Lecture 5 - Therapeutic Exercise: pain, motor adaptations, and tissue healing

understanding of motor adaptation and motor learning principles (dosage, frequency, duration)
specific goals of intervention directed towards body structure (impairments), activity (functional limitations) and participation (disability)
use principles of OPTIMAL theory to enhance motor learning (autonomy, increased expectancies, external focus of attention)
knowledge of stages of healing/physical stress theory and incorporate appropriate stresses to maximize tissue recovery (dosage, frequency, duration)

adaptive changes within and between muscles influence the mechanical behavior of tissue

protection from further pain or injury
Good in acute phase (adaptive)
bad in long term (maladaptive)

multiple levels
locally
centrally

Exercise for pain modulation and mobility ->
retraining due to motor adaptations (motor learning) ->
Goal is to promote increased mobility and enable the brain to experience pain free movement ->
exercise prescription typically high volume deloadd to reduce tissue stress, may include global exercise ->
3 sets of 30-40 reps, as long as pain monitoring results in positive outcomes

deloaded exercise that enables arm to go overhead assisted

pulley asissted rotation
gentle elbow flexion
prone shoulder extension
assisted shoulder flexion and abduction

increase aerobic activity or work lower body segments

a set of processes associated with practice or experience leading to relatively permanent change in skilled behavior
NOT STRENGTH

High practice volume
practice conditions - task based, variable
feedback - internal or external

optimizing performance through intrinsic motivation and attention for learning
expands on what we know about motor learning
addresses motivational and attentional influences on motor behavior

increase learner autonomy
enhance expectancies for future performance success
provide an external focus of attention: the individual concentrates on the intended effect of the movement

provide control over aspects of the practice conditions
provide choice (even incidental)
use instructional language that is autonomy-supportive vs controlling

increase self efficacy (confidence)
appropriate challenge
provide positive feedback after good trials
provide social-comparative feedback
use self-modeling
encourage a growth mindset vs fixed

direct attention away from one's own body part and toward the intended effect of the movement
ehances all aspects: effectiveness, accuracy, efficiency, form
promotes automaticity
facilitates goal-action coupling
enhanced outcome with less effort

focus on knowledge of results vs peformance
ask questions that solicit active problem solving
resist concurrent feedback, it hinders learning
use hands-on as last resort

intermittent compression

intermittent tension

intermittent shear

high volume, to promote cell to cell interaction
dosing - 3 sets of 3-40
frequency - multiple times a week with PT and must be supplemented at home
need good quality of movement
progress to reduction of rest as biological healing and clinical symptoms improve

7-10 days
pain with active ROM may still have minor swelling but no increased heat
safe to move tissue

pain mediation and tissue repair
exercise may be targeting metabolic changes for pain inhibition
protect the injured structure

2-4 weeks
mobility may still be limited by pain
no pain at rest
willingness to move

tissue repair and motor learning
begin first session with 2-3 ex
week 1 up to 6 exercises
week 2 up to 10 ex
progress exercises anywhere from 8-14 if time and tolerance
vary position and environment of practice
random order and variable speed

4-6 weeks
pain free movement for the most part

tissue repair and remodeling and motor learning
resistance exercise with some assisted exercise used during relative rest and for motor planning
introduce functinal movement
motor learning: part task - full task

6 weeks - 1 year
pain free movement with relatively good control but limited tolerance to increase activity

return to activity and functional restoration
Functional tasks - perform with control and no loss of coordination
strength training - exercise muscles to fatigue
endurance training - exercise muscles to fatigue

must be painfree
must have equal action to rest
prescribed by structure and stage of healing
can use the same exercises as for reducing pain!