Control the Five “Rs” of Rehab Training
strain on the involved tissues. Proper instruction, continued monitoring, and specific corrections are necessary factors preventing overload injuries. A Trio of Errors
by Kim D. Christensen, DC, DACRB, CCSP, CSCS The human body reacts positively to the increased stresses placed upon it. As one of the basic tenets of physical rehabilitation, this is the whole reason we command muscles to lift more weight, tendons to pull more tension, and joints to undergo more movement. In order to develop and improve our physical capabilities, we place increased, yet controlled stresses on our bodies. P a r a d o x i c a l l y h o w e v e r, increased physical stress is often the cause of symptomatic conditions and physical breakdown. What is the difference? Actually, several have been identified. Progressive overloading of responsive tissues is, in essence, the principle that underlies the benefits of exercise training. Benefits which accrue as the body’s normal recuperative processes respond and improve in function include increased strength and endurance, better flexibility, and improved coordination. Our goal is to stimulate these beneficial improvements, while avoiding any errors which might place excessive
Texas Journal of Chiropractic
There are three categories of exercise errors that indicate excessive loading of involved tissues. Most problems with exercises are associated with a “loss of form.” (1) This somewhat nebulous phrase can be defined as consisting of three problems: Postural Imbalance, Misalignment, and Movement Restriction. By paying attention to our patients as they perform their exercises, we can identify these problems early on, and make appropriate recommendations. Postural Imbalance. Look for any abnormal or imbalanced postures during exercising. Whether the patient is strengthening, stretching, or walking, hyperextensions and lateral shifts indicate an overload situation. This is easily seen during cervical training, when patients strain and push their heads forward, instead of maintaining a balanced alignment throughout their exercise. Misalignment. The more subtle deviation of misalignment during exercising relates primarily to the extremities. This can be 3
especially noticed in the feet (toe-out), ankles (excessive pronation), and knees (knockkneed). These are all indicators that additional exercising in these conditions will likely bring about a recurrence of symptoms, rather than improvement. Addressing the misalignments and asymmetries are paramount for progress, and may require custom-made stabilizing orthotics. Movement Restriction. Any limitation in range of motion during an exercise should prompt a search for the underlying cause. This may be a reasonable selfprotective response due to r e c e n t i n j u r y, o r ( m o r e commonly) an inappropriate fear response. It is also possible that the patient is placing excessive loads on sensitive tissues that are incapable of handling that amount of stress in their current state. A Quintet of Solutions Excessive loading, whether of r e s i s t a n c e , f l e x i b i l i t y, endurance, or proprioceptive exercises, is never helpful, and can be counterproductive. Five solutions all start with the letter “R.” They are: Rest, Range, Rate, Resistance, and Repetitions. (2) Rest. By increasing the rest period between exercises, or www.chirotexas.org