People often wonder why rehabilitation is a necessary part of the treatment plans here at IHS. The vast majority of the patients we see here have had one of the following issues as a main cause or contribution to their pain. 

Below, we will discuss: the purpose of rehabilitation, specific instances when rehabilitation is very helpful, the rehab progression we use at IHS, and a recent case from start to finish.

The Purpose of Rehab

According to the World Health Organization, rehabilitation is defined as “a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment”.  

“Put simply, rehabilitation helps a child, adult or older person to be as independent as possible in everyday activities and enables participation in education, work, recreation and meaningful life roles such as taking care of family.” – WHO

Physical rehabilitation is  reducing pain, preventing pain, and most importantly improving function. 

Rehab is useful for: relaxing chronically tight muscles, correcting trigger points, activating muscles that aren’t performing as they should be, returning joints to proper function, and preventing further injury. 

When is rehab helpful?

Physical rehabilitation is extremely helpful at reducing or eliminating pain, improving function, and even helps keep problems that may not be that bothersome from getting worse. The following are common reasons people present to IHS for rehabilitation and treatment and do very well. 

1. Car accidents-  As anyone who has been in a car accident knows, you can be perfectly fine one moment, and not the next. These injuries are usually referred to as whiplash type injuries and are a combination of sprains of ligaments and strains of muscles.  

These sprain/strains result from the extremely fast deceleration that happens in car accidents.  The body is often jostled back and forth at the moment of impact with micro-tears in both ligaments and muscles occurring. 

The tissue will heal, but rehab ensures it heals correctly. 

Rehab helps you heal while attaining both proper range of motion and function of the muscles to engage and protect from future injury.

2. After Giving birth – Nothing is more amazing than what the human body is able to accomplish during gestation and delivery. However, there are major muscular and  ligamentous changes that happened to the body during pregnancy. These include an increase in the movement between joints as well as a significant loss of core strength. Additionally, the third trimester often brings with it a reduction in activity as well as changes to walking, getting out of bed and many other movements. 

As pregnancy progresses, the baby essentially takes up residence in the middle of the core musculature. The pelvic floor musculature must be able to open to allow for the delivery of the baby and the front of the core often also opens a bit to give baby more room and due to functional changes. This is called a diastasis recti and is something that typically heals after delivery. Amazingly, the baby can actually help stabilize the core during pregnancy by buttressing the  lumbar spine from the inside!

However, after the baby is born it takes time for that ability to stabilize the core to come back. The pelvic floor and abdominals have to close back so that proper pressure can be generated again and mother can return to optimal function. 

This is especially important for women who have had multiple births. Lower back pain affects up to 60% of pregnant women and can progress with successive births. Getting back to proper function in between pregnancies can greatly affect stability and discomfort in the next pregnancy. 

3. Post Injury/Trauma–  This is usually referring to falls, but also applies to athletes who have contact-less injuries. Such as the basketball player who falls after a jump but nobody touched them. This is an indication of an improper movement pattern and the jump just brought it to the surface.

 Athletes get better with practice, but if the movement is not correct, then the practice can cause pain over time. Fixing the pattern restores proper movement of the body and often improves the speed and strength with which the athlete is able to perform. 

Additionally, this would include any major falls such as on ice, down stairs etc. They may seem insignificant at the time, and they may be. But, if they change how you are moving, over a few months it is possible to develop a problem, most likely on the same side. These types of pains seem to come out of nowhere, but if you had a significant fall a few months ago, that could be contributing. 

4. Chronic Stressors/ Muscular Imbalances – These account for the majority of cases in our clinic and are incredibly common. Causes of muscular imbalances from chronic stressors would include jobs that involve very repetitive tasks, unbalanced training programs, and general inactivity over time can also lead to imbalances. 

If this sounds like you, clues to look for would include pain with a particular movement that you often perform, one side or half of your body seeming or looking stronger than the other, or if you have significant differences in flexibility from side to side.

Again, most people searching for pain relief from this type of imbalance have had it for some time and it has gotten progressively worse. 

Rehab would correct the loss of symmetrical function and ideally, aim to correct as much as possible what caused it in the first place. All in order to optimize movement. 

Rehab at IHS: A Four Step Progression

All the doctors at IHS have taken extensive continuing education in both Dynamic Neuromuscular Stabilization (DNS) and Select Functional Movement Assessment (SFMA) in order to improve their ability to correctly diagnose and classify the reason for the patient’s chief complaint (usually pain), Additionally, to uncover what functional improvements need to be made to correct the issue. 

These systems are both diagnostic, in that they help uncover what is lacking, and rehabilitative. Specifically, DNS is very concerned with proper breathing and stability and SFMA has a progression of types of exercises in order to meet the patient where they are and progress them to where they need to be. This model works well for everyone, from professional athletes to retirees wanting to be able to be more active.

Interestingly, both models are based on how we learn these movements the first time as babies!  

There are a vast array of possible exercises with more created and imagined all the time. This lends itself very well to perfectly individualized care. 

Have a knee replacement and can’t perform certain exercises? We can easily work around that. We even routinely work around what equipment a patient has at home in order to make it easier to get started right away. 

The 4 step progression model increases the level of difficulty from exercises lying on the ground, to on all fours (quadruped), to kneeling exercises, and finally to standing. By breaking down the position of the exercises as well as the difficulty of what is being performed, the exercises can be tailored specifically to the patient in a way that can be repeated correctly at home. 

Treatment plans take into account a patient’s current abilities with goals consisting of what they are interested in being able to do that they cannot currently do, as well as what is necessary to get them to their goals. Not everyone needs to progress all the way through. Care is patient centered and specific. With exercises chosen that are challenging enough, but possible to perform correctly at home. 

One of the most rewarding things to watch is how quickly progress can be made once the body remembers how to use the correct musculature. It’s not just strength, or even mostly strength that we are focusing on, but the order of muscle activation and stability. Due to this, progress often moves faster than simple muscle strengthening would suggest. 

 A Recent Case

The below is a case study of a recent patient that really represents a common set of symptoms and causes. Sitting all day is a very common cause of muscular imbalance and inactivation that can cause a whole host of symptoms, including lower back pain. 

We recently had a patient, ‘John’ come in complaining of low back pain. Low back pain is a very frequent reason people seek care and rehabilitation as it is one of the top reasons people miss work and have disability in the US.  

John had a seated desk job that he had had for 20+ years and other than cycling several times a week, was fairly inactive. He reported spending around 8 hours a day seated at his desk.  On his first visit, John was evaluated and classified as having a weak or disengaged core and gluteal muscles. The main cause of this was the vast amount of time spent sitting! 

With long term sitting, the brain begins to inhibit the activity to the glutes and core, because you need them much less when seated. 

Essentially, John’s body changed over time to be really good at sitting, but not as good at other things. 

Then, when John would try to rake leaves in the yard, or do something else he didn’t do as often, his body would use less than ideal muscles to accomplish the task and back pain would result. This is because when a muscle tries to do the ‘job’ of another muscle, it is less efficient and effective, thus becoming overloaded. This chronic overloading often leads to chronic tension and pain.

John’s treatment began with breathing and exercises that ‘turned on’ his core and that he could work on at home. He progressed to gluteal exercises on the floor and then resistance was added. Next, we worked on an exercise called bird dog that begins to blend the core and gluteals so that your body has to work on stabilizing the back when lifting a leg. Prior to this, John would have essentially been using his back to lift his leg behind him. 

With diligence with his home exercises, he progressed to kneeling and standing exercises. His back pain was completely gone before he got to the kneeling exercises, however, completing the rehab through to the end ensured he was able to do more than before and that his function was complete at all levels. This will protect him from lower back pain and other pains associated with sitting too much in the future.

Additionally, John was encouraged to get a sit/stand desk so that he is not spending so much time sitting. Cycling is a great exercise, but in this case, the position while cycling is too similar to the position when seated and it did not really help ‘undo’ John’s day job. So, activities and stretches to better balance his work postures were also taught in order to empower John to help himself in the future. 

To Sum It Up

• Rehab is helpful for correcting muscular imbalances, correcting and optimizing joint function, restoring proper function,  relieving pain, and reducing the likelihood of future injury and pain.
• Rehab can be helpful in several instances, including the following: car accidents, having a baby, falls and injuries, and habitual movements or muscular imbalances.
• Rehab at IHS is a 4 step progression that works on stability and breathing in increasingly harder positions and exercises.
• ‘John’ had a successful result and you can too. Rehab is a wonderful gift you can give yourself. If any of the above sounds like you, reach out and we would love to help!

Content provided by Dr. Elizabeth Bouse