham D, Brittenham G: Stronger Abs and Back. Human Kinetics. Champaign, Il 1997.
2. Bompa TO: Periodization of Strength; The New Wave in Strength Training. Veritas Publishing. Toronto, ON 1993.
3. Bompa TO: Serious Strength Training; Periodization for Building Muscle Power and Mass. Human Kinetics. Champaign, Il 1998.
4. Bullock-Saxton JE: Muscles and Joint: Inter-Relationships with Pain and Movement Dysfunction. University of Queensland. Course Manual, 1997.
5. Chaitow L: Muscle Energy Techniques. New York. Churchill Livingstone, 1997.
6. Clark MA: A Scientific Approach to Core Stabilization Training. Chapter 16. In; Rehabilitation Techniques in Physical Therapy. McGraw-Hill, 2000.
7. Clark MA: Muscle Energy Techniques. Chapter 14. In; Rehabilitation Techniques in Physical Therapy. McGraw-Hill, 2000.
8. Clark MA: Functional Core Training. Chapter 25. In; Knee Ligament Rehabilitation. Churchill Livingstone, 2000.
9. Clark MA: The Scientific and Clinical Rationale for the Use of Closed Chain and Open Chain Rehabilitation. Chapter 19. In; Knee Ligament Rehabilitation. Churchill Livingstone, 2000.
10. Clark MA: Functional Testing. In; Sports Performance. Human Kinetics, 2000.
11. Clark MA: Core Competency Underlies Functional Rehabilitation. Biomechanics 7(2):67-73, 2000.
12. Clark MA: Functional Training and its Importance in Closed Kinetic Chain Rehabilitation. Clinics of North America, 2000.
13. Clark MA: Hard Core Training; A Functional Approach. Training and Conditioning 9(4):34-40, 1999.
14. Clark MA: An Integrated Approach to Human Movement Science. National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
15. Clark MA: A Scientific Approach to Understanding Kinetic Chain Dysfunction. National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
16. Clark MA: Integrated Kinetic Chain Assessment. National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
17. Clark MA; Integrated Core Stabilization Training. National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
18. Clark MA: Integrated Neuromuscular Stabilization Training (Balance). National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
19. Clark MA: Integrated Reactive Neuromuscular Training (Power). National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
20. Clark MA: Integrated Strength Training. National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
21. Clark MA: Integrated Flexibility Training. National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
22. Clark MA: Focus on Function; Integrated Manual Therapy. National Academy of Sports Medicine (Publishers). Thousand Oaks, CA 2000.
23. Clark MA: A Formula for Function; A Functional Approach to Training and Rehabilitation. Training and Conditioning 7(4):24-29, 1998.
24. Clark MA: Concepts and Applications for Periodization; Chapter 4. In: Current Trends in Therapeutic Exercise for the Rehabilitation of the Athlete. Sports Physical Therapy, 1997.
25. Clark MA: Open Kinetic Chain Assessment and Rehabilitation. Athletic Training ; Sports Health Care Perspectives 1(4):347-370, 1995.
26. Creager C: Therapeutic Exercise Using Foam Rollers. Executive Physical Therapy. Berthoud, CO 1996.
27. Dominguez RH: Total Body Training. Moving Force Systems. East Dundee, Il 1982.
28. Edgerton VR, Wolf S, Roy RR: Theoretical Basis for Patterning EMG Amplitudes to Assess Muscle Dysfunction. Med Sci Sports Exerc 28(6):744-751m 1996.
29. Gambetta V: Building and Rebuilding the Complete Athlete. Gambetta Sports Training Systems. Sarasota, FL 1996.
30. Gambetta V: Following a Functional Path. Training and Conditioning 5(2):25-30, 1995.
31. Gambetta V: Everything in Balance. Training and Conditioning 1(2)15-21, 1996.
32. Gray GW: Chain Reaction Festival. Wynn Marketing. Adrian, MI 1996.
33. Gustavsen R, Streeck R: Training Therapy; Prophylaxis and Rehabilitation. New York. Thieme Medical Publishers, 1993.
34. Holt LE: Scientific Stretching for Sport. Dalhouise University Press. Halifax, 1976.
35. Jesse J: Hidden Causes of Injury, Prevention, and Correction for Running Athletes. The Athletic Press. Pasadena, CA 1977.
36. Janda V, Vavorova M: Sensory Motor Stimulation. Body Control Systems. Brisbane, Australia 1990.
37. Liebenson CL: Rehabilitation of the Spine. Baltimore. Williams and Wilkins, 1996.
38. Mayer-Posner J: Swiss Ball Applications for Orthopedic and Sports Medicine. Ball Dynamics International. Denver, CO 1995.
39. Poliquin C: The Poliquin Principles; Successful Methods for Strength and Mass Development. Dayton Writers Group. Napa, CA 1997.
40. Sahrmann S: Diagnosis and Treatment of Muscle Imbalances. Washington University. St. Louis, MO 1997.
41. Siff MC: Facts and Fallacies of Fitness. University of Witswatersrand. Johannesburg, South Africa 1998.
42. Siff MC, Verkhoshansky YV: Supertraining; Special Strength Training for Sporting Excellence. Strength Coach Inc. Painesville, OH 1997.
43. Voight M, Brady D: Plyometrics. In Davies GJ (4th ed). A Compendium of Isokinetics in Clinical Usage, pp 226-240. Onalaska, WI: S&S Publishers, 1992.
44. Voight M: Stretch-Shortening: An Introduction to Plyometrics. Orthop Phys Ther Clin North Am 1-2, pp 243-252. WB Saunders, Philadelphia 1992.