Any proper care program for a joint or muscle complaint has to include some form of rehabilitative movement plan. In the case of one-off type injuries (i.e. slips, trips, etc.) it is a fairly straight forward process of providing an environment for tissue healing to take place while progressively loading the injured area as tolerated and focusing on eliminating compensatory movements before they become habitual.
If done correctly and in the right time frame, most of these injuries will resolve fully, leaving no trace of disability or dysfunction.
On the other hand, conditions that are more insidious in nature–chronic, recurrent, nagging, “woke up with it” types–tend to require a much more thoughtful approach if meaningful improvement is to be achieved. To address these types of issues a proper rehabilitative plan should do the following things:
- Identify and Improve Areas of Lost Range of Motion – All of our joints are designed to move within predictable ranges of motion. When that range is lost, our bodies have to compensate to move around it. The most common causes of lost range of motion is tightening of active structures (e.g. muscles ), or stiffening of passive structures (e.g. joints, ligaments, and tendons), usually both. These restrictions often improve with in-office soft tissue care and joint manipulations, but should also be addressed with at home mobility drills designed to target areas where range loss has been identified. There are complications like joint deformity due to trauma or disease, and anatomical variations which will limit the extent to the effectiveness of this approach, but there is almost always room for improvement.
- Address Core Activation and Movement Sequencing – Our nervous system is inherently wired for self preservation, which means that it’s primary directive is to protect and preserve the brain and spinal cord– There is a logical flow of movement that begins with stabilizing your core and deep neck flexors and cascading out from there. If we don’t respect the order of operations, our nervous system will seek stability from other muscle groups causing lost range of motion, dysfunctional and damaging movement patterns, and ultimately, pain.
- Be Progressive and Minimalist – Packets of ten or more prescribed exercises are a thing of the past. They tend to include a lot of overlapping exercises, often skip core training, and don’t include mobility exercises. A problem with this is that if you don’t address your mobility issues first, then learn how to control your core, you will often end up reinforcing the bad habits that got you where you are in the first place. Your plan should be progressive, in that it takes you from an unloaded position, to fully standing under load–taking advantage of the innate mechanism by which we learned to move from infancy and gradually increasing spinal load that our nervous system has to deal with. An advantage to this approach is that it minimizes the number of exercises you have to do, and has clearly defined, goal-oriented start and end points which should lead to greater therapeutic success.
- Bridge the Gap Between Rehab and Reality – If your rehab program does not provide pain relief, or increase your body awareness and quality of movement in your day-to-day life, then it has failed. Doing glute bridges for their own sake will only make you good at glute bridges. Your provider should be able to explain how your ability to do a proper bridge should increase your ability to willfully extend your hip and decouple that movement from your spine. That your ability to do these things will protect you from pain and injury when doing things like getting up from a seated position, or going up and down stairs. Lastly, your plan should include strategies for minimizing physical stressors with day to day activities like working at a computer, driving, bending, etc.
So there you have it! Our simple approach to improving your quality of life through better movement. Let us know if we can help design a program for you.