Rehabilitation


Inflammation Management - An Update
Rehabilitation
Written by Dr. Mitch Mally   
Tuesday, 14 December 2004 23:16

A cascade of physiological, biomechanical and biochemical events complicate Acute and Repetitive Injuries. Musculoskeletal pain and range of motion is affected by biomechanical aberration, joint dysfunction, segmental hyper/hypo-mobility and the result of several pathways and stimuli. However, the inflammatory response may be treated anecdotally by ice, compression and elevation. Allopathic recommendations often include anti-inflammatory medication with significant side effects (consumed like candy), cortisone (with lidocaine or marcaine) injections and other more aggressive medicinal aids (nerve block, etc.) are commonly prescribed and administered for patients refractory to care.

Enzymes to the rescue

I recall numerous childhood athletic injuries for which my late doctor, L. C. Winnick, MD, would prescribe ice, elastic bandage and Ananase. Years later, I learned that ananacea, in Latin, translates to pineapple. The effective proteo-lytic enzyme found in the stem of the Hawaiian fruit is otherwise known as bromelain (an enzyme known to help modulate bradykinin activity, reduce excessive fibrin deposition, inhibit pro-inflammatory cytokines and help soft tissue damage). Other common, extremely beneficial enzymes, such as papain and trypsin when combined, are very effective for acute inflammation. However, the body must produce anti-enzymes  in order for them to be adequately processed and, as such, after prolonged exposure to high levels of enzymes, the body can no longer produce the required anti-enzymes and build-up occurs.

NOTE:  Extended use of these powerful and effective enzymes for acute inflammation is NOT recommended, as the effects can lead to long term complications.1

Natural COX-inhibitors

Prostaglandins, the hormone-like substances responsible for inflammation, are formed from arachadonic acid. The first step in their formation is catalyzed by the enzyme cyclo-oxygenase, or COX. Turmeric, ginger and boswellia extract help inhibit the production of COX. Excessive tissue oxidation can also lead to inflammation related pain. Rosemary extract and a lemon bioflavonoid complex, both powerful antioxidants, help mitigate this inflammatory factor. Bromelain derived from pineapple (ananas bracteur, ananas cosmosus) contains, among other components, various closely related proteases, demonstrating, in vitro and in vivo, anti-edematous, anti-inflammatory, anti-thrombotic and fibrinolytic activities.2

The 1-2 punch

Additional anti-inflammatory support is maximized when coupled with turmeric (inhibits production of leukotrienes), ginger (limits lipoxygenase production), citrus bioflavonoid, rosemary and boswellia. The powerful combination of proteolytic enzymes for acute tissue trauma and subsequent soft tissue de-flaming support, previously noted, has proven cost effective and efficacious as well. This 1-2 punch enhances the acute and chronic recovery process and affords the patient rapid, safe and natural relief of pain due to inflammation. Patients with chronic inflammation and those in the rehabilitation phase of care require a maintenance formula to prevent the post-acute injured tissue from becoming re-inflamed.1

Conclusions

Inflammation is becoming well recognized as the cause of many health problems/conditions and not solely the result. As cause and effect practitioners, we chiropractors pride ourselves on RESULTS. Whether your belief is right- or left-wing, pain management is an integral part of patient care and the most common reason for portal-of-entry in health care today.

This anti-inflammatory protocol is extremely effective in supporting the chiropractic adjustment, as muscles and joints that remain inflamed retard the natural healing process. As you know, patient history clearly demonstrates that patient’s recalcitrant to rapid pain relief will seek alternative pain management. Let the buck (patient) stop here, at your office!

References

1.  Seaman DC, David, Clinical Nutrition, 1st Edition, NutrAnalysis Inc.)
2.  Bucci, L R. Nutrition Applied to Injury Rehabilitation and Sports Medicine

For more product and seminar information, e-mail Dr. Mally at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
Achilles Tendon Rehab Procedures
Rehabilitation
Written by Kim D. Christensen, D.C., C.C.S.P., D.A.C.R.B.   
Sunday, 14 November 2004 22:53

Most injuries of the Achilles tendon are not due to a recent acute injury; they have actually developed gradually, over a period of weeks or months.  These are “overuse” or “misuse” conditions, and are caused by excessive and/or repetitive motion, often with poor biomechanics.  The end result is a microtrauma injury—the body is unable to keep up with the repair and re-strengthening needs, so the tissue begins to fail and becomes symptomatic.  If it is not very painful (or when the pain is eliminated by pain-killing drugs), continued stress can eventually lead to complete failure, with a resulting acute tear of the tendon.

The Achilles tendon insertion on the calcaneus is medial to the axis of the subtalar joint, making the calf muscles the most powerful supinators of the subtalar joint.1 Therefore, when excessive pronation occurs, eventually the tendon undergoes overuse degeneration and inflammation.  Clement, et al., described how “pronation generates an obligatory internal tibial rotation, which tends to draw the Achilles tendon medially.  Through slow motion, high-speed cinematography, we have seen that pronation produces a whipping action or bowstring effect in the Achilles tendon.  This whipping action, when exaggerated, may contribute to microtears in the tendon, particularly in its medial aspect, and initiate an inflammatory response.”2 These investigators believe that the control of functional overpronation with corrective orthotic devices is a necessary treatment for most patients with Achilles tendinosis.

Impaired circulation may be a contributing factor to Achilles tendon overuse injuries, especially with tendon tears.  The same researchers speculate that “in individuals who overpronate, the conflicting internal and external rotatory forces imparted to the tibia by simultaneous pronation and knee extension may blanch or wring out vessels in the tendon and peritendon, causing vascular impairment and subsequent degenerative changes in the Achilles tendon.”2 This “region of relative avascularity” extends from 2 to 6 cm above the insertion into the calcaneus, and is a common site of rupture of the Achilles tendon.  This makes it especially important to ensure good blood flow during the healing of this condition. 

The New Paradigm for Care

It’s not surprising that abnormal biomechanics of the foot and ankle can cause problems with the largest tendon in the leg.  Symptoms are usually described as diffuse pain in or around the back of the ankle (from the calf to the heel).  The pain is aggravated by activity, especially uphill running or climbing stairs, and relieved somewhat by wearing higher-heeled shoes or boots.  Palpation will find a tender thickening of the peritendon, and there may be crepitus during plantar and dorsiflexion.  Often, a recent increase in activity levels (such as more stair-climbing) or a change in footwear is reported by the patient.

Macroscopically, overused Achilles tendon tissues examined at surgery are dull, slightly brown, and soft, in comparison to normal tendon tissue, which is white, glistening, and firm.3  There is a loss of collagen continuity and an increase in ground substance and cellularity, which is due to fibroblasts and myofibroblasts, and not inflammatory cells.4  This is the reason that anti-inflammatory strategies (such as NSAID’s, drugs and corticosteroid injections) are not indicated for these conditions, and actually may interfere with tendon repair.5  We now know that the condition we usually have described as “tendinitis” is actually better understood as “tendinosis,” and is not due to inflammation, but an underlying degeneration of collagen tissues in response to mechanical overuse.6  This “new paradigm” will help to guide our management of all tendon problems, and provide more effective rehabilitation for Achilles tendons.

Rehab Procedures

When an injury is acute, an initial period of relative rest is needed.  Occasionally, the weakened tissues will tear through, resulting in a ruptured Achilles tendon.  This may require surgical repair and a period of rest before rehabilitation can begin.  During this period, though, exercise of the opposite ankle should be encouraged.  Vigorous exercise of the uninvolved contralateral ankle muscles produces a neurological stimulus in the injured muscles (called the “cross-over effect”), and helps to prevent atrophy.7  Initial treatment should also include heel lifts to reduce the strain on the Achilles tendon, and cross-fiber friction to improve circulation.  Complete return to function will then require attention to range of motion, functional strength, and orthotic support.

Range of motion.  In addition to appropriate foot and ankle adjustments, stretching of the tight and shortened gastrocnemius/soleus muscle complex is a necessary part of Achilles tendon rehabilitation.  Gentle stretching should be started early, putting a linear stress on the tendons and stimulating connective tissue repair.  The standard is the “runner’s stretch,” performed against a wall.  Patients with tightness and pronation will often allow the foot to flare outward while stretching, which forces the medial arch to drop.  This tendency must be carefully corrected, with the foot positioned straight ahead and the medial arch kept elevated.8 Even better, is to perform the stretches with corrective orthotics in place.

Functional strength.  Isotonic strengthening exercises that focus on the eccentric (negative) component have been shown to improve the healing of tendons and accelerate return to sports participation.9 These exercises are progressed to closed-chain, loaded eccentric exercises, in order to stimulate collagen fiber reorientation and strengthening.10  The patient is instructed to stand on the edge of a stair, do a toe raise up, then drop the involved heel as far as possible, returning by pushing back up with the uninvolved leg.

Conclusion

Achilles tendon injuries can be successfully rehabilitated conservatively.  Steroid injections and casting are seldom used these days.  Once the local inflammation has been controlled, improved blood flow to the region of relative avascularity is necessary.  Correct stretching and strengthening exercises can be demonstrated and monitored in the office. 

Kim Christensen DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Washington.  He is a popular speaker, and participates as a team physician and consultant to high school and university athletic programs.  Dr. Christensen is currently a postgraduate faculty member of numerous chiropractic colleges and is the past-president of the American Chiropractic Association (ACA) Rehab Council.

He is a “Certified Strength and Conditioning Specialist,” certified by the National Strength and Conditioning Association.  Dr. Christensen is the author of numerous publications and texts on musculoskeletal rehabilitation and nutrition.  He can be  reached at PeaceHealth Hospital by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References:

1. Subotnick SI. Sports Medicine of the Lower Extremity. New York: Churchill Livingstone; 1989. 475.
2. Clement DB et al. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 1984; 12:179-184.
3. Astrom M, Rausing A. Chronic achilles tendinopathy: survey of surgical and histopathologic findings. Clin Orthop 1995; 316:151-164.
4. Khan KM et al. Histopathology of common tendinopathies: update and implications for clinical management. Sports Med 1999; 27:393-408.
5. Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc 1998; 30:1183-1190.
6.  Khan KM et al. Overuse tendinosis, not tendinitis. Part 1: a new paradigm for a difficult clinical problem. Phys Sportsmed 2000; 28:38-48.
7. Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders. 2nd ed. Philadelphia: JB Lippincott; 1990. 334.
8.  Ninos J. Chain reaction: a tight gastroc-soleus group. Strength Cond J 2001; 23:60-61.
9. Niesen-Vertommen Sl et al. The effect of eccentric versus concentric exercise in the management of Achilles tendinitis. Clin J Sport Med 1992; 2:109-113.
10.Alfredson H et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998; 26:360-366.

 
Rehab of CAD Injury
Rehabilitation
Written by Kim D. Christensen, D.C., C.C.S.P., D.A.C.R.B.   
Tuesday, 14 September 2004 22:10

People who present with whiplash injuries (Cervical Acceleration-Deacceleration) often do not respond completely to care.  In fact, persisting symptoms are common in this group.1  One review found that “between 14% and 42% of patients with whiplash injuries have chronic neck pain and that approximately 10% of this group experience constant, severe pain.”2  In fact, there is over 50 years of literature demonstrating this fact.

Doctors of chiropractic who incorporate rehab exercises can provide “multimodal care” to whiplash patients, in order to minimize the risk of long-term problems.  This has been defined in the previously referenced study as care that applies manual procedures (spinal manipulation, mobilization, and massage), along with physical training to improve muscle strength and endurance, including sport activities.  Multimodal care has been found to be effective in preventing many of the persisting symptoms of “late whiplash syndrome.”2,3

Injury Biomechanics

Recent research has defined the mechanism of this spinal injury more accurately.  Panjabi and his co-workers have clarified the intervertebral kinematics and quantified the functional injuries to the soft tissues.4  Dr. Panjabi’s group found a much more complex injury mechanism than cervical hyperflexion/hyperextension.  They documented very clearly that, initially, the spine translates (a straight-line motion), with practically no head extension.  They described an “S-shaped curve resulting in local extension of the lower cervical spine with upper cervical spine flexion.”

This helps to explain the constellation of injuries we see in patients who have been struck from behind.  In fact, even at low speeds, the nervous system is “jolted” during this translation movement.  A jolt is “a sudden, unexpected, forced stretching and/or reflex contraction of skeletal muscle induced by a barrage of impulses from receptors in muscle spindles and joint capsules.”5  Active rehabilitation takes this biomechanical and neurological information into account when planning a rehabilitation program.

Active Whiplash Rehabilitation

Many studies using various exercise approaches have demonstrated the benefits of the active approach.6  Traditionally, patients are told to spend much of their exercise sessions on the stretching of tight muscles.  Unfortunately, stretching exercises, whether at home or in the clinic, may demonstrate little or questionable therapeutic value.7  Dynamic exercise with progressive resistance to stimulate the muscles and the nerves is a useful form of active exercise.8

A rational approach to auto-related CAD injury is to give consideration to the following:9

· Range of active motion of the injured spinal regions
· Strength of the related musculature
· Postural control and balance of opposing soft tissues
· General muscular power (for daily activities)
· General aerobic fitness and endurance.

Loss of Support Strength

When injured, the soft tissues of the neck no longer provide adequate support for the movements and weight of the head (12 to 15 pounds).  Graduated resistance exercise is an efficient method to progressively stimulate these important muscles to strengthen and return to full function.  During isotonic exercising, the joints move (stimulating the mechanoreceptors), and the opposing muscles relax through reciprocal inhibition.

Posture and Movement Abnormalities

Patients with a history of neck trauma often have multiple, significant limitations in their ranges of cervical motion, in comparison to those with no such history.10  Whiplash patients also have problems with proper re-positioning of their necks.11  Now that we understand the mechanism of the injury better, it’s not surprising that many whiplash patients demonstrate an obvious Anterior Translation postural imbalance.This posture is secondary to the damaging “S-curve” motion that injured the lower and upper spinal regions in very different vectors.

Once in the forward head posture, a constant strain develops in the muscles of the neck and especially the upper back because of the forward leverage of the heavy head.  Without correction, this posture may develop into a chronic myofascitis in the muscles of the upper back and shoulder girdles.  If left untreated, the patient is likely to develop a permanent limitation that affects many activities of daily living.  Initially, the patient can perform a series of active exercises to slowly stimulate the corrective musculature as demonstrated in Figure 1 thru 6 (Outcomes Assessment 2004 available thru FCER). An effective exercise to correct this postural imbalance is the Posterior Translation exercise performed against isotonic resistance in a position of function such as the Necksys System.

Conclusion

An appropriate and progressive rehab program should be initiated early in the care of patients with whiplash-type injuries.  Dynamic rehab techniques for the cervical region that don’t require expensive equipment or great time commitments are easily implemented.  A closely monitored home exercise program allows the doctor of chiropractic to provide cost-efficient, yet very effective, rehabilitation care.

Kim Christensen DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Washington.  He is a popular speaker, and participates as a team physician and consultant to high school and university athletic programs.  Dr. Christensen is currently a postgraduate faculty member of numerous chiropractic colleges and is the past-president of the American Chiropractic Association (ACA) Rehab Council.

He is a “Certified Strength and Conditioning Specialist,” certified by the National Strength and Conditioning Association.  Dr. Christensen is the author of numerous publications and texts on musculoskeletal rehabilitation and nutrition.  He can be  reached at PeaceHealth Hospital by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

1. Hagstrom Y, Carlsson RTP. Prolonged functional impairments after whiplash injury. Scand J Rehab Med 1996; 28:139-146.

2. Vendrig AA, van Akkerveeken PF, McWhorter KR. Results of a multimodal treatment program for patients with chronic symptoms after a whiplash injury of the neck. Spine 2000; 25:238-244.

3. Provinciali L, Baroni M, Illuminati L, Ceravola MG. Multimodal treatment to prevent the late whiplash syndrome. Scand J Rehab Med 1996; 28:105-111.

4. Grauer JN, Panjabi MM, Cholewicki J et al. Whiplash produces an S-shaped curvature of the neck with hyperextension at lower levels. Spine 1997; 22:2489-2494.

6. Jordan A, Ostergaard K. Rehabilitation of neck/shoulder patients in primary health care clinics. J Manip Physiol Ther 1996; 19:32-35.

7. Wilkinson A. Stretching the truth: a review of the literature on muscle stretching. Aust J Physiother 1992; 38:283-291.

8. Berg HE, Berggren G, Tesch PA. Dynamic neck strength training: effect on pain and function. Arch Phys Med Rehabil 1994; 75:661-665.

9. Ameis A. Cervical whiplash: considerations in the rehabilitation of cervical myofascial injury. Can Fam Phys 1986; 32:1871-1877.

10. Osterbauer PJ, Long K, Ribaudo TA et al. Three-dimensional head kinematics and cervical range of motion in the diagnosis of patients with neck trauma. J Manip Physiol Ther 1996; 19:231-237.

11. Heikkila H, Astrom PG. Cervicocephalic kinesthetic sensibility in patients with whiplash injury. Scand J Rehab Med 1996; 28:133-138.

 
Avoiding Rehab Overload - The Variables
Rehabilitation
Written by Kim D. Christensen, D.C., C.C.S.P., D.A.C.R.B.   
Thursday, 08 July 2004 21:52

One of the underlying principles in physical rehabilitation is that the body responds positively to the increased stresses placed upon it.  This is the whole reason for asking muscles to lift more weight, for asking tendons to pull more tension, and for asking joints to undergo more movement.  We have a mechanism for developing and improving our physical capabilities when we place increased, yet controlled, stresses on our bodies.  On the other hand, increased physical stress is often the cause of symptomatic conditions and physical breakdown.  What is the difference?  Actually, several have been identified.

Progressive Overload

Gradual and paced overloading of res-ponsive tissues is the essential principle that underlies the benefits of exercise training.  Benefits accrue as the normal recuperative processes of the body respond and improve in function; this includes more strength, better flexibility, increased endurance, and improved coordination.  Our goal is to stimulate these beneficial improvements, while avoiding any excessive strain on the involved tissues.  Proper instruction, continued monitoring, and specific corrections are necessary factors preventing overload injuries.

There are three categories of exercise errors that indicate excessive loading of involved tissues.  By paying attention to our patients as they perform their exercises, we can identify these problems early on, and make appropriate recommendations.  Most problems with exercises are associated with a “loss of form.”1  This somewhat nebulous problem can be defined as consisting of three problems, all of which are easily identified by a doctor of chiropractic.  These include problems with posture, alignment, and range of motion.

Posture.  Be on the lookout for abnormal or imbalanced postures during exercising.  Whether the patient is strengthening, stretching, or walking, hyperextensions and lateral shifts indicate an overload situation.  This is easily seen during cervical training, when patients strain and push their heads forward, instead of maintaining a balanced alignment throughout their exercise.

Alignment.  The more subtle deviation of misalignment during exercising relates primarily to the extremities.  This can be especially noticed in the feet (toe-out), ankles (excessive pronation), and knees (knock-knees).  These are all indicators that additional exercising in these conditions will likely bring about a recurrence of symptoms, rather than improvement.  Addressing the align-ments and asymmetries is paramount for progress, and may require custom-made orthotics.

Range of Motion.  Any limitation in movement range during an exercise should prompt a search for the underlying cause.  This may be a reasonable self-protective response due to recent injury, or (more commonly) an inappropriate fear response.  It is also possible that the patient is placing excessive loads on sensitive tissues that are incapable of handling that amount of stress in their current state.

Rehab Solutions

Excessive loading, whether of resistance, flexibility, endurance, or proprioceptive exercises, is never helpful, and can be counter-productive.  Five solutions for this all start with the letter “R”:  Rest, Range, Rate, Resistance, and Repetitions.2

Rest.  By increasing the rest period between exercises, or between sets, we allow the body to recharge and to better handle the overload.  This is often the simplest of the solutions, as sufficient rest is frequently all that’s needed to avoid rehab overload.

Range.  Controlling the range of an exercise or a stretch may be needed, especially in the initial phases of rehab.  Particularly after an injury, connective tissues may be easily aggravated by forcing too much range.  This is where the body can often let us know when we have gone too far, since it will give us a pain message.  Initially, we should recommend that exercises be performed only within a pain-free range of motion.

Rate.  Slowing down the pace of an exercise and incorporating a relaxed breathing cycle will often reduce exercise stress significantly.  In fact, slow and controlled exercising stimulates more neurologic control and re-training without overstressing tissues.

Resistance.  Whether using exercise bands, weights, or machines, careful control of the amount of resistance is important.  Isotonic strengthening exercises that focus on the eccentric (negative) component have been shown to improve the healing of tendons and accelerate return to sports participation.3  However, excessive resistance can quickly produce the problems in posture, alignment, and range of motion described above, resulting in a poor response to care.

Repetitions.  And, finally, one of the easiest ways we can overload our patients is to recommend too many repetitions of too many exercises.  It is far better that a few repetitions of a few exercises be done regularly and consistently, and be interspersed with sufficient rest.

When we keep our eyes peeled for the three types of  “loss of form”, and then carefully control the five “R’s” of rehab training, we can avoid exercise overload and ensure a smooth response to chiropractic rehabilitation training.

Kim Christensen DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Washington.  He is a popular speaker, and participates as a team physician and consultant to high school and university athletic programs.  Dr. Christensen is currently a postgraduate faculty member of numerous chiropractic colleges and is the past-president of the American Chiropractic Association (ACA) Rehab Council.

He is a “Certified Strength and Conditioning Specialist,” certified by the National Strength and Conditioning Association.  Dr. Christensen is the author of numerous publications and texts on musculoskeletal rehabilitation and nutrition.  He can be  reached at PeaceHealth Hospital by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

1. Mullineaux M. Strength conditioning: developing your teaching technique. Strength Cond J 2001; 23:17-19.
2. Mullineaux M, Rowe L. Manipulating training variables for safety and effectiveness. Strength Cond J 2003; 25:33-36.
3. Niesen-Vertommen Sl, et al. The effect of eccentric versus concentric exercise in the management of Achilles tendinitis. Clin J Sport Med 1992; 2:109-113.

 
Joint Rehab and Exercise Tubing
Rehabilitation
Written by Kim D. Christensen, D.C., C.C.S.P., D.A.C.R.B.   
Tuesday, 08 June 2004 20:35

Current research describes the advantage of early, progressive rehabilitation exercise for many types of joint conditions.1-6  These benefits include: restoration of range of motion; decreased pain and swelling; decreased neural inhibition; quicker return of muscle function; and improved performance in sports and all daily activities.  Some studies even speculate that early rehabilitation programs may reduce the number of joint re-injuries.7-9

Contemporary concepts in joint rehabilitation emphasize functional activities and re-training of normal loading and movement patterns.  It is especially important to regain full neurological coordination of the surrounding muscles and connective tissues, because that is the true source of joint stability.  An important component in addressing these needs can be the frequent use of exercise tubing.

The Values of Functional Rehab and Elastic Tubing

The proprioceptive input from receptors in the muscles, connective tissues, and joint capsules differs when going from standing to lying down.  That is why it is so important to bring joint rehab exercises closer to real-life positions, and it explains why patients can progress much more quickly when they are instructed to exercise in a functional position.

Exercises done on the floor, on a weight bench, or constrained by a machine may not train muscles and joints to function optimally during usual daily or sports activities.  The neurological patterns that are developed on the floor or in a pool are considered preliminary to the joint function during upright demands.  Learning new skills and movement habits in a machine doesn’t always translate to better functioning during regular, independent activities, or improved sports performance.  Some of the time patients spend on open chain exercises for their lower extremities may be unnecessary.  In addition, it’s expensive to get patients into a facility with machines, or a pool to exercise.

Elastic tubing allows patients to exercise in a weight-bearing, functional position that has been shown to be both effective and safe.3  It has the additional benefit of being easier for most patients.  In addition to being more focused and practical, upright exercising trains and strengthens the joints to perform better in everyday activities. 

  • Resistance Variation: Elastic tubing provides a unique form of exercise.  The actual amount of resistance varies significantly with the amount of stretch applied to the tubing.10  This attribute is used most effectively by initiating the rehab program with some slack in the tubing, thereby ensuring relatively low resistance.  As the patient improves, the exercise is performed with less slack, increasing the resistance gradually and safely.  Eventually, the exercise effort progresses to starting with some “pre-stretch,” in order to stimulate and activate a more widespread neurological response to the exercise movement.  In this way, most patients are able to advance through their entire joint rehab program with just one exercise tubing design, rather than having to purchase several different levels. When provided to a patient, the exercise tubing generally needs to be accompanied by a strap device and/or handles, along with an illustrated, descriptive exercise booklet.  It should also be packaged with a system for temporary, but dependable, attachment to a door or wall (such as straps or clips).  Even with these additional necessary items, exercise tubing is both lightweight and inexpensive.  It is easily carried on business and vacation trips to provide continuous rehab.
  • Aditional Advantages: Exercise tubing is also very non-threatening, and has been used extensively in home-based exercise programs for older adults.11  Since setup is easy to learn, and requires little manual dexterity, it can be used by patients with no gym experience.12  An additional benefit is being able to customize sports equipment with elastic tubing to provide very sport-specific joint rehab.  Exercise tubing is commonly used with tennis racquets and golf clubs to enhance performance and prevent injury.13

Early Involvement for Best Results

Appropriate and progressive rehab programs should be started early in the treatment of patients with joint conditions—both acute and chronic.  Retraining programs using simple, isotonic resistance techniques are readily available, none of which require expensive equipment or great time commitments.  A closely monitored home exercise program using exercise tubing is recommended, since this allows the doctor of chiropractic to provide cost-efficient, effective, and specific rehabilitative care. TAC

Kim Christensen DC, DACRB, CCSP, CSCS, directs the Chiropractic Rehab & Wellness program at PeaceHealth Hospital in Longview, Washington.  He is a popular speaker, and participates as a team physician and consultant to high school and university athletic programs.  Dr. Christensen is currently a postgraduate faculty member of numerous chiropractic colleges and is the past-president of the American Chiropractic Association (ACA) Rehab Council.

He is a “Certified Strength and Conditioning Specialist,” certified by the National Strength and Conditioning Association.  Dr. Christensen is the author of numerous publications and texts on musculoskeletal rehabilitation and nutrition.  He can be reached at PeaceHealth Hospital by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

  1. Lill H, Korner J, Rose T, Hepp P et al. Fracture-dislocations of the elbow joint—strategy for treatment and results. Arch Orthop Trauma Surg 2001; 121(1-2):31-37.
  2. Carpenter DM, Nelson BW. Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exerc 1999; 31(1):18-24.
  3. Glasoe WM, Allen MK, Awtry BF, Yack HJ. Weight-bearing immobilization and early exercise treatment following a grade II lateral ankle sprain. J Orthop Sports Phys Ther 1999; 29(7):394-399.
  4. Shrader JA. Nonsurgical management of the foot and ankle affected by rheumatoid arthritis. J Orthop Sports Phys Ther 1999; 29(12):703-717.
  5. Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains. Am Fam Physician 2001; 63(1):93-104.
  6. Lynch SA, Renstrom PA. Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment. Sports Med 1999; 27(1):61-71.
  7. Barkler EH, Magnusson SP, Becher K, Bieler T, et al. The effect of supervised rehabilitation on ankle joint function and the risk of recurrence after acute ankle distorsion. Ugeskr Laeger 2001; 163(23):3223-3226.
  8. Holme E, Magnusson SP, Becher K, Bieler T, et al. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports 1999; 9(2):104-109.
  9. Cleeman E, Flatow EL. Shoulder dislocations in the young patient. Orthop Clin North Am 2000; 31(2):217-229.
  10. Hughes CJ, Hurd K, Jones A, Sprigle S. Resistance properties of tubing during shoulder abduction exercise. J Orthop Sports Phys Ther 1999; 29:413-420.
  11. Mikesky AE, Topp R, Wigglesworth JK, Harsha DM, et al. Efficacy of a home-based training program for older adults using elastic tubing. Eur J Appl Physiol Occup Physiol 1994; 69(4):316-320.
  12. Skelton DA, Young A, Grieg CA, Malbut KE. Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. J Am Geriatr Soc 1995; 43:1081-1087.
  13. Lindsay DM, Horton JF, Vandervoort AA. A review of injury characteristics, aging factors and prevention programmes for the older golfer. Sports Med 2000; 30:89-103.
 
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