PHYSICAL REHABILITATION ADVICE

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1 PHYSICAL REHABILITATION ADVICE WHAT IS REHABILITATION? Rehabilitation combines various approaches to help your body function in a healthy way and prevent reoccurrences or future injuries. It works in a similar way that regular brushing helps keep your teeth healthy. If exercise sounds dreary think of it as body-play. Make it fun and enjoy! WHY REHABILITATION? Most people getting backache can have another 4 episodes within 1 year. Many other problems such as neck pain and headaches can reoccur frequently to. Such pain is usually caused by problems with the joints, muscles, ligaments and nervous system. Chiropractic treatment quickly increases your comfort levels, but it takes time to correct your underlying problems. Once your joints have normal movement and position and overall posture is starting to improve, it is possible to start an exercise programme. The majority of people with back pain have weakness in certain muscle groups. Things like sedentary lifestyles or postural problems can cause this. Increasing the muscle strength and the nervous system control is vital to help improve things. People who are physically fit generally get less pain and recover faster if they do get problems. Correcting your de-conditioning is the key to prevention. BENEFITS OF REHABILITATION Assists your recovery and prevents future problems. Keeps your body supple and makes it stronger. Improves co-ordination and balance to reduce re-injury. Improves your body posture and movements during work and leisure so helping prevent future damage. Optimises your bodies healing of damaged tissues. Increases fitness and overall health. Reduces pain and psychological stress. Makes you feel better.gives you greater confidence.

2 WHAT DOES REHABILITATION INVOLVE? If you want to enjoy the benefits of increased strength, flexibility and reduce the frequency that you have aches and pains, then like eating, drinking and brushing your teeth, it works best as a regular part of your routine. Regular exercises for mobilisation and de-conditioning. A minimum of 10 stretching sessions per week. Strengthening 2-3 times per week. Aerobic activity 2-3 times per week. Balance and co-ordination exercises. HOW ARE THE EXERCISES PRESCRIBED? Exercise prescription comes from the analysis of posture, muscle length, muscle strength, muscle speed and the balance and co-ordination of muscle activity. MOBILISATION EXERCISES Your exercise programme starts with mobilisation exercises during the first two weeks of treatment. Each exercise is limited to the pain free range of movement to minimise the risk of re-injury. Your chiropractic treatment helps to free the local stiffness in the joints. Regular mobilisation helps to maintain that movement. Mobilisation assists healing and reduces de-conditioning. Remember normal healthy movement, allows the joints and muscles to act like batteries which help keep the nervous system active and healthy. Range of movement exercises gentle stimulate the connect between your brain and body. Mobilisation exercises are repeated times. STRETCHING EXERCISES As the joints and soft tissues start to heal well, gentle stretching exercises are introduced to relax tight muscles. Even though some of your pain may persist, a moderate increase in activity will not harm you and will actually allow further improvement. It takes about 2 months of regular stretching to free tight muscles and up to a year to stretch tight ligaments. These exercises start to challenge the pain barrier. When stretching the challenge should produce a slight pulling sensation. Stretches are performed with a moderate pull and held for seconds. Muscles do not respond in the first seconds or if pulled too hard. Pain after stretching probably means you ve pulled too hard. Pain after stretching exercises may require ice therapy or modification of exercises. Activity specific programmes may be given.

3 STRENGTHENING EXERCISES Sedentary lifestyles and localised stiffness in joints causes weakness in muscles. Once the joints are positioned and moving well and tight muscles stretched, it is necessary to strengthen weak muscles to prevent re-occurrence and improve posture. Significant strengthening can be observed by exercising 2-3 times weekly for 2-3 months and maintained after that by weekly training. Again strengthening exercises can lead to achiness caused by fatigue. Type of strength exercises vary depending on particular muscle group and function but involve different ratios of repetitions and sustained contraction. As your body strength improves the exercises are gradually progressed. Training Phase Weights - Core Stability Sets Repetitions 1 st 1-2 weeks Light - Easy Weeks 3-5 Heavier - Moderate Weeks 6-8 Heaviest - Complex Strengthening exercises may also be given to improve specific home, work or leisure activities. It is advised that strengthening exercises are done when the body is more supple at the end of the day and that you don t stretch immediately prior (within 1 hour) to strengthening. CO-ORDINATION AND BALANCE AEROBIC EXERCISE Adaptation after injury requires that muscles are retrained to work together well. In order to protect the joints, muscles need increased co-ordination, increased speed of activation and improved programming. It is about nervous system control. Working on balance helps further improve stability and increase body awareness, which helps prevent reinjury. Exercising for fifteen minutes a day quickly shows good improvements. These exercises are only introduced once dysfunction has normalised, otherwise training is on faulty movements and is training in the pathology. WILL EXERCISING CAUSE ANY PROBLEMS? Aerobic exercise is crucial for improving overall fitness particularly cardio-vascular and lung function. Aerobic exercise can help boost mood. Moderate to strong aerobic exercise can increase bone density, burn fat and release painkillers. You ll be encouraged to perform at least 3 half-hour sessions per week. Though aerobic exercise is not strictly necessary to improve spinal pain, it is essential for overall health. Recent studies show that sitting puts more stress on the discs than running. Walking and mild daily activities do not even worsen disc herniations. In fact one study showed that 92% of people with severe problems, selected to have an operation on a lumbar disc problem could return to work

4 through aggressive exercise intervention alone such as stretching and strengthening. Exercise programmes have also been shown to be very useful in those continuing to have problems after back surgery. The recommendation is: even though some pain may continue, increasing activity will not produce harm. As function returns to the body then pain will reduce. CAN EXERCISE HELP WITH ARTHRITIS? Exercise is safe for many conditions and can have benefits for forms of arthritis such as Osteoarthritis, Rheumatoid Arthritis and Ankylosing Spondylitis. The key is to be careful and if you feel pain you ve overdone it by 50%. HOW MUCH DO I NEED TO DO MY CORE STABILITY EXERCISES? Intensity Do the exercise and hold for as long as you can without hurting yourself (this is your single repetition maximum - SRM). When you re training, each repetition should be submaximal, less than 50% of your SRM. Shouldn t be painful! If it is do more gently. If it s still painful, stop and ask your chiropractor to check you out. Sets and repetitions: start with 1 set of approximately 6 repetitions at your 50% of your SRM Progress to 1 set of 12 repetitions o Build it up every fortnight o Further progress after the reverse pyramid approach of adding a second set of 8 repetitions, and a third set of 4 repetitions Hold times: emphasise endurance by holding for 1 to 2 breaths (6 to 10 seconds) Form: movements should be performed slowly with appropriate form for motor control training and injury prevention Frequency: Daily or twice daily to improve motor control o First 2-4 weeks Build it up gradually to 4 sets per day o After 4-8 weeks Duration: up to 3 months required to re-educate movement patterns in patients with chronic pain. Other Guidance: Muscle strength is lost at a rate of 3-7% per day of rest. Muscle strength improves 0.5-1% per day with training. It takes a minimum of 8 weeks to build up muscle strength. DO I NEED EXTRA EQUIPMENT FOR CORE STABILITY? When you progress to the more advanced strengthening and co-ordination exercise programmes accessory products such as exercise balls, wobble boards and elastic tubing are essential. A minitrampoline can also be very useful. Springs on the trampoline need to be 15-18cm ideally. Less than 7cm are not good enough.

5 GENERAL The more you are able to stick with your exercise programme the fewer treatments you will need, the quicker you will recover and the less likely it is that you will have a re-occurrence of your problem. Also remember rest and recovery after exercise is at least as important as doing the actual exercises. THE EXERCISE PRESCRIPTION FOR MINIMUM GOOD HEALTH. Improvement Training Maintenance Programme Mobilisation times per week 10 times per week Stretching 15 times per week 10 times per week Strengthening 2-3 times per week 1 time per week Co-ordination 15 minutes per day No known research Aerobic 30 mins 3 times weekly 30 mins 3 times weekly The above chart is a general guide, it s what you can do that will reduce your risk of serious medical illness. Certain specific conditions may need specialised programmes. For example diabetics benefit from 20 minutes aerobic exercise daily. I HAVEN T GOT TIME! IMPLEMENTATION STRATEGIES Fit the exercises in with things you do regularly each day. Do the exercises before getting up or when going to bed. Link them to brushing your teeth, making a cup of tea or travelling. Fit them in to the work routine or during breaks. Some sitting exercises are best done at least every 30 minutes. Set an alarm or watch the clock. Make a game of them with the kids. Try introducing more walking during the day park your car or get off the bus further from your destination. Take stairs as often as possible. Ask your chiropractor for exercise variations you can introduce more easily. WHAT S THE OPTIMAL LEVEL OF ACTIVITY FOR HUMAN HEALTH? Compared to most of our ancestors, our lifestyle today is movement deficient. Using studies of surviving modern hunter-gatherer, it is possible to gather insights in to the way of life of our ancestors. The average activity was found to be 1-2 hours of aerobic activity daily and 2-3 episodes of intense physical activity alternating with rest days per week. Our genes evolved expecting this as normal. Exercise can be thought of like diet our cells need exercise like they need food. Choosing not to exercise, quite bluntly, is choosing to commit suicide. Our genes today are pretty much identical to our ancestors and we need the same level of exercise.

6 OPTIMAL BODY-PLAY PROGRAMME FOR NORMAL GOOD HEALTH To be fit and healthy too much or too little exercise is a problem. The table below outlines the optimum time and sets you could be doing if you want to perform at your best. Type of Exercise Mobilisation Spinal R.O.M. (Range of Movement) Balance Co-ordination Postural Muscles: Abs, Lower Trapezius, Neck Flexors (YWTL/ Wall AHC) Stretching Core Stability Strengthening Speed & Power Aerobic Training 2-5 times per day 2-5 times per day 3-5 minutes per day 3-5 times per day 3-5 times per day 2-3 times per day 3-5 times per week 2-3 times per week 2-3 times per week 1-2 hours daily

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