In our previous article we mentioned that prevention is better than the cure BUT what if you are sitting with the problem already? What are the various components of rehabilitation?
In general, the ‘process to recovery’ would start with the person seeing their general practitioner (GP), the GP would then refer to a specialist if they can’t assist with the problem and from there it would be decided whether surgical or conservative treatment is required. In our articles to follow we will be going through various conditions and situations (post-surgery and conservative treatment) and explain what their rehabilitation processes (focusing on physical rehabilitation) would involve, so make sure to read the articles to come. As for today, we will be looking at the different components of physical rehabilitation and the importance thereof.
When a person comes for physical rehabilitation, the biokineticist will firstly do an initial evaluation. This will help the biokineticist understand what the person’s needs are for their current situation, as well as get more information about their medical history. Based on this information a rehabilitation program is put together for the person and this compromise of different components.
Components of Rehabilitation
Flexibility can be explained as the range of motion (ROM) in which a person can move a joint or a series of joints. Furthermore, it also refers to the mobility of the muscles as this will allow for less or more movement around the joint.
Flexibility is affected by various factors. These include age, gender and joint structure – unfortunately we can’t do anything about these factors. Other factors that influences flexibility, which we have more control over, include muscle bulk (individuals who tend to be ‘bulkier’ generally have reduced ROM), internal environment (whether your muscles and joints are ‘cold’ and you need to warm them up) and previous injuries (injured muscles and connective tissue can thicken which reduces elasticity and therefore reduces ROM).
A person can improve their flexibility through a variety of stretching exercises.
Different Stretching Exercises
- Ballistic Stretching: With this form of stretching a person makes use of momentum to force a joint or body part beyond it’s normal ROM (bouncing down repeatedly to touch your toes). It is not advised to make use of this type of stretching as it often leads to injury.
- Dynamic Stretching: Dynamic stretching involves moving parts of your body – gradually increasing reach and/or speed of movement. This form of stretching is not the same as ballistic stretching as it is a controlled movement (no bouncing) and you gently move to the limit of your ROM.
- Active Stretching: During active stretching, you the individual stretch yourself. Thus, you assume a position and hold that position with the strength of your agonist muscles (opposite).
- Passive Stretching: Passive stretching is when you assume a position and hold it with another part of your body, with the help of another person holding the position for you or making use of equipment to hold your body in that position.
- Isometric Stretching: Isometric stretching can be described as a stretch that involves resistance of a muscle group through isometric contractions (tensing) of the stretched muscle. The proper way of performing an isometric stretch would be to a assume the position of a passive stretch for the desired muscle, then to tense that muscle for 7 – 15 seconds, followed by relaxing the muscle again for at least 20 seconds.
Flexibility is an important part of rehabilitation and general conditioning, though often overlooked by many. A person will yield many benefits from maintaining good flexibility including reduced risk of injuries, reduced pain levels, improved posture and balance, greater strength, improved physical performance and a better state of mind.
Strength training is a form of exercise where you make use of resistance to induce muscular contraction. This in turns builds strength, anaerobic endurance (a short duration of activity without oxygen), the size of the skeletal muscle as well as bone density.
The benefits of strength training are endless and include:
- Improved muscle, tendon and ligament strength
- Enhanced joint function and stability
- Better posture
- Reduced risk of injury
- Increased bone density (helps prevent conditions such as osteoporosis)
- Increased metabolic rate (helps with weight management)
- Improved cardiac function
The overall aim of this training technique is to progressively increase the force output of the muscle through increasing the weight used for resistance over time. One can achieve this by using a variety of exercises and types of equipment to target specific muscle groups.
Equipment/Techniques for Strength Training
- Body weight training – this allows anyone to do strength training anywhere. Exercises such as push-ups, pull-ups, planks and squats fall in this category.
- Resistance tubing or bands – these are lightweight elastic tubing/bands that provide resistance when stretched.
- Free weights – making use of weights such as dumbbells or barbells.
- Weight machines – easy to use machines that usually targets specific muscle groups.
Endurance training refers to training in an aerobic state, meaning the body uses oxygen to meet the energy demands during exercise through aerobic metabolism (combustion of carbohydrates, amino acids and fats in the presence of oxygen). Endurance exercise includes activities that increase your breathing as well as your heart rate, make use of large muscle groups and are generally activities that can be performed for longer than 10 minutes. Examples include walking, jogging, cycling and swimming.
As with strength training, the benefits of endurance training are endless and include:
- Strengthening of the muscles that assist in breathing, and in turn allow better oxygen absorption into the blood stream and elimination of carbon dioxide.
- Strengthening and enlarging the heart muscle, which improves the circulation of oxygenated blood from the lungs into the blood and muscles.
- Reduction in blood pressure due to improved circulation.
- Increase in red blood cell count, which improves oxygen transport to various parts of your body.
- Improved metabolism as well as increase in muscle mass, reduction in body fat and increase in bone density. With these changes you will most likely find a reduced risk of diabetes (blood sugar).
- Better muscle recovery time after high intensity exercise
- Improvement in mental well being as well as cognitive function.
Proprioception can be defined as your body’s ability to know its position in its surrounding and allows you to move quickly and freely without consciously having to think about it. For example, when a person touches their nose with their finger, they can move their finger to their nose smoothly and without hesitation whether they have their eyes open or closed. Proprioception is achieved by specialised nerves in your muscles and joints that provides continuous feedback to your brain. It tells your brain in what position your joint is as well as how much stretch and strain is placed on the muscle/s surrounding the joint.
Proprioception is often disturbed by neurological disorders, injuries or surgery and can interfere with simple activities of daily living (ADL). Signs and symptoms of disturbed proprioception include:
- Poor balance
- Uncoordinated movement
- Poor posture
- Inability to realise your own strength
- Avoiding certain movements or activities
Coordination can be defined as the ability to execute smooth, accurate and controlled movements by making use of the correct muscles at the correct time with proper intensity to achieve the desired action. Coordination is considered good when the movement is performed with the appropriate speed, distance, direction, timing and muscular tension.
Coordination consists of the following components:
- Volition – the ability to start, maintain or stop a movement
- Proprioception – as explained in section above
- Engram – a suggested physical or biochemical change in neural tissue that represents a memory. An engram is achieved through thousands of repetitions.
3 types of coordination:
- Fine motor skills – which are movements that make use of the smaller muscle groups, for example writing or fastening shoelaces.
- Gross motor skills – for these movements large muscle groups are recruited, for example walking or running.
- Hand-eye coordination – hand-eye coordination makes use of the visual system to coordinate visual information, such as catching a ball.
When a person is unable to coordinate movements accurately, it is said that the person suffers from ataxia which can be brought on by various diseases and injuries including stroke, Parkinson’s disease, seizures, infections and alcoholism. Being able to coordinate movements, whether simple or complex, is important for achieving basic activities of daily living and therefore important to incorporate such exercises in the rehabilitation program.
Functional rehabilitation can be described as rehabilitation or training that aims to return a person to performing their specific sport or purely being able to perform activities of daily living (ADL). It is all encompassing of the components mentioned in the article, with the movement mimicking that of the movement the person might require to not only return to their sport/ADL but performing or functioning optimally in their given sporting event, work place or being able to live independently. The rehabilitation program is designed to progress from simple activities to highly complex activities, whilst the final phase of the program entails whether the person can return to their sport, workplace or live independently.
Throughout this article you will notice that many of the components of rehabilitation have similar benefits, work hand in hand and as described with functional rehabilitation can work as a unit. And it should work as a unit at the end of the day. After all, we don’t go through life moving in single planes. We are far more complex, functioning in multiple planes and should therefore make sure our rehabilitation program simulates exactly that.
Should you require further information on how we as biokineticists can assist with your recovery and rehabilitation, please don’t hesitate to Contact Us.