A recent interaction with a client saw me fending off a barrage of frustration at a physiotherapist who was giving exercises for lumbar disc bulge rehabilitation. The client was frustrated by the tiny exercises that were being given and the ‘turtle like’ rate of progression in which exercises were coming forward. This person is used to training hard - doing work and sweating it up each week. He was sitting there wondering why on earth he was getting these ‘…ridiculous exercises, which didn’t feel like I was contracting any particular muscle at all’.
In any rehabilitation program for a client there is a cycle of progression.
RELEASE – POSTURAL REINFORCEMENT – ACTIVATION – STRENGTH
The release and postural reinforcement is something that as a Remedial Therapist I take control of. Ensuring the soft tissues and even the skeletal structure are in the most advantageous position to enable safe and efficient movement. The ‘activation’ stage is the realm of actually doing exercises and key movements to ensure that muscles work ‘sequentially’ and as a group, to perform safe and efficient movement. This is also where a lot of patients fall down because they ‘don‘t do their homework’ These all important exercises that a patient has to do to contribute to their own recovery are a vital part of the program to recovery and pain free movement.
Often with ACTIVATION it is a case of doing the minor and tiny exercises that ‘turn a muscle on’ so that they are active and ready to perform their role in a large movement. Often these are the smaller ‘stabiliser’ muscles. They don’t require large motor movements but moreso, small range of motion exercises that are specifically aimed at small contractions of a muscle preparing them. Their job is providing the stable platform that makes movement efficient not, moving joints through space.
Like a car engine, sometimes you have to clean out the spark plugs to make an engine start smoothly and with ease. So to with activation exercises. It’s about getting these smaller muscles to be fired up and ready to go so that they are not over-ridden by the big power muscles. Like the giants in a Lord of the Rings battle, the larger power movers shouldn’t come into play until the 2nd or 3rd line of attack, the smaller muscles need attention and the chance to be conditioned and ‘trained’ too.
Often with the smaller activation exercises, there isn’t a huge amount of movement, contraction, performance or even fatigue involved when ‘training’ them up. It’s more about getting them to ‘fire’. Waking them up if you like so that they are primed and ready to go before the big beheamouths take over. Usually these exercises should be performed before activity, such as in the warm up phase before a run – or perhaps on the side of the court before a game. You don’t see a soccer player running straight onto the pitch from the sub bench, they are warming up, getting active on the side lines before running on.
Often the activation phase is about conditioning the smaller muscles. Focussing on specific muscles and ensuring you can feel when they are contracting and noting when they are tighter. A baseball pitcher needs his shoulder to be stable, hence small lateral rotation of the shoulder is vital so that he has a solid base from which to swing his arm. Even a runner sometimes needs to fire up his peroneals or dorsi flexors so that the kilometers of track he is about to run does not fall solely on his main ankle movers.
In my clients case, it was the case of ‘switching on’ his external obliques’. Those core muscles which we hear so much about. Doing the small exercises and truly feeling when they are ‘truthfully’ activating in the right muscles is sometimes just as important as doing the big situp. This is training your muscles to work ‘as a team’ so that the impact doesn’t fall to one large muscle.
Everyone needs their team of minions to make things happen!
Spending time on these minor muscle groups, whilst frustrating and seemingly ‘dull’ should not be confused with ineffective or pointless activity. Sometimes you need to spend extra time focusing on the smaller details and ensuring they are getting attention to maximize the larger goal or in this case – movement.
The rehabilitation phase from injury is frustrating by nature. It’s slow – it’s deliberate – it’s specific. But it’s not minor. We have to ‘re-learn’ how to move the body and to make sure that it moves efficiently to avoid injury. Sometimes that requires the quiet and relatively meditative approach to ‘feeling’ a movement or an action and really focusing on what is active first. As we have discussed in other articles here, ‘sequential activation’ is primary to ensure you have a stable base.
“If your butt muscles ain’t switched on, no matter how powerful your legs are, you ain’t getting up that hill”
So if you can’t feel that those exercises are working or ‘doing anything’ maybe you need to revisit the instructions and ensure that you are feeling what is happening and getting it right. Don’t discard it. Perhaps you need to do more of that type of work so that can begin to ‘feel’ those smaller muscles being active.
It’s all part of the bigger picture.