Functional retraining is a term used in rehabilitation to describe a progressive approach of breaking down functional movements into components to reprogram how we move. Functional movement includes anything we do in daily life at home, work or for recreation. It is necessary to establish more efficient movement patterns to prevent injury or further impairment of our bodies. Often with injury or surgery, our functional movements are impaired from pain, lack of range of motion, muscle weakness or muscle tightness and/or decreased flexibility. A skilled physical therapist will perform a physical examination to determine where these deficits lie so that an individualized physical therapy treatment program can be instituted to address these deficits followed by a structured approach to functional retraining. This may involve stretching, self-range of motion exercises and relearning and performing parts and pieces of a functional movement before integrating the entire function. Restoring a patient’s ability to run for example may involve stretching lower extremity muscles, strengthening of lower extremity muscles, hip mobilization, orthotic prescription and balance prior to the patient running again. Once the movement, strength and proprioception has been improved, the patient may begin by running at a slow speed on a level surface with feedback and correction from the physical therapist with progression to higher speeds and inclines for a full return to function.
Local and Global Muscles
As part of functional retraining we specifically focus on the deep stabilization muscles of the spine called the local muscles that serve to protect the spine as well as the larger ones called the global muscles that perform large movements of the trunk and spine. The global muscles include the rectus abdominis and obliques which most people are familiar with.
How and why we test local muscles
“Getting to the Foundation”
Local muscles are the smaller muscles that attach directly to the spine. Research has shown the importance of these local muscles in contributing to the stability and function of the spine. Their primary roles include: controlling segmental translation, maintaining activation that is continuous and independent of the direction of movement, and to protect the spine by anticipating movement. Local muscles stop working like they should in the presence of pain or a history of pain. Non-mechanical or pathological pain can have the same effect. Therefore, retraining of a local stabilizer is necessary to reduce recurrence of the pain symptoms.
So why retrain these small seemingly insignificant muscle groups vs a traditional strengthening program? Research has shown that problems with local stability muscles are related to motor control deficits, not weakness. These deficits can be retrained with specific low load exercises. Strengthening programs do have some placebo effect by releasing endorphins but in the presence of dysfunction of local musculature, strengthening programs may contribute to that dysfunction and pain.
Retraining these muscles can be challenging as it often requires learning how to get control of a muscle you never thought about using before. Motor control is the priority initially in a good spine rehabilitation program, not strength and flexibility.
Global stabilization muscles
“Learning to Move Without Pain”
Another major component of rehabilitating the spine is global stability retraining. The purpose of global stability retraining is to learn how to move above and/or below an area of pain without moving that segment. This often involves instructing someone to move one part of their spine without moving another. This becomes especially important when teaching a patient to protect an injured disc or to avoid putting pressure on an injured nerve or joint. Seeing a spine specialized therapist to accomplish this is key because they have the tools to give the necessary feedback to achieve global control. Gaining control of the global stabilizers often results in a patient learning what motions/activities cause them pain and how to avoid or modify them.
When doing a rehab program for the spine it is important to remember that “no pain, no gain” does not apply. If any exercise reproduces your symptoms or makes your pain worse, stop.
Included in these sections are some basic exercises and a good place to start. Please contact Denver Back Pain Specialists for a more specific and individualized program.