Functional rehab..what does it mean?

Posted: October 16, 2011 in Therapeutic Exercise

“functional training” is now the standard for exercise programs these days. We all hear about sport specific training for sport specific results. While I think many of these concepts are great, I do think much of it is overkill. I may offend a few people here, but I feel like many trainers have “brainwashed” young athletes and their parents into thinking that they need to do highly specific and tailored training programs for little Johnny to make the NHL. All kinds of gizmos and gadgets have been produced to supposidly give athletes the “competitive edge”…just walk into any golf store and see the amount of complete rubbish there is out there. Ironically, the nature of golf is such that those that play the sport often have a little ( or a lot more) expendable income then those that play other sports. Funny how their are sooo many “must have” items being sold to golfers…i’ll let you draw your own conclusions as to why.

How does all this relate to physiotherapy? It is my contention that no amount of sport specific or functional training will drastically help an athlete improve their game until their fundamental biomechanics are correct. You can’t build a house without first constructing a solid base…same goes for people! You can’t train a body if the body isn’t in a position to be trained…well you can, but the results will be minimal at best…and here is where i start my shpeal on WHY we develop low back pain and why training before correcting the WHY is a waste of time..and money!

Clearly the bulk..i’d say about 75-80% of low back pain (LBP) patients I see cannot identify a particular offending event (no specific injury). Ironically, the onset of LBP is often associated with the very simple act of bending forward.

If there is no singular event then it must be what we do day in and day out that triggered the pain (the foundation of the house isn’t where it needs to be). If we can identify the cause of the pain, then logic assumes we can eliminate the consequence–back pain

In its simplest form, the body is a series of body parts linked together. Each segment has a specific role and influences its neighboring segments.

The ground breaking work by Mike Boyle and Gray Cook, both respected trainers and therapists respectively, have developed a system that assigns either a stability or mobility role to each segment. These responsibilities alternate as one progresses from the feet to the head….called the Joint by Joint Theory

For example, the body starts out with a stable foot followed by a mobile ankle, a stable knee and mobile hip, a stable lumbar spine(low back), and a mobile upper back..etc

Issues arise when links or body segments assume an inappropriate role-that is a mobile segment becomes restricted or stable. This then forces the segments above and below that area to change their role. For example: When our hips get tight (from sitting so damn much) we have to find a way to keep our body mobile. Our body does this by forcing the low back to move from a stable are to mobile area. This places stress on areas that shouldn’t have stress and a whole cascade of events can unfold…leading to pain.

Remember that song we learned as kids…” the shin bone is connected to the leg bone, leg bone is connected to the hip bone…” That song was right on the mark…everything is connected!!!

When the low back moves too much we develop pain in the back but possibly in other areas as well (neck and shoulders..even knees). It therefore makes little sense to me, to train an unstable area using mobile activities..such that are done in hockey and golf training. We must first fix the biomechanical problem before we can allow mobility drills to be done…functional rehab at its best!

There are many things that can be done to fix seemingly unrelated problems. These include manual therapy, soft tissue release, postural reeducation and of course corrective exercises. If you are in pain and don’t know why, chances are something is “out of whack” and needs to be looked at.

Any and all questions are always welcome

Jesse Awenus B.A Hons (Kin), MSc.PT
Physiotherapist

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