Sometimes patients have to take a step backward to move forward, and sometimes their voyage is not so much about discovery as rediscovery. Stiffness is not the major chief complaint I hear from clients, but it is often checked off on their intake forms. Stiffness can be associated with pain, inflammation, fatigue, and any other complaint that bring clients in my office. The most common reason for stiffness is the effects of immobilization of the joints and muscles. The spinal joints, hip joints, knee joints, shoulder joints, and ankle joints are the most commonly involved. Muscle and joint pain commonly originates from bad habits of sitting, standing, sleeping, and walking. Stiffness has real consequences if ignored.
A Functional Workout
It doesn’t matter if my client is young, middleaged, or a senior citizen; I use the functional training approach as part of my treatment, especially for relief of stiffness. I start my rehab recovery teaching patients body-weight maneuvers and floor exercises. Then, I progress patients to use bands. I incorporate Thera- Bands for rehabilitation, functional movement training, sport-specific conditioning, and group classes. The next progression I use is to free weights and Kettlebells. Our profession was inundated with laser therapy and decompression tables, while the strength-training world was invaded by Kettlebells. I like to think that I have access to every kind of equipment out there, but through it all, I am still a big proponent of the minimal and inexpensive need for equipment in “authentic” functional training, like Thera-Bands. Thera-Bands can provide the basis for an authentic functional workout limited only by the imagination and knowledge of the practitioner. Functional exercise is based on its outcome, not how the exercise looks. Don’t ask me how to activate specific muscles (that question was answered years ago). Instead, ask: Why did this person lose the movement pattern in the first place?” Thera-Bands help me get rid of stiffness and improve functional strength, which is usable strength. Functional strength is hard to measure. That’s why I attempt to identify it by using many unorthodox movements, such as assisted posterior reaches. his exercise is one of the best methods of developing functional abdominal strength in overhead athletes, or athletes in sports that bring the arms overhead, such as tennis and basketball. Stand on both legs (eventually progress to one-legged stands) facing away from a Thera-Band firmly held in place. Hold the band in both hands, and extend your arms straight up above your head. Bring the hips forward and the hands back. Lean backward as far as you can without feeling pressure in your lower back. Engage the lower abdominals to return to the starting position. Using the Thera-Bands, I teach movements that train the body to do what it was meant to do. These can simply be broken down into four pillars: 1) Standing and locomotion (gait). One of my favorite exercises that improve the hip rotator stabilizers (gluteus) is to have clients wrap the Thera-Band (usually the green band) around the ankles and walk sideways across the room or down a hall to activate the gluteus. This one maneuver alone has helped more patients improve altered gait than any other. 2) Movements that lower or raise the body’s center of mass, such as squatting, lunging, and climbing. I have clients stand on a band and hold the ends of the band in their hands while doing squats, and perform an overhead press on the way up. 3) Pushing and pulling, such as standing rows and pressing maneuvers. 4) Rotation. These are changes in direction. For example, torso rotation and proprioceptive neuromuscular facilitation (PNF) band chops are a functional way to train the abdominals.
Everyone talks about the core, which includes the major muscles attached to the trunk, above the ischial tuberosity, and below the superior aspect of the sternum. Approximately 87% of the core muscles are oriented either diagonally or horizontally and have rotation as one of their actions. Our body was made for rotation, yet very little rotational training is addressed in today’s standard training protocols. Thera-Bands make rotational training easy. The most annoying things about the bands is getting the latex powder on your clothes and occasionally the bands break while you are in the middle of a set. An advantage to band assessing and training is the observation of symmetrical or asymmetrical movements. The link between uncontrolled spinal and joint intersegmental translation or uncontrolled range of motion, and the development of musculoskeletal pain and degenerative pathology, is well-known. Often, patients are not even aware of the bad movement pattern that they are doing over and over that is causing the stiffness. Sometimes, it is only clearly seen when the muscles fatigue and pain sets in. The inefficient control of muscles and bones, poor movement habits, and poor posture give rise to very subtle and unique imbalances in the body-stability system. This puts mechanical stress and strain on the joints; and the muscular, neurological, and connective tissue systems of the body. This leads to cumulative microinflammation, which leads to pain and pathology. This predisposes joints to early aging and stiffness. A significant amount of injuries and stiffness occurs in clients with right- to left-sided strength and flexibility imbalances. My recommendations with the Thera-Band are to put the core first and to look for the following asymmetries:
and realizes how critical it is for the inner core of the body—namely, those joints closer to the spine, to be supported by the postural muscles designed with strength. You can create strength using the tubing made by Thera-Band. If you don’t tend to strengthen, the natural progression is for the body to lose it.
I usually recommend that stretching is the last thing a person does once he or she is pain-free. I see many patients that injure themselves from overstretching in yoga class and with Pilates. Stretch to increase flexibility, but don’t overdo it. I encourage patients to feel the muscle barrier and don’t go past that point. Otherwise, you start pulling on the ligaments and these were not meant to be pulled apart. Neuromusculoskeletal function involves a complex integration of proprioceptors facilitating; muscles reacting and joints moving simultaneously in sagital, frontal, and transverse planes of motion in a groundforce kinetic chain reaction response. This is facilitated by the moving body in relation to the ground and gravity. Use Thera-Bands to put patients through movements that allow you to see how an individual can control outside forces that are irregular in intensity, speed, load, symmetry, nd direction, just like sports and real life.
The purpose of flexibility varies for the different muscles around the joints. For the major power muscles, it is important that flexibility allows freedom of movement for the pelvis, hips, trunk, scapula, and humerus. Freedom of movement needs to be symmetrical.
General Muscle Strength
Once the foundational issues of consistency, core stability, flexibility, and balance control are being implemented, I then look at the bigger picture of the “outer core.” The rest of your body will need strength to carry you into your 80s and 90s. Performance as you age will be improved
Jeffrey Tucker, DC, DACRB
has been in continuous private practice for over 25 years in Los Angeles. His practice includes stretching, yoga, Kettlebells, & FMS training. He teaches courses in rehabilitation. Contact him at www.DrJeffreyTucker.com