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Rehabilitation & General Exercises

(Mel Cash, Advanced Remedial Massage And Soft Tissue Therapy, 2010)

Norfolk Tissue Therapy can help your recovery journey, through assessing, treating and providing professional advice and exercises. Injuries are not also the sensation of pain, if muscles are restricting the body from performing normal functional movement and range of motions then this may also be addressed.

Active Movements

Active movements are an important stage of rehabilitation post-acute injury. If the injury is only minor for example a strain or sprain has occurred and they have rested and adhered to the RICE protocol, then the rehabilitation programme may begin. Only however, if there is no evidence of inflammation such as redness, swelling and heat.  Active movements involve the client performing concentric contractions using the opposing muscle/tendon. An example of this may be if the client had an injured the gastrocnemius/soleus or Achilles’ tendon, they would be asked to dorsiflex their ankle.

Another example may be if the triceps muscles were strained, then flexion of the elbow could be performed. This will benefit the person as it will help to relax and stretch the injured muscle through reciprocal inhibition, while contracting the non-injured muscle (s). Contraction of the injured muscle can later be performed if there is success during the early stages, with little to no discomfort. As a result of contracting (shortening) the injured muscle gently; mobility, flexibility and a small amount of strength will hopefully be restored. This can then escalate to eccentric contractions being completed slowly and with control, which lengthens the injured muscle.

This is a critical stage which needs to be revisited and practiced as this will benefit the person’s ability to perform everyday functional movements again, as prior to the injury. For example, decelerating after running requires eccentric contractions, along with lowering a weight or an object safely. The final benefit is also that, due to the movements being active rather than passive, the client is in control.

This means that the chances of going too far and worsening the injury is small as the client will know when to stop, if too much discomfort is experienced.  This will help prevent the muscles from becoming weak and fibrous tissues from binding to the area.

Resistive Movements

Resistive movements involve several different movements, potentially moving an adjacent joint in different directions simultaneously, against a light resistance. These movements are beneficial to the muscles as they ensure the experience of both concentric and eccentric contractions for the injured muscle. This therefore allows the muscle to shorten and lengthen against a slight resistance, which will help to rebuild the strength that may have potentially been lost prior to rehabilitation.

At first the therapist may only apply force against the client whilst performing these movements. However, they can also progress in adding equipment such as resistance bands or light weights. An example of a resistive movement for a strained bicep, may be performing a bicep curl. This could be done with a resistance band, light weight, or with the therapist applying pressure whilst shortening the muscle on the upward phase.

Another example may be if the client has strained their hamstrings. They would begin by lying face down, with a resistance band place around their ankle, whilst the therapist holds it for support. The client would then flex their knee, against the resistance. As the client progresses, weight can be increased gradually and adapted within these exercises, this will help rebuild strength.

The benefits of these rehabilitation exercises, post-acute injury, will hopefully result to further strengthened muscles, improved function of the muscles and a better quality of movement of both the muscle and at the joint.

Functional Movements

Functional movement exercises are critical in rehabilitation, post-acute injury. This is because they help to restore mobility and stability, when performing normal functional movements. They also help to improve any imbalances that may have been induced from the injury, as the client will have to become more aware of the movements being made.

An example of a functional movement exercise may be, at the glenohumeral joint (shoulder), the client would place the opposing arm across the anterior body and hold down the shoulder on the opposite side to prevent movement. Then slowly move the shoulder, that is not being held in place, through its full ranges of motion. With practice, this would improve the stability and mobility of the glenohumeral joint.

If a client struggles with mobility at the lumbar spine, then they can perform the yoga stretches ‘cat and cow’. This consists of the client in an all-fours position, shoulders in line with the wrists, and arching the back up (cat pose) and then dipping the back downwards (cow pose) slowly, whilst tucking the chin in. Ensuring that the focus is directed to the lumbar spine, which will help enhance mobility throughout the spine as well as at the lower back.

A Functional movement screening (FMS) test can be implemented within a rehabilitation. This is beneficial for the therapist and the client as it enables a broader understanding of the individuals functional control abilities. These may include exercises such as Deep Squat, Hurdle Step, In-line Lunge, Active Straight-leg Raise, Trunk Stability Push-up, Rotary Stability and Shoulder Mobility.

Functional movement exercises should be practiced before returning to their chosen sport. This will help to reduce the risk of injury recurring, as functional control will be engaged, bettering the stability and mobility at a joint. The return of basic muscle strength will help the client when returning to normal activities, however, if the functional control is lacking then further musculoskeletal issues may develop later. Further supporting the benefits of functional movement practice post-acute injury.

Proprioception

Proprioception refers to the body’s ability and awareness to sense its location and movements. It involves the relay of information between the sensory receptors, nervous system and the body. If an injury has previously occurred for example a sprained ankle, creating minor damage to the supporting ligaments, the proprioceptive capabilities could become impaired.

An example of an exercise that may help to improve the ankle’s proprioception, may be getting the client to stand on one leg. This is advised to be done barefoot, so that their senses and stability is not impaired further. The client may begin with their eyes open and arms out to the side to help with balance. However, with practice as this exercise improves, they should then progress to closing their eyes whilst balancing on one leg and relax their arms to their side.

This type of exercise will be beneficial, as the proprioceptive system will make the necessary instant adjustments to the ankle joint. In turn resulting to improved proprioception to the ankle. In order to help the hip, knee and ankle together, a simple deep squat action can be performed slowly. In addition, gentle lunges forward by flexing the knee and then returning the leg back to the upright position, slowly and with control, will benefit the proprioception of the knee. The step length can be increased once strength and functional control progresses.

Proprioceptive exercises can also be used to rebuild the client’s confidence and can help to prevent the development of poor posture, as a result from the injury. It is an important part of the rehabilitation programme as proprioception is used day to day, with movements as simple as walking. Proprioception exercises will help the following issues: poor postural control, lack of coordination, balance and an ability to recognise an individual’s own strength.

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