The Triune of Exercise
Rehabilitation
Written by Dr. James P. Cima, D.C.   
Thursday, 30 January 2003 00:00 Read : 1396 times

When treating soft tissue injuries, especially the chronic degenerative ones, you must be well versed in the Triune of Exercise. 
I’m not just talking about athletes but about patients as well.  They all suffer from some type of soft tissue injury, as well as being subluxated.  In fact, why do you think their subluxations persist?  Because nobody ever handled the underlying soft tissue injury correctly.
Please remember this: “The nervous system controls function, but the musculoskeletal system supports the nervous system allowing it to function”.  When addressing a subluxation, it would behoove you to address the soft tissue, as well, via the Triune of Exercise.
The purpose of the Triune of Exercise is to help repair and rebuild the surrounding soft tissue to compensate for the degenerative joint; and, thus, to some degree, to remodel the soft tissue, restoring normal function to that joint, reducing exacerbations and continued degeneration.  This is done through the proper conditioning of the surrounding soft tissue.

The triune consists of:

  • Progressive resistance training (weight training)
  • Stretching (flexibility conditioning)
  • Cardiovascular (“repetitive stamina conditioning”)

In order to condition soft tissue properly you must utilize this approach.  If you do not, you cannot treat soft tissue injuries effectively.

Why Stretching is Important

As you may be aware, damaged soft tissue, left untreated, causes the soft tissue to become fibrotic.  Fibrotic tissue (scar tissue) causes loss of joint mobility; thus, stretching is extremely important.

Why Cardiovascular Exercise is a Great Conditioner

We all know the importance of cardiovascular exercise for our heart, lung and circulatory tree; but, are you aware of the benefits to our stamina, or the ability to do things repetitively, which often decrease as a result of soft tissue injuries?  Whereas, previously, you could run for miles, you find it difficult to walk down the block, due to circulatory disturbance to soft tissue.
Progressive resistance exercises and cardiovascular exercises are extremely important in reducing muscular fatigue and enhancing muscular stamina and endurance.

Why Progressive Resistance (Weight Training) is an Important Conditioner

I saved the best for last. 
Muscles lose up to 30-40% of their strength within weeks of an injury and their strength continues to decline, as time goes on.  Soft tissue loses flexibility and stamina as well.  The best part of weight training is that you can accomplish all three:

  • Increased flexibility
  • Increased strength, and
  • Increased stamina

Weight Training

About 1984, I began to exercise, using weights.  At that time, weight training was gaining popularity.  I started to see professionals from all fields (tennis, golf, baseball, basketball, etc.) using a specific program that included weights to enhance their performance.  Prior to this, the mentality had been (and still is, to many people) that you never wanted to exercise with weights, because you would become “muscle bound” (whatever that means).  Also, when you stop working out with weights, all that muscle turns to fat. 
In fact, I bet half the doctors reading this article still, to some degree, believe those statements to be true.  If you think I’m exaggerating, just go to any state chiropractic convention and look at the physiques of some of the doctors attending.  Your physical appearance speaks volumes about you, as a doctor.  After all, are we not the doctors that state, “STRUCTURE GOVERNS FUNCTION”?
Some of us look like “LONDON BRIDGE”.  You want to be a super success in practice?  Start looking like the healthy specimen you are capable of being.
Your body is a billboard (like free advertisement).  Your state board should make it a prerequisite that, in order to practice chiropractic, you must understand the concept, and train with weights at least three times per week.
Do you not want this very same thing for your patients?  Well, if you are not well versed in the physiological and anatomical relationships between weight training and its effect on function via its effect on structural integrity, then you are missing a big piece of the pie.
I cannot, in this short amount of space, even begin to explain the fundamentals of weight training without doing it a grave injustice, so I won’t even go there.  Just realize that weight training, like chiropractic, has a philosophy, science and art.  It requires a great deal of understanding, on your part, to be successful using this valuable tool.

 
Flexibility (Stretching)
Guidelines to Follow When Stretching

When developing a program of stretching for your patients, use stretches that stretch every major muscle group/joint through the respective ranges of motion, and follow the rules below:

  1. Stretch in the morning, or evening, or both, depending on injuries or tight areas.  Each session should last 15-30 minutes.
  2. Stretching daily helps create a routine (like brushing your teeth) that eventually will become a habit.  In fact, I look forward to my morning stretches, which I also use as “quiet time” to get in touch with my mind and body.  By the way, the only way to gain flexibility is to stretch daily.
  3. Taking a hot shower before the stretch loosens the muscles.
  4. Never perform ballistic or bouncing, hard-type stretches that are painful.  These exercises are dangerous and can cause a lot of joint damage.
  5. Always use a comfortable firm surface; and, if there are low back or neck injuries, use a roll behind your neck and/or a roll behind your knees.
  6. Always start your stretching in the lying position, then proceed to sitting, then to kneeling, and then into your standing stretches.
  7. Always use deep, relaxed breathing when stretching.

When stretching a muscle, you must stretch as far as you can comfortably, at which point, you must focus on two things:  Breathing, and blending your mind with that muscle, with the focus on relaxing it.  When you reach the point in the stretch where the muscle starts to tighten and ache from the stretch, you use breathing and mind/muscle relaxation to gain more stretch in that muscle or joint.  Focus on deep, relaxed breathing, gaining a little more stretch on exhalation.  In other words, as you exhale, you will be able to push the stretch a little more, and then hold that position while you inhale.  Then, when you exhale, you may gain a little more, or hold that position longer.  Then, repeat the cycle one more time. 
At this point, you can hold the position for another 10-15 seconds, and then release the stretch slowly.  Your mental focus should be on consciously relaxing that muscle or joint, by visualizing the muscle relaxing. 
This process can be repeated two more times, if needed, and you will get a further stretch by the third time. 
At some point, you will notice that you hit your sticking point—you cannot stretch any further.  You may have pain or the muscle may start to cramp.  In this case, you should stop the stretch and slowly bring the muscle or joint out of the stretch.  I also recommend that you lightly massage the muscle or joint that you are working while you are stretching that muscle or joint.  Always spend more time on the tight muscle or the tighter side.

Cardiovascular Exercises

  • Walking
  • Jogging
  • Dancing
  • Swimming
  • Cycling
  • Skating
  • Aerobic classes
  • Climbing
  • Cross-country skiing
  • Rowing

Progress resistance performed one set after another with little or no rest (circuit training)

Guidelines to Follow When Creating an Aerobic Program for Your Patients

  1. Make sure that the exercise fits the patient.  Overweight patients or patients with knee injuries, etc., should not jog, play basketball, etc.
  2. Monitor and keep score of their pro-gress.  When it comes to measuring your patients’ cardiovascular performance, their pulse and respiratory rates must be determined.  This is what you should measure—not how much weight they are losing.  It is interesting to note that most people do cardiovascular exercise for weight loss, which is not the purpose when measuring cardiovascular performance.  As you condition your body properly, cardiovascular exercise will cause the weight to come off, provided you are eating right and intensifying your conditioning, using your pulse and respiratory rates as indicators.  You must be able to take the following measurements:
    · Resting heart/pulse rate.
    · Target heart/pulse rate (approximately 60-80% higher than the resting rate).
    · Resting respiratory rate.
    · Target respiratory rate (approximately 60-80% higher than the resting rate)
  3. There are three phases of cardiovascular training that patients must go through.
    · Warm-Up Phase:
    This portion takes five-to-ten minutes, as you approach your target heart rate.
    · Maximum-Effort Phase: This takes from ten-to-twenty minutes.  When achieving higher levels of conditioning, you want to intensify your routine by using methods other than time (how long you work out).  Grueling sessions lasting hours at a time, or working out countless hours during the week lead to burnout and poor results.  
      There are other ways to intensify your cardiovascular program; wind sprints are an excellent example.  This procedure is not for the beginner, but for the athlete, or someone already in good condition.  Wind sprints are performed toward the end of maximum effort when you increase your speed to the point of labored breathing, which takes focus and perseverance.  Sustain this level for as long as you can and then slow back down to your maximum-effort level.  Once you catch your breath, you repeat the sprint two or three more times.  Please note that wind sprints will take your target heart rate over 100 percent, so be careful.  For those just starting out, the goal is to nudge the target rate up over time. 
      How much time?  That depends on your age, your condition, your diet, etc.  Just continually push the envelope and reach higher target heart rates for up to 40 minutes and then you will be ready for wind sprints.
    · Cool-Down Phase:  This takes five to 10 minutes, as you slow your pace and come to the end of your routine.
  4. How often should your patient perform cardiovascular conditioning?  Three or four aerobic workouts per week are sufficient for most people.  Any more, and you are causing too much stress on the body. 
    Remember, it is not how many times or how long you exercise; it is the intensity of your exercise sessions.  And, there you have it:  An exercise program that will support and improve sports injuries, degeneration, and joint damage. TAC


Dr. James Cima has been teaching, and writing on this subject for 20 years.  Dr. Cima also teaches seminars and has created a software package for the doctors to help them assess their patients’ needs.  For more information, call toll free 1-877-627-2770 or fax 561-624-3871, or e-mail Dr. Cima at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


 
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