Exercises and Exercise Theory

Every year thousands of people turn to chiropractic for treatment of chronic and acute musculoskeletal disorders. They find relief I professional adjustments- but many patients require additional therapy to achieve full recovery, especially from joint injuries. Prescribed exercise helps to develop strength and endurance, and work with the adjustment to help attain full and proper healing of the injured area.

Muscles are joints’ primary stabilizer. When injury or illness interferes with muscle function, joint integrity declines. The chiropractic professional must address this interrelationship of bone and soft tissue to effectively treat musculoskeletal complaint.

A comprehensive rehabilitation program combine the chiropractor’s skill and the patient’s cooperation with exercise. A well-devised, scientifically-based exercise program can produce:
Enhance muscle performance
Decrease risk of injury
Decrease the severity of injury
Accelerated rehabilitation and return to activity.

Why Movement Helps
Before reviewing biomechanical principles of exercise, consider the effects of immobilization on musculoskeletal structures. Historically, accepted procedure was to immobilize the injured joint and to allow pain and swelling to subside. But such as course did not address the cause of that pain. nor did it offer hope for regaining maximal joint integrity.

Soft tissue follows the use disuse principle: when used, it remains strong; it weakens, Immobilized muscle atrophy at an approximate rate of 1.5 percent per day. Studies show that muscle atrophy begins within six hours of immobilization.

Detrimental effects of immobilization have also been noted in the synovial joint, connective tissue and tendon structure, which loses tensile loading capacity. Seriously irreversible damage to the articular cartilage can also occur.

In addition to soft tissue, vascular and neurological structures suffer from extended immobilization of injured joints. Significant changes in the impulse patterns of motor neurons weakening the immobilized muscle have been noted.

Adhesion formation is another risk of immobilization, causing more pain and loss of range of motion. Uncontrolled fibroblasts and scar formation make rehabilitation more difficult.

Exercise Theory
The goal of chiropractic management of musculoskeletal conditions is to develop the strength, endurance, and joint stability required for activities of daily living. Rehabilitation of soft tissue through exercise can accelerate recovery. The cornerstone of the therapeutic exercise is known as Davis’ Law, which states that the soft tissue will model according to imposed demand. This principle was demonstrated by Frost, who revealed how collagen fibers adapt to mechanical demands. He found that intermittent tension loads stimulate cells to produce additional collagen. Stearns drew a similar conclusion from his study some 50 years ago of fibroblastic activity and healing of connective tissue. He discovered that the movement was responsible for developing an orderly arrangement of fibrils. This results in a small flexible scar that facilitates recovery from musculoskeletal injury.

Types Of Exercise
One of the most important requirements for effective chiropractic treatment is knowledge of various training methods and exercise techniques. Exercise not only shortens recovery, it can help prevent injuries and reduce the risk of rein jury, as well.

With the popularity of fitness clubs and today’s heightened awareness of exercise programs. Activities applicable to chiropractic care can be categorized in three groups:
Isometric exercise is static. It produces no joint movement and affected muscle hold a fixed length. Speed and resistance is fixed.
Isotonic exercise produces joint movement. It too, utilizes fixed resistance, but speed varies.
Isokinetic exercise also involves joint movement. It is performed at a fixed speed, but resistance will vary to match the applied force.

This viable resistance means that isokinetic exercise will accommodate pain and fatigue. Patients benefit form movement and soft tissue modeling while they achieve pain-free maximal muscle loading.

Benefits Of Isokinetics
The nature of is kinetic exercise offers the greatest benefit is cases of musculoskeletal complaints. We have already seen movement encourages formation of a flexible scar. Other physiological principle of exercise demonstrate the value of isokinetics.

Velocity spectrum
Most functional activities occur at very fast contractile velocities. Walking, for example, generates movement of 233 degrees per second in the knee joint. Cross country skiing over flat terrain moves the hip 469 degrees per second Successful rehabilitation helps prepared a patient to resume activities at normal contractile velocities. The advantage of isokinetic is that it allows a patient to rehabilitate at a speed which is comparable to functional daily activities.
Crossover
Any isokinetic exercise program should involve both the affected joint and its anatomical opposite. Exercise routines should begin with the unaffected area and progress to the site of injury.
Facilitate
Joint injury disrupts normal neuron pathway to the involved muscles. The law of facilitation states that when an impulse passes through a certain set of neurons to the exclusion of others, it will traverse this path in the future. Each time the impulse follows this course, resistance in the pathway lessens.
Overflow
When patients experience pain through a part of the affected joint’s range of motion, it is unlikely they will comply with a prescribed exercise program. The overflow principle of isokinetic enable a patient to exercise without pain yet still benefit from the activity.

Clinical Protocols For Applying Isokinetics
The Thera-Ciser exercise utilize a flexible tubing to create resistance in affected muscles. Resistance builds gradually as the patient progresses through four activity phases:
PHASE I
Features short range slow-paced movements.
PHASE II
Continues short range movements but at a faster pace. This level encourages neurological reeducation for enhanced muscle tonus and facilitates collagen healing.
PHASE III
Exercises are performed at a slow pace and full range of motion to begin duplicating normal functional movements. The patient performs Phase 3 muscle contraction only on alternate days to avoid fiber deterioration.
PHASE IV
Introduces the patient to fast paced, full- range movement. Emphasis is on developing strength and endurance lost through muscle atrophy.

In Summary
Isokinetic exercise has broad application in chiropractic management of musculoskeletal disorders. It is especially well suited to conditions involving pain with range of motion. A chiropractor’s efforts to treat musculoskeletal complaints will be enhanced by instructing patients in proper joint exercises , with emphasis on isokinetic range of motion therapy.

*references can be made available upon request.