Physiotherapy

The last 10-15 years has seen significant research into treatments that physiotherapists offer. The consistent message is that any effective physiotherapy treatment programme includes a significant exercise based component.

While physiotherapy as a profession is often criticised for not using enough active exercise as an integral part of treatment, physiotherapists at Health and Fitness Solutions excel at it.

Effective rehabilitation is the key component in treating the underlying causes of pain and injury, and here is how we do it….

Postural Correction
Movement pattern re-education
Muscle activation
Muscle strengthening
Muscle conditioning – strength, power, endurance
Flexibility / stretching exercises
Core stability
Proprioception (’balance’) exercises
Function / sport-specific exercises
Cardiovascular Fitness

Posture Correction
Correction of posture is the first step in any successful rehabilitation programme regardless of the injury. The importance of posture in preventing low back and neck pain is obvious, but it is equally important with both lower limb and upper problems.

To be efficient human movement requires the joints to be positioned correctly in relation to one another. When postural alignment is not ideal key stabilising muscles are inhibited and as such fail to activate when appropriate, irrespective of whether they are strong or whether the individual has good ‘brain to muscle’ control over them.

To learn more about postural correction click here.

Movement Re-education
Often there is so much focus on how much we move (i.e. flexibility) that we sometimes forget to consider how we move. Our bodies are designed to handle the stresses of movement and weight-bearing when those movements are performed a certain way. When moving ‘badly’, that is moving in a way that differs from the ‘norm’, we are asking our joints and tissues to work in positions where they are vulnerable to overuse and strain

Any given movement involves contribution from a number of different joints / regions. For example when bending to touch the toes or pick something up off the floor there should be movement in the hip joints and the spine in equal proportions. Sometimes these proportions are altered, often the hip joint part of the movement becoming restricted (often due to tight hamstring muscles), and the individual compensates for this restriction by moving excessively in the low back itself. Repetition of this faulty movement pattern over time leads to the development of excessive movement in the low back in that direction (hypermobility) and is commonly observed in those with low back pain.

Retraining of movement pattern is achieved with exercises to re-educate these ‘normal’ limb and whole body movement patterns, and initially involves significant concentration to ‘get it right’. With repetition the movement pattern becomes more subconscious and eventually default behaviour. It is vitally important that training reaches this stage as if not the poor movement habits tend to re-establish themselves with recurrence of pain and injury resulting.

Muscle activation
Effective function of the muscles in our body is not just about strength - a muscle that is strong will be of little use if it does not switch on at the appropriate time. Specific regions of our brains are tasked with planning and controlling muscle contraction.  All movements start with a conscious thought and these ‘command centres’ tell our muscles when, how much, for how long to work, and which other muscles to work with.

Research has demonstrated that pain itself tends to inhibit these ‘brain to muscle’ connections, and unfortunately this tends to happen most frequently in our stability muscles, that is the very muscles which support our skeletons thus preventing pain and injury. Vicious cycles can then develop with pain leading to stability muscle inhibition leading to further pain.

Retraining these ‘brain to muscle’ connections involves exercises that focuses on isolating low effort contractions of specific muscles for relatively long periods of time.  Once this connection is restored this critical part of muscle control is reintegrated back into the whole “motor programme”.  Like learning anything that requires movement skill, frequent practice is required in order that very quickly it becomes habit.

As the saying goes, “strength is nothing without control”.

Muscle Conditioning – strength, power, endurance
Muscle strength
Muscle strength has a significant role to play in rehabilitation and injury prevention and is especially relevant for those individuals involved in manual work or sports.

Strengthening exercises are performed against resistance which could include machine / free weights, cable pulleys, or even simply our own body weight. In order to develop strength these exercises must overload the muscle, that is challenge its current strength capacity, so there should be a real sense of muscle fatigue following any strengthening exercises. The main determinant of muscle strength is muscle bulk which takes at least 12-16 weeks of training to effect. However gains in strength can be made in shorter timeframes (about 3 weeks) and can be attributed to increased efficiency of the nerve to muscle connection.

When we strengthen muscles we do so by repeating a pattern of movement against resistance.  If the pattern of movement is not normal, at the same time as getting stronger, we will also inadvertently get better at moving badly and unfortunately this is very common place in gyms and sporting environments.  A very high percentage of people we see in our clinics get aches and pains from doing just this.  It is vital that we strengthen “normal” movement patterns.

Muscle Endurance
Most things in life do not actually require a huge amount of strength but do need our muscle to have endurance.  We all have individual needs; some people sit at a desk all day and others run and play sports or have manual jobs but the common theme is that we all need to have a level of muscle endurance so that we are able to maintain controlled posture and movement for the whole run, the whole task or for the whole of the day – not just for the start of it.

Muscle endurance is trained by repeating high repetitions of a movement against a low to moderate load rather than the higher loads used in strengthening exercises. Often the use of our own body weight is most appropriate resistance with this type of exercise.

Muscle Power
Put simply muscle power is its ability to produce a given movement with speed. This is especially important in those individuals playing sports which require sudden acceleration or change of direction.

Muscle power is developed by performing exercises against moderate to high loads, but with an emphasis on moving the load quickly. As with muscle strengthening exercises it is important to ensure that these exercises are performed within normal movement patterns and as such a pre-requisite for this type of training is to first establish adequate control of these movement patterns. Repeating an exercise at speed with an abnormal and stressful movement pattern just leads to further pain and injury.

Flexibility / Stretching exercises
This is a hotly debated area of muscle research and evolving constantly.  Clearly flexibility is important in order to achieve normal movement.  The question is when a muscle is not flexible enough, does stretching help? 

The answer seems to be sometimes yes, sometimes no! Flexibility of a given muscle is determined by two main factors, the stiffness of the tissue within the muscle, but also the background tone in a muscle. Tone can loosely be defined as the background activity in a muscle when it is at rest. Muscles which have excessively high tone are almost constantly ‘on’ even when at rest, usually because they are over-working to compensate for other muscles that aren’t doing enough. Stretching of muscles with excessively high tone may produce gains in flexibility, but unless the muscle imbalances are address they are likely to ‘tighten up’ again relatively quickly as they continue to compensate for these other ‘lazy’ muscles.

Proprioception/Balance Exercises
Proprioception is a body awareness sense that allows us to coordinate posture, movement and balance.  Our joints, tendons and muscles have tiny receptors built into them and are constantly updating our brain with information about our body’s position and the direction and speed of each body parts movement.  Without this we would constantly injure ourselves as our movements would be uncoordinated and clumsy.  Unfortunately these receptors are often disrupted with injury to the tissues they are contained within, our proprioception becomes impaired can often remain impaired and as such needs to be trained again. 

Retraining proprioception involves performing specific exercises with the eyes closed or on an unstable surface such as a ‘wobble-board’ so that individual must rely more on their proprioception to perform the exercise.

Functional Sport-specific Exercises
When we train any movement pattern repeatedly it becomes a more conditioned, fitter or stronger movement.  The training response is quite specific to the conditions that it was trained in and this is not necessarily transferable to other situations even though they may seem quite similar.  Sports and work specific skills should be trained in the same environment with the same resistance, frequency and repetitions of movement that that person is trying to become more competent.  This ensures that there is maximum carry through of these skills to benefit that person with their chosen sports or activities.

Cardiovascular Fitness
As we exercise, various receptors in the brain as well as the heart and blood vessels recognise a change in the chemistry of our blood as our muscles work progressively harder.  The response to this is that we breathe more deeply to get more oxygen into the blood and the heart beats faster and with bigger volumes to get that blood loaded with oxygen into the muscles to feed them.  In this way the muscles are able to sustain this new higher work load for long periods of time.  Of course there is a ceiling to this and for most of us it is the volume of blood that the heart can pump around the body.  As we continue to train over a period of time the ability of our muscles to do work improves and the demand on the heart and lungs for a given work intensity decreases.  This is why after a few weeks or months of doing the same work out it starts to seem relatively easy.  As such we can achieve the same things with less effort or with the same effort achieve more strenuous goals.  This is getting “fitter”.  In order to do this we engage in whole body physical activity of moderate to high intensity for long periods of time i.e. cycle, row, run etc.

Health and Fitness Solutions
Having gone through this programme of rehabilitation you would be posturally well aligned with enough strength, control and balance to have efficient, effective movement patterns.  Your fitness levels would be enough to easily get you through the days work and sporting activity with plenty to spare and your sports performance would be better than ever before.

You now have minimal risk of getting injured and of developing aches and pains as you age.