Why is the Neurodevelopmental Sequence Important to Trainers?

The neurodevelopmental sequence is the normal movement progression that infants follow as they grow and develop the abilities to roll, crawl, stand, walk and more.

The same sequence provides rehabilitation professionals with guidance by giving a logical progression of postures and movement strategies to follow.

Sadly, many rehabilitation professionals often put people on their feet without first making them master the postures and movement strategies of lower developmental postures. Many fitness pros are unaware of the normal sequence. A better awareness would definitely help them with corrective exercise progressions and regressions.

Since these lower developmental postures provide the necessary strength, stability and coordination required of more challenging postures, skipping over them in the movement rehabilitation process can often leave clients without the foundation they need to be successful at higher levels. Movement efficiency is decreased and they are at a higher risk of injury.

Whether you’re a rehabilitation professional working with the general population or athletic population—both of which build more complex movements from a general movement base—you should understand and apply the neurodevelopmental sequence.

The Neurodevelopmental Sequence
Babies enter the world with uncompromised mobility, and follow a progression of movement patterns (developmental milestones) naturally and predictably. They start with head and neck control and progressively move to rolling, creeping, crawling, kneeling, squatting, standing, stepping, walking, climbing and running.

Each movement pattern serves as a stepping stone, helping to sufficiently build correct posture, balance, mobility, stability and alignment to allow them to move onto the next level.

These basic movement patterns provide the foundation for higher level movement skills and should be examined when seeking to rehabilitate or restore faulty movement.

For the most part, a baby starts life in a supine position, supported by a mattress or an adult’s arm. This is an extremely low-level, flexion-biased position.

At around six weeks, an infant begins to develop the ability to hold the head erect when held upright.

After this is the prone position. The prone position is what we think of with infants as tummy time. It’s an extension-biased pattern, allowing an infant to develop extension strategies to be able to lift the head and neck, and raise the face off the ground or crib mattress.

At around eight weeks, infants develop the ability to lift themselves from the prone position by their arms. They develop stability and mobility in the cervical spine, the scapulothoracic joints and in the upper extremities. They learn to stabilize the trunk while reaching and imparting force through the arms.

Rolling
Rolling begins in infants as early as three weeks, though most start from eight weeks. Infants usually start rolling from their sides to their backs or from prone to their sides. At around 18 weeks, they usually develop the necessary strength and stability to start rolling from their backs to their sides.

Rolling is initiated with the head and is often the first change in postural position in infants.

When it comes to adults, rolling as a movement strategy isn’t used very often and is often deficient. Rolling is a great assessment and intervention technique to restore synchrony of movement between the lower extremities, the trunk and the upper extremities.

Rolling can only be initiated by the lower extremities or the upper extremities. The core, which lies in the middle of that kinetic chain, has to be able to transmit force from one end to the other.

If you are using rolling as an assessment or intervention technique, pay close attention to sticking points where a person simply cannot move any further into a rolling pattern without cheating or using momentum. Sticking points occur where the sequence of motor control cannot naturally flow. It usually does not happen because of weak or inhibited muscles, but because of a broken pattern.

Quadruped and Crawling
Active grasping occurs somewhere between two to seven months in infants. Infants then move into sitting and quadruped positions once they develop the stability they need in the hips and pelvis. The quadruped position then transitions into crawling at around seven months.

The quadruped position is a great developmental posture for adults to experience. We have between four and six points of contact with the ground and have removed the direct stimulus of either the the belly when prone or the back when supine.

It involves a lot of weight-bearing stimuli through the arms and legs, consequently through the scapular girdle or the scapulothoracic articulation in the pelvic girdle.

In the quadruped position, closed kinetic chain activities such as weight shifting can be initiated—helping determine where the neutral spine is.

New fitness interventions use crawling—either rapid crawling or in-place crawling or in-place stepping with hands and knees—as a way to emphasize stability of the proximal stabilizers of the pelvis and of the scapulothoracic region and the spine.

From crawling, infants then go into the transitional postures of tall-kneeling and half-kneeling as they move closer toward a standing position. These will occur at around eight months.

Tall-kneeling provides an anterior-posterior challenge to the core and the lower extremities without using the feet and are valuable in rehabilitation. They help improve the stability and dynamic control of the core and pelvis.

Gray Cook & Dan John: Working in the Tall-Kneeling Position

Want drills to work on the developmental movement patterns?
In Prehab-Rehab 101—The Groundwork Progressions Mark Cheng explains and demonstrates five positions in the developmental sequence—

• Periscope
• Sphinx
• Crawling
• Tall-Kneeling
• Half-Kneeling

These five positions are shown in high detail and you are given the tools you need to break these exercises down and use them with your clients, athletes and patients.

Mark will take you from the most fundamental developmental positions all the way up to half-kneeling, the precursor of standing, symmetrical stance, split stance and single-leg stance.

Here are some clips and drills from the DVD:

Mark Cheng: Movement is Just Like Money

Mark Cheng Sample Tactile Cue in Sphinx Position

Mark Cheng: A Discussion About Sphinx Position Drills

Mark Cheng Explains Cross-Crawling in Place

Mark Cheng: Tall-Kneeling Position

Mark Cheng: Half-Kneeling Rotation Drill

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If you found this article useful, here are some additional resources that will interest you:

Neurodevelopmental Sequencing Audio Lecture

In this short talk, physical therapy professor Barb Hoogenboom outlines the normal order of movement learning, and tells how she uses this concept in rehabilitation.

Click here to learn more about Neurodevelopmental Sequencing.

Prehab/Rehab 101

Restoring fundamental movement patterns can go a long way in unlocking performance and reducing injury risk. In Prehab/Rehab 101, Mark Cheng teaches five groundwork progressions based on the neurodevelopmental sequence. These progressions will help you form a solid foundation for more challenging movements and activities.

Click here to learn more about Prehab/Rehab 101.

Movement

If you’re looking for the missing puzzle piece to help protect your clients from future injury and to eliminate the roadblocks that hold them back from greater performance, you’ll find Gray Cook’s Functional Movement Systems as detailed inside the Movement book invaluable.

Inside you’ll discover a system that not only helps you screen and assess a person’s movement quality, but it’s also a system that helps you identify the corrective strategies needed to help protect your clients from injury and help them move better.

If you’ve ever wanted to—

• understand why people get injured, and why their pain keeps returning
• improve your patient’s recovery process
• give people a strong foundation before loading them with weights
• eliminate training mistakes that delay results
• improve your client’s chances of making it through the athletic season without suffering a non-contact injury
• restore the quality life in people who have suffered in pain due to movement problems
• build more functional, longer lasting athletes
• avoid frustrations and improve patient outcomes when working with other healthcare and fitness professionals by learning a standardized language to communicate

… then Movement may be just what you need.

Click here to learn more about Movement.

Assessing Movement

Though the FMS and SFMA have been both been the subject of academic research for years, there still remains a lot of debate and controversy behind the validity and value of a quick and general tool like the FMS, especially for injury prediction.

In particular, many people have highlighted a supposed difference in approach to screening, assessment and spine stabilization between Gray Cook and Stuart McGill, one of the world’s leading low back experts.

Craig Liebenson realized this, and proposed for these two giants in the field to present their approaches, clarify their positions and critically analyze the FMS.

The result is what you’ll find inside Assessing Movement: A Contrast in Approaches & Future Directions.

In the Assessing Movement DVD—

• Gray explains the principles, intent and incorrect assumptions people make about the FMS
• Stuart reviews the literature surrounding the FMS, and highlights areas of agreement and disagreement
• Stuart outlines his approach to assessments in Developing the Ideal Screen or Assessment
• Gray demonstrates the FMS tests, and Stuart demonstrates some of the assessment tools he uses with clients
• Craig discusses the history of human movement in medicine and patient care
• Gray and Stuart take questions about both their methods
• …and much more

Click here to learn more about Assessing Movement.

Essentials of Coaching and Training Functional Continuums

There is no question that tapping into the right movement can radically change an athlete.

In Essentials of Coaching and Training Functional Continuums, Dan John and Gray Cook will show you the approach you need to identify and work on hidden weaknesses in your training programs that are holding back the athletes you coach.

They’ll show you how to take information from assessments, and categorize your training priorities to ensure that you have no holes in your athletic base, and are working on the activities that will give you a bigger return on athletic performance.

You’ll learn—

• Exercise choices for power, work capacity and metabolic load
• How to evaluate movement health, competency, capacity and complexity
• The difference between an exercise continuum and a training progression
• Minimum standards to progress, hold or regress
• When to correct and when to coach
• The metrics of the 4 Bs—Breathe, Bend, Balance, Bounce
• What it means to play, practice or train, and who needs which
• Postures and patterns, and drills to develop both

Click here and learn more about the Essentials of Coaching and Training Functional Continuums.