by Mitch Hauschildt, MA, ATC, CSCS
The world has created some great combinations over the years. Peanut Butter and Jelly, Batman and Robin, Mac and Cheese, Han Solo and Chewbacca, and the list can go on and on…
I would like to add another duo to that list…Rehab and Fitness.
Some of you may think this is a little strange, especially if you are used to the traditional therapy model of focused treatment on the injury site and not looking globally with our interventions. But, a very strong argument can be made that fitness levels are directly related to a patient’s ability to recover from injury.
We know that the cure for most chronic medical problems is diet and exercise, right? That is all we really need to know. A good diet and exercise do a lot to cure what ails us. But, if you need a little more in depth understanding of why this due is so important, here you go.
pH Levels
I think its easiest to start by understanding a little bit about our body’s pH balance. First off, with our American diet, lack of exercise, and overall unhealthy lifestyle, many people have at least some level of acidosis as compared to years gone by. Acidosis is associated with high levels of fatigue, shortness of breath and muscle cramping, just to name a few. If the blood becomes too acidic, we actually begin to see a decrease in oxygen levels and cellular death.
We also know that the pH levels in the area of tissue surrounding a trigger point in a muscle is more acidic than the rest of the body (1). Is it the pH levels causing the trigger point or the trigger point causing the low pH level? I don’t know, but I do know that they’re associated with each other. The reason that I bring it up is that we know that pH levels are associated with muscular dysfunction. Thus, if I want to improve muscular function, restoring normal pH levels is a good place to start (many patients suffer from ongoing issues related to trigger points after an injury).
Lastly with regards to pH, we know that when someone performs high levels of exercise, they become acidic as their body attempts to blow off the by-products of exercise to restore normal function to the body. This one of the factors that is related to fatigue during exercise.
If we understand that exertion produces acid, and acid is related to spasm, and acidosis is related to chronic health problems, then we understand that we need to reduce acid levels and restore a normal pH.
One way to impact blood pH is through exercise. Our bodies don’t produce nearly the same levels of acid when they are aerobic as they do when they are anaerobic. When we pass our anaerobic threshold, we begin producing by products at a very high level that our body has to deal with (recall the Kreb cycle). Thus, with higher levels of aerobic fitness, we typically find a more neutral pH balance and a more efficient running body.
Cardiovascular Fitness
When we talk about tissue healing, it is also important that we consider the role that the cardiovascular system has on tissue. In order for tissue healing to occur on a cellular level, our body needs oxygen and nutrients to be delivered by the blood, which is circulated by the heart. Without fresh, nutrient-rich blood circulating through injured tissue, optimal healing cannot occur. Someone with poor cardiovascular conditioning will struggle clear debris within the tissue and deliver nutrients to heal damaged structures.
Let’s face it, many patients that are being seen in clinics around the country are 50+ pounds overweight, many of them smoke, and most are inactive. With cardiovascular fitness at an all time low, how can we expect optimal healing to take place?
The Answer
The answer is simple, GET MOVING! If you are a patient reading this, get as fit as you can prior to surgery and then as fit as you can as fast as you can after your injury. If you are a clinician, get people moving…NOW! The earlier the better. One can make the argument that in the first few weeks following a shoulder surgery, that making someone walk daily for 30-60 minutes will have just as big or bigger impact on their long term shoulder health than local interventions.
If you work with athletes, they will love to sweat after an injury. Be creative. If they have a lower extremity injury, put some battling ropes in their hands and go to work. If they have low back pain, teach them a good bearcrawl and watch them go to work. Have fun with it and make it challenging.
As I wrap this up, I do want to address one more item related to this concept. Many clinicians tell me that all of this sounds good, but they have limited visits as it is and they can’t afford to focus 1/2 of their daily treatment session just on this, which I can appreciate. My argument back is that I’m more concerned with patient outcomes than I am their number of visits. Meaning, if they can only get approved for 2 visits per week, those are the sessions that you must use to work on their local problems. But, there’s nothing to say that on the other 3 days of the week that they can’t use your treadmill or elliptical machine at no charge. You make up any lost revenue in great outcomes and patient referrals. Your other option is to utilize their home exercise program to integrate aerobic fitness. I realize not all patients will be compliant (which is no different than any other interventions), but the ones who are, will ultimately thank you.
1. Shah JP, Gilliams EA (2008). “Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome.”. J Bodyw Mov Ther 12 (4): 371–84. doi:10.1016/j.jbmt.2008.06.006. PMID 19083696.
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