Type of rehab exercises that you should aware of

I’ve always been a strong advocate for integrated exercises and stretching in treating acute or chronic neuromuscular injuries including neck pain, low back pain, shoulder pain, knee pain, etc..  Thanks to the internet and YouTube, how-to exercises and stretching are widely available.  Unfortunately, many people including some health professionals have proceeded with the wrong approach in exercises and stretching.

Properly conducted exercise programs not only expedite recovery, but they also prevent injuries.  All exercise programs must have a specific goal, whether it’s design to increase strength, performance or cardio.  There’s too much information for me to discuss the various therapeutic rehab exercises for each neuromuscular condition and how or when to apply them.  However, all therapeutic rehab exercise programs should integrate Davis’ Law, the Law of Facilitation and the SAID principle.

Davis’ Law is a physiological law of soft tissues; it implies that soft tissue models according to the imposed demands.  The collagen fibers in muscles and tendons adapt to the mechanical demands placed upon them.  “Use it or loss it” is essentially Davis’s Law.  The Law of Facilitation is a neurological law that has significant implications not only in neuromuscular treatments but also in rehabilitation.  There are various stages of rehabilitation, which is too much for me to discuss in this blog.  Perhaps one day I’ll fully discuss these various stages of rehabilitation exercises that I use in my chiropractic practice.  Anyway, stage 2 of the rehabilitation process makes use of the Law of Facilitation; muscular tonus is enhanced and the neuromuscular system is better coordinated by re-educating the neurological pathways in stage 2 of the rehab process.  The SAID principle states that the body makes “specific adaptation to imposed demands”.  The more specific the exercise, the more specific the adaptation is.  Therefore, rehab exercises should be as specific as possible.

There are three basic types of exercise rehab programs: isometric, isotonic and isokinetic.

Isometric exercises are static exercises; when you contract and tense up your muscles without moving a joint, you’re performing isometric contraction.  There is great amount of tension produce by the involved muscles during isometric contraction which is strenuous and tiring for the muscles.  An example of isometric exercise that your body is doing daily that you may not be aware of is sitting upright and maintaining good posture.  When you’re sitting, the low back muscles contract isometrically to keep the body and spine upright against gravity.  But after awhile of sitting straight upright, you’ll begin to slouch as the back muscles start to tire out.

The main advantage of isometric exercises in neuromuscular rehabilitation is that they allow for localized muscle contraction without moving the joints; they are best suit in the early part of the rehab programs when the injured or immobilized extremity’s muscles can still be tensed and contracted statically immediately after the pain has subsided.  Isometric rehabs prevent early muscular strength loss and atrophy while the injured extremity is still in a cast or splint.  Another advantage of isometric exercises is that strength increases more rapidly during isometric exercises than with dynamic exercises.

There are three main disadvantages associated with isometric exercises.  Isometric exercises are anaerobic exercises; static muscle contractions compress the capillaries within the muscles during isometric exercises which prevents sufficient supply of oxygen and removal of metabolic wastes.  Isometric exercises also cause great compression strain on the joints.  Therefore, people with arthritis, history of heart diseases and thrombosis should not engage in isometric exercises.  And finally, there is a lack of the necessary muscle coordination required for daily musculoskeletal activities when performing isometric exercises.

Unlike isometric, isotonic exercises are dynamic in which there are joint movements during muscle contractions. For example, when you lift a dumbbell during a biceps curl, the biceps shortens and contracts to bend the elbow joint.  And when you lower the dumbbell, the biceps also contracts but lengthens to straighten the elbow joint.  There are two kinds of isotonic exercises: eccentric and concentric.

Concentric isotonic contractions occur when the muscle fibers shorten and contract. During the biceps curl, the biceps shortens and contracts concentrically as the dumbbell is lifted.  During the “lifting phase of the dumbbell”, the elbow joint is travelling through its range of motion.  The speed and tension generated by the biceps during the lifting phase of the dumbbell vary throughout the elbow’s range of motion.  The biceps strength increases to a peak and then decreases throughout biceps curl.  Because of the strength fluctuation associated with concentric isotonic exercises, muscle loading is accomplished at the weakest points in the range of motion.  Therefore, there is potential injury should the weight be too much during concentric exercise.

Eccentric isotonic contractions occur during the relaxing phase as the muscle fibers go through a lengthening process during contractions. When you lower the dumbbell, the biceps muscle lengthens and contracts eccentrically to control the lowering process.  If the biceps does not contract eccentrically, the forearm and dumbbell would flop down rapidly and uncontrollably resulting in injury.  Eccentric contractions generate the most tension and force among all exercises.  So the main advantage of eccentric exercises is that they allow the muscles to gain the most strength and mass.  The main disadvantage to eccentric exercises is that there is considerable residual muscular soreness which may decrease performance due to the pain inhibition in the muscles.

Isotonic exercises are often prescribed in many rehab programs since they provide the necessary contractions for the entire range of motion in both concentric and eccentric phases. Isotonic exercises can also be varied easily to desired demands.  However, as I mentioned above, there are potential injuries and disadvantages with isotonic exercises associated with the concentric and eccentric phases.  Therefore, concentric and eccentric phases must be strategically integrated in the isotonic rehab exercise program.

Although not often utilize within the rehabilitation arena, you should be aware of isokinetic exercises. Isokinetic exercise is a relatively new form of rehabilitation that involves expensive exercise machines.  Isokinetic exercises are completed opposite to isotonic exercises.  With isotonic exercise, the resistance such as the weight of the dumbbell is a fixed constant but the speed of isotonic exercise varies.  In isokinetic exercise, the speed of the exercise is a fixed constant but the resistance varies throughout the range of motion.  Isokinetic exercise machines allow the resistance to vary to exactly match the preselected speed of the exercise so there is no fluctuation of muscle loading during the range of motion.  By controlling the speed of the exercise, maximum resistance is developed throughout the range of motion with isokinetic exercise.  Because of this, isokinetic exercises can accommodate to pain and fatigue.  As the appropriate resistance is applied throughout the range of motion, resistance can be reduced at the point of pain.  When there is no pain, isokinetic exercise has a major benefit as maximal resistance and loading of the muscle to its capacity can be applied throughout the entire range of motion.  Like other types of exercises I’ve discussed, isokinetic exercises should also be strategically integrated into the rehab program.

Personally, I believe that treating neuromuscular conditions such as knee pain, shoulder pain, hip pain, etc., without integrating any rehab program into the treatment program is incomplete.  Rehab strengthening exercises not only prevent future injuries, but they also increase muscular performance.  Whether it is daily activities or athletic competitions, without strengthening exercises, an improvement in any functional activity is impossible.

Thanks for reading.  🙂

Elbow pain in golfers

With Vancouver weather improving, avid golfers can barely contain their excitement.  Unfortunately, with the increase in golf popularity, there is also an increase risk of golf related injuries.  The most common area to be injured, especially in amateur golfers, is the elbow.  Ah yes, the infamous golfer’s elbow.  Golfer’s elbow is a common expression referring to inner, medial elbow pain.  Golfer’s elbow is often the result of jarring impact of the golf club as it hit the ground when the golfer misses the ball.

Although people often associate golfer’s elbow with golfing, it is not the most common golf related injury.  Surprise?  Outer, lateral elbow pain, lateral epicondylosis, is five times more common than golfer’s elbow.  Why is that?  In golfers, lateral epicondylosis is from repetitive forearm extension, excessive gripping of the club during the swing and poor swing technique.

Whether you ended up with lateral epicondylosis from golfing, tennis or from work, the most common cause of lateral epicondylosis is repetitive eccentric contraction and micro-traumatic tearing of the extensor carpi radialis brevis muscle and the common wrist extensor tendon.  So when you experience elbow pain with computer typing, hitting golf balls or having trouble picking up heavy objects with your hand, be mindful of lateral epicondylosis.  The pain is often localized to the lateral aspect of the elbow but it can radiate down the forearm with carrying items in the hand or certain elbow, forearm or wrist movement.  Lateral epicondylosis pain is often more in the morning or after the elbow has been held in a flexed position for extended time.

If you have elbow pain, icing and taking Tylenol, Advil, ibuprofen, etc., may provide some initial relief.  However, don’t delay the assessment as chronic lateral epicondylosis can cause calcific tendonitis in the common extensor tendon and posterior interosseous nerve entrapment in the forearm.

If an elbow brace has been suggested, than consider wearing a counter-force wrist extensor brace.  Place the brace slightly below elbow lateral epicondyle and not over it to reduce the stress and strain loads to the extensor carpi radialis brevis muscle and the common wrist extensor tendon.

Proper treatment of lateral epicondylosis associated with golfing should include breaking down the adhesion and scar tissues within the extensor carpi radialis brevis muscle and the common wrist extensor tendon, incorporating appropriate rehab exercises and stretching and improving golf swing technique.

I hope this month blog provide you with some insight for elbow pain.  Thank you for reading.  Cheers!  🙂