EXERCISE REHABILITATION

The purpose of stretching, working on mobility or using exercises to enhance stability is to have a positive impact on functional movement.

Keeping this in mind the first step is to properly assess your functional movement patterns to determine which patterns are dysfunctional. Once this is achieved you now have a target or goal, improve that particular movement pattern. Any exercise you work on should lead to enhanced performance and that improvement should be measurable.

At the Body Genius Institute we utilize some of the most advanced screening tools in the world and we can demonstrate clearly to you that your corrective exercises are effective and helping you to move better.

Let’s assume that during the Functional Movement Screen® it’s determined that a client has a faulty lunge pattern, which is worse on their left side compared to their right.

Functional Lunge Pattern Score

Left = Dysfunctional

Right = Minimally Functional

The goal then for any corrective exercise (stretching, mobility, stability) is to improve the selected functional movement pattern – lunge. For example, the Body Genius practitioner may provide you with a hip mobility exercise to perform each day. To determine if this exercise is ‘working’ then the test movement pattern is simply re-evaluated.

Performing corrective exercises that do not lead to improvements in functional movement are a waste of time for both the client and the practitioner.

There are two key points that need to be discussed when answering this question.

First, there are literally hundreds of research papers that have looked at patient compliance with regards to various types of therapy including lifestyle modification. The evidence is clear; the more complex and time consuming the plan, the less likely the patient is to follow through. And three is no surprise that this significantly reduces the likelihood of a positive outcome.

Our approach at Body Genius is far different to this. Initially, we may have selected four to six exercises that we believe will improve the functional movement pattern that is deemed to be dysfunctional. We then test each of the corrective exercises to determine which one(s) have the strongest impact on the test movement. In most cases, there are one or two exercises that demonstrate the strongest benefit. As such, you will be provided with one or two exercises that you’ll be asked to perform daily for up to 10 minutes.

Second, many people believe that stretching and mobility work takes time, often weeks or even months before any significant results are achieved.

Our experience at the Body Genius Institute would lead us to believe that when the right corrective exercise is implemented it will yield results in just minutes. In our opinion, if the corrective exercise does not provide significant improvements in five minutes or less than it’s highly unlikely to provide benefits, even after weeks of diligent effort.

As described above, the process involves selecting a dysfunctional movement pattern and then testing corrective exercises to see which one has an immediate impact on improving that functional movement pattern. When changes happen this rapidly, motivation soars!

The process is highly rewarding for both the client and our Practitioners alike.

We could easily insert the words ‘calves’ or ‘hamstrings’ for hip flexors in this question.

This question is slightly more complex and it would take a skilled practitioner to sort this out for you. First, we need to establish whether your hip flexors are actually tight or ‘short’ in length. Sometimes this area feels tight or sore and yet the actual hip flexors are of normal length. A standard Thomas Test may provide insight into whether the hip flexor muscle is actually tight or not.

Thomas Test

• Hip Flexors
• ITB
• Quadriceps

The next step is to determine why your hip flexors are tight. Is this from training? Is this from prolonged sitting postures at work or when studying? Can we find a way to reduce the load on these structures?

The skilled practitioner then needs to determine if the hip flexors are tight as a result of other structures within the body. In other words, are the hip flexors being overloaded or ‘tensioned’ because other structures within the body are ‘unhappy’? If this is the case then no amount of hip flexor stretching will yield benefits. The tight hip flexors are the ‘symptom’ and the ‘cause’ can be found elsewhere within the body.

This is more of a clinical decision making process that may lead to corrective exercises or may be more easily solved with hands-on therapy.

If pain is not an issue for you, then the first step may be to assess your functional movement patterns to see how well you move. Instead of focusing on stretching the hip flexors, corrective exercises would be aimed at improving a given functional movement pattern. In the majority of cases, as movement improves the tight hip flexors will ‘let go’ and tension will have been alleviated.

Although this is not a straightforward question due to the potential complexity of the problem, there are still several key points that warrant a discussion.

First, the Body Genius Practitioner would want to make sure that you are ‘clinically’ clear. That means that your neural pathways (nerves) are clear and that all major joints and muscle lengths in your body are normal. Although this is a hamstring problem, we still need to ensure that your feet, ankles, knees, hips, lowering back, middle back, neck, shoulders, elbows, and wrists are all moving freely. Remember, everything in your body is connected!

Once this is established, the next step is to perform an Athletic Screen that includes standardized, objective tests that provide a measurable evaluation of how well you move. You stated that you have been performing your exercises diligently. You should be commended for your efforts, however if these exercises are not leading to measurable improvements in your functional ability then your risk of injury remains high on returning to sport or activity.

To really make this point clear, it’s worth taking a brief look at the Body Genius ‘Performance Pyramid.’

In your case you are continually re-injuring your hamstring while playing sport. As you can see ‘sport’ participation lies at the top of the Performance Pyramid. In order to ‘qualify’ for this level you must first satisfy at least the minimal requirements of all the levels below. As described early, you need to be deemed ‘clinically clear’ (Pain & Dysfunction) by the Body Genius practitioner. Next, you need to be evaluated functional for the ‘Mobility & Flexibility’ and ‘Stability’ levels.

At the Body Genius Institute we use the Move2Perform software, which provides us with a precise, individualized evaluation of your injury risk at the time of evaluation. We can clearly see where you are moving well and potentially movement patterns that are dysfunctional.

In almost every case, the cause of the recurrent injury or pain is found in one of the first four (4) levels of the Performance Pyramid – Health, Pain & Dysfunction, Mobility & Flexibility, and/or Stability.

Heather was a 32-year-old swimmer who trained four days per week and swam approximately 8km combined. She suffered from reoccurring pain in her neck and left shoulder and had been treated for years by many different health professionals. Most of these health professionals agreed that Heather had neck stiffness, tight chest muscles and tight lats (back muscles).

Over the years Heather had been treated with joint mobilization and manipulation, deep tissue releasing and had been given chest and back stretches, along with rotator cuff strength exercises. Although her pain often resolved for periods of up to a few months, it always returned again when she increased her volume of training.

At the time of evaluation, Heather’s pain was not an issue so she was taken through the Body Genius Athletic Screen. The highlights of this testing were as follows:

           

 

• A dysfunctional straight leg raise pattern
• A dysfunctional overhead squat pattern
• A dysfunctional reach pattern

Heather and the BG physiotherapist agreed that the active straight leg raise test was the ‘most’ dysfunctional of the three tests and as such chose that as the functional movement pattern to correct. The BG physiotherapist selected five (5) exercises that they believed would have an immediate impact on Heather’s straight leg raise test. Each of these corrective exercises were tested and it was determined that a prolonged calf stretch was having the most significant impact.

Prolonged Calf Stretch

5 minutes in the morning, 5 minutes in the evening

A progression was made so that Heather would perform 5 minutes during her work day and 10 minutes each evening.

Within 5 days Heather’s active straight-leg raise test had improved from dysfunctional to the upper end of ‘minimally functional’. This reflects a significant change for this test. Interestingly, both the reach test and overhead squat patterns improved significantly as well.

 

At this time a second exercise was implemented to enhance the functional straight-leg raise test.

A stretch similar to the Yoga pose, ‘Downward facing dog.’ Heather was asked to spend five minutes performing this exercise while continuing with 10 minutes of prolonged calf stretching.

Five days later Heather was re-evaluated again. Her straight-leg raise test was now optimal, her reach test on both sides was now optimal and her squat test was minimally functional. In less than two weeks she had taken her injury risk profile from ‘moderate’ (30%) to just ‘slight’ (16%). More advanced functional testing was undertaken at this time.