Is Movement Based Rehab for Everyone??

In recent months, I have worked with my good friends at Medical Minds in Motion to introduce a new continuing education course entitled “Functional Treatment and Movement Assessments for Post-Op Shoulder Rehab”. It has been a fun and enlightening experience overall and I continue to enjoy the opportunity to share the information and knowledge that I have gained over the years.

Before I go further, I want to acknowledge that the vast majority of the people who attend these courses are well-intended clinicians who have their patient’s best interest at heart. Unfortunately for many of them, a movement-based approach to rehabilitation is completely foreign to them.

While the course is about post-op shoulder rehab, it is really a movement course. We discuss the principles of regional interdependence, proximal stability for distal mobility, the Functional Movement Screen, and using specific exercise progressions and regressions to improve range of motion, stability and overall function.

It never ceases to amaze me at what kind of feedback I receive at the end of the 1-day course. Obviously I work at a NCAA Division I university full time, so I admit that my patient population is more active than the typical therapist’s and I am blessed with the resource of almost unlimited amounts of treatment time if needed to assist an athlete recovering from an injury. The number #1 criticism that I receive following the course is “I can’t apply these principles to my patient population.”

It is true that I can do some things with my patients that the general population and the elderly may struggle with, but the idea that a movement based strategy isn’t for everyone is something that I fundamentally disagree with.

A few of the basic concepts that are taught in the course are:

• Hip Hinge
• Farmer’s Carry
• Overhead Pressing
• Rotational Movements

So, that leads me to a few basic questions…

If these basic concepts don’t apply to geriatric or general populations, does that mean that only athletes bend over to pick things up? Do elderly people ever carry an object while walking? Are we so spoiled in our society that our general population never has to reach and get something off the top shelf of their kitchen cabinets? Do only athletes ever rotate to reach for something? I think you get my point.

I can even understand it to a certain degree when therapists say that they don’t need to know the basics of a quality Kettlebell Swing. But, I find it hard to believe that most general clinicians in today’s world of boot camps and Crossfit don’t encounter patients who need to refine skills such as swings, cleans, and so on. Thus, to me it makes sense to help them understand these movements.

Over the last 30 years, the therapy world has been so consumed with treating pain and symptoms, that we forget about the person that we are treated. The human body is a group of complex systems all working together to survive and prosper under the most difficult circumstances. Because of this, we must keep in mind that it is our duty as health care professionals to treat our patient’s dysfunction, wherever it exists. We know that the number #1 predictor of future injury is previous injury. Thus, we owe it to our patients to evaluate and treat them as a person and not just as a shoulder, knee, ankle or spine. When they leave our care, there should be no doubt that they will not be back in our clinic or training room any time soon.

So, how do we use movement to rehab the non-athlete (and athlete for that matter)? Here are a few suggestions:

• Evaluate movement  –  If you don’t understand your patient’s dysfunction, you won’t know where to start with their treatment. I recommend the FMS and/or SFMA as your evaluation tools. Both have been researched and proven to be effective tools for people of all ages and activity levels. With that being said, the exact tool isn’t as important as the fact that you have a tool to evaluate movement.
• Understand the concept of regional interdependence and train the systems of the body.  –  Whether you call them fascial lines, sling systems, or whatever, there is no doubt that the body is fully integrated and connected. Accepting that something like an ankle restriction really can impact the stability of the shoulder is important if we are ever going to truly improve function within the body.
• Train proximal stability to allow for distal mobility  –  This is closely related to regional interdependence. It is easy to say that everything begins with the core. But, most people that make that statement don’t truly understand what that means. The easiest example that I can use is that of the interaction between the hip flexors and the inner unit of the core. The inner unit is designed to stabilize the pelvis. But, if it isn’t working correctly (and most don’t), the hip flexors will turn on to stabilize the pelvis. Now that the hip flexors are turned on, it will limit mobility in the lower extremity. By improving proximal stability, we can increase distal mobility. The same holds true of the core and pecs as it relates to the shoulder.
• Understand the role of soft tissue in dysfunction  –  The vast majority of people who don’t move well have shortened and overactive muscles somewhere. If you never release the soft tissue, they will never restore their function. Static stretching alone WILL NOT mobilize this tissue. If you want to make an effective change, you need to combine manual therapies with active mobility and neurological re-patterning. Of course you have to use common sense with your manual techniques. You need to work with each person’s body type and adjust for his or her skin integrity.
• Restore breathing patterns  –  The diaphragm is designed to expand in all directions. Very few people know how to use their diaphragm effectively and I’m yet to meet any patient who comes into my clinic or training room who doesn’t breathe, thus it can be trained with virtually everyone.
• Train in progressions  –  We need to constantly put our patients in a position where they are successful. This occurs when we start with simple movements that they can perform well and then layer difficulty on top of the simple movement. My exercise library has at least 3-4 versions of every exercise so I can always progress and regress it as needed.
• Use the principles of periodization to improve strength and energy system utilization  –  These are foreign terms for most clinicians, which is a real shame. Telling your patients to do 3 sets of 10 over and over is doing nothing to help them restore their active lifestyle. Get your patients active and throw a lot of variety at them. They will enjoy it and it will help them tremendously with tissue healing, strength, and overall health. In almost every case that I can think of, your patients are able to do a lot more than you give them credit for.
• Utilize appropriate tools  –  Items like the TRX Suspension Trainer, Ultimate Sandbag, Kettlebells, and Bands are great for adding load to your movements because they are scalable. As an example, if your patient is too old or too overweight to perform planks on the floor, use the TRX to challenge them appropriately without having to get on the floor.
• Forget about passive modalities
• Think outside the box!!

Overall, training movement is the key to improving function over time. Training movement with the general population and elderly individuals can and should be performed as part of their rehab process. Get creative and challenge them when they are ready.

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