What is Post Rehab Training?
Post Rehab Training simply means training people who are not injured right now, but who have experienced either acute injuries in the past, are suffering from either constant or intermittent chronic pain, or find that every time they try and exercise they get hurt and have to stop. (Or some combination therein.) [DISCLAIMER: If it hurts when you work out, talk to your doctor. Please. We’re not just saying that.]
Acute injuries are injuries that have a definite cause, as in you were moving a couch and your back went pop and you couldn’t walk. The time from when that happens until the time you can move again is defined as the acute phase of an injury.
Chronic pain is pain that has no specific cause. A good example of chronic pain is waking up with a sore shoulder that seems to have never really gotten better since you slipped on the ice over a decade ago.
How long the acute phase of an injury lasts varies with several factors. Typically the scope of practice of Post Rehab Training is that we can start to work with people once they are capable of some pain free passive (you just go limp while I move you) movement of the injured joint. I also use a number of techniques to make movement less painful immediately, including massage techniques, compression, elevation, distraction, etc etc etc.
Moving: It’s good for you
One of the fundamental principles of Post Rehab Training is that, once we are out of the acute phase, the sooner we can get movement the better as long as it is pain free. The body is a dynamic system of systems and it cannot heal itself fully if it can’t move.
The sooner we can begin to move, the better the area will heal.
At this point we have two goals. One: increase the strength, mobility and stability of the joint. Two: reintegrate the joint into the body and ensure proper movement patterns.
One of the problems with the traditional approach to musculoskeletal injuries is that it fails to address the second goal. Usually the reason an injury happened in the first place was that a movement pattern had broken down, and resulted in incorrect loading of the tissues involved. Once the injury is out of the acute phase, that movement pattern needs to be improved otherwise we will see a recurrence of injury.
Simply resting, being told, “don’t do that anymore” and taking anti-inflammatories is not helpful. And in my opinion, it frankly calls into question all the student debt accumulated just so that person could dispense that advice.
Even if the injury was a result of something other than a dysfunctional pattern, because of the injury there is a detraining of movement efficacy (ability to move correctly) and that must be corrected for a complete recovery.
To illustrate this I’ll provide a practical example.
Example: Lower back pain
One of the most common issues I help people resolve is lower back pain. Initially we can perform a variety of stretches, and drills to get the lower back to relax, get some blood into the area and start healing the tissues and alleviate pain and stiffness.
Then, in order to prevent a recurrence of the injury, we start to strengthen the lower back muscles, while simultaneously decompressing the spine. Spinal compression is a big contributor to lower back pain. When the intervertebral disks become compressed, the nerves that emanate from the spine outwards get compressed as well, and this causes pain. It also interferes with the connection they provide to several internal organs, which can cause all sorts of problems with digestion and metabolism to name just two.
Core activation is also critical and needs to be assessed here to help stabilize the spine.
Once we have addressed these things, we begin to reteach movement patterns and restore the proper length tension relationships in the surrounding muscles.
A length tension relationship describes the forces produced by muscles around a joint. In the case of lower back pain, we typically have tight hip flexors and weak glutes that are causing excessive curvature in the spine leading to excessive compression.
There are several other factors that need to be addressed as well, but this isn’t the intent of the article. I’m merely illustrating the overall concept of the approach.
Treating the body and brain as a whole
Important point – the brain and the body are not merely “connected,” they are interdependent. Feedback from the body will affect neural signalling in the brain, and vice versa. This complex relationship is difficult to improve when we treat muscles and nerves in isolation because they simply don’t work like that.
Instead, it is much more effective to treat the body and brain as a whole. I hesitate to say holistically, since it’s a term that tends to get abuse and have myriad huggy feely connotations but in this case the shoe fits.
This explains why simply doing exercises that strengthen one muscle is incomplete. In the case of restoring back function to reduce pain and to injury-proof it, the only way to do that completely is to teach proper bend, squat, lunge, step up and twist patterns.
Once we do that, we begin to rehabilitate the entire body, not just the injured area.
There are so many orders of complexity in coordinating the contractions of all the muscles, the orientation and position of the joints, and the pliability of the connective tissues, that we are better off focusing on queuing correct technique in the primary movement patterns, and allowing the neuromuscular system to optimize all of those aforementioned things.
The neuromuscular system is incredibly adaptive and powerful. Defense researchers have tried to develop a robot that can emulate a simple walking pattern for decades at a cost of billions. They still haven’t fully succeeded, so I’m dubious about claims trainers/therapist make that simply strengthening the hamstrings will improve your ability to move without pain. It’s not that simple.
Luckily we are granted a simple abstraction. By teaching correct movement, the powerful neuromuscular system reintegrates with the body optimally, and takes care of all the complexity for us.
Yes, of course there are times when we need to administer stretches, or strengthening exercises for specific muscles or groups of muscles. However in the general case movement optimization is the goal. Move correctly, and pain will disappear and strength and health will return.
As mentioned earlier, the benefits of this extend far beyond the musculoskeletal system, as all systems in a body are interdependent. For example if nerve conductivity is compromised because of a misaligned spine, perhaps the stomach becomes less functional, and digestion suffers, causing weight gain, low energy or even pain.
I hope you can see that this means that restoring function and movement can have a huge impact on overall health. Furthermore if you are trying to lose fat, and get healthier, then ignoring your Post Rehabilitative needs is a huge disadvantage.
Unfortunately, the ability to address these needs is not within the skill set of most trainers. It requires specific training, and, like most things worth doing, practice.
Luckily, thanks to Fitocracy, being connected with a Post Rehabilitative Trainer is as easy as using your smart phone or laptop.
I’ve been practicing PRT for over 10 years, and have helped hundreds of in person and online clients to rebuild their health while fixing long term issues that have, in the past, prevented them from doing the things they want to do.
I hope this article has helped you to see that dealing with pain maybe common but it is not NORMAL. There is a lot you can do, and I’d love the chance to help you.
My Rookie to Rockstar program integrates Post Rehab Training, Metabolic Training and Functional Nutrition to provide a powerful One-Two-Three-Punch to knock out all the road blocks that have stymied your previous efforts to get healthy.
More importantly my passion is to share all this information with you, so you can learn and feel empowered to continue on your journey a healthy life. Hence the impetus to write this article. This is sustainable, this is realistic, this doesn’t need to suck, and you CAN do it. Thanks for taking the time to read this.
Featured image courtesy of Flickr user Emily and used under a Creative Commons license.