What’s Your Major Mal-Function?
Ali Othman, CPT
Our ability to successfully perform daily activities is paramount to living a vibrant and happy life. Having trouble with any activity you perform regularly can add stress and anxiety to your day resulting in a diminished quality of life. Perhaps you suffered an injury from which you have not been able to fully recover; or maybe you’ve noticed that as you age activities which were once simple and routine have become difficult and uncomfortable. Functional training can help you address these issues by focusing on the specific movements or motions which have become troublesome, and retraining your body to function properly.
The roots of functional training originated in rehabilitation settings, with physical therapists intervening after an incident that resulted in a dysfunction in ones activities of daily life. Physical therapists work to correct the deficiency by reorienting the body to move as it once did without pain or discomfort. This is done with repetition and progression, using motions that mimic the original movement as closely as possible and progressively increase in intensity using weights or resistance. The continuous repetition trains the mind to more effortlessly move the body as it once did, and the progressive resistance strengthens the muscles to make the movement less painful. As functional training gained popularity, it spread to other segments of the population such as a baseball player trying to correct his swing, a doctor attempting to correct the slumped posture of a child, and women preparing for pregnancy.
Let’s look deeper into using functional training techniques as a method of rehabilitation for both stroke survivors and post-surgical patients. Following these, we’ll look at a lesser known group who can use similar techniques to serve a different function. With proper preemptive and post-natal care, pregnant woman can prepare their bodies for delivery using functional techniques, and may even be able to reduce the amount of pain suffered during and after childbirth. This demographic cannot always handle full-on strength or agility training, so an exercise regimen of functional training is often an ideal way to help manage and overcome issues brought on during and after pregnancy. In order to best explain the purpose of functional training, we will concentrate on these three demographics and explore the possible benefits of its use.
A stroke occurs when there is an interruption of blood supply to the brain. Nowadays more people are surviving strokes than in the past; and stroke survivors generally have long roads to recovery. Among an array of other complications, loss of muscle movement at some level is extremely common. Stroke survivors often require physical therapy to regain the motor function necessary to perform simple activities like eating, walking, and dressing themselves. Stroke survivors are ideal candidates for employing functional training as a part of their physical therapy. Let’s take a look at how this training can be used to help a stroke survivor regain the motor control required to walk unassisted.
Walking can be broken down into what are known as Gait Cycles. The gait cycle involves all of the events from the point where one foot is in contact with the ground and that same foot raises, moves forward, and returns to contact the ground again. The two main phases of the gait cycle are stance and swing. In order to successfully propel forward during the swing phase, the heel comes off the ground, the hip, knee, and ankle are flexed; the toes come off the ground; the lower leg is swung forward; and the heel returns to the ground followed by the toes, resulting in a firmly planted foot. It’s hard to imagine that something as unassuming as walking contains so many moving parts; but this simple activity is extremely challenging to master as a child and just as difficult to remaster for stroke survivors.
Walking can be successfully retrained in many stroke survivors by physical therapists in several ways, one of which involves the use of functional training. The initial swing, or the part of the gait cycle where the hip, knee, and ankle are flexed requires the use of many muscles in the legs and the body’s core. It also requires a small degree of balance, which is often lost after a stroke. For this reason it can be one of the most difficult parts of learning to walk, and an ideal candidate for using functionally specific training as a teaching tool.
Core strength and stability are critical parts of the initial swing, but it’s important to reiterate that for the training or therapy to be considered functional, the exercises should mimic the movement as closely as possible. This means that all the muscles which are used to move and balance during the initial swing should be worked together the same way they are used during the motion. The motion is trained repeatedly so that muscle memory can begin to take over and the movement becomes second nature.
To successfully train the initial swing in a stroke survivor, the client can stand while grasping a wall rail (or something similar if being done outside of a therapy setting) with the left hand to assist with balance. With the right leg slightly behind the left, the client raises their heel, bends the knee, and flexes the hip simultaneously. If the client isn’t able to return their leg to the starting position for the next repetition, the therapist can assist by sliding their leg back once it returns to the ground. Once this skill is mastered, the use of ankle weights can add a little resistance to the movement and aid in the growth of the muscles that are used to produce the motion. Depending on the severity of the stroke and level of impaired movement, the therapist may train the entire gait cycle as one movement, or break the cycle down into smaller more easily mastered sections as described here. Either way, this type of exercise application is the very base of functional training.
Recovery from a severe joint injury and the subsequent surgery is always a difficult task; and if left unattended loss of muscle mass and flexibility around the joint can be debilitating. I had a client who was recovering from a knee surgery, and was suffering from the expected pain, stiffness, and loss of flexibility. The incident and the surgery that followed left him unable to sit on the floor with bent knees during his daily prayers. After several months of working with a physical therapist, he noticed marked improvement in strength and balance. During these sessions he performed a variety of exercises designed to strengthen the muscles surrounding the knees as well and the muscles of the hips and ankles. His strength and muscle tone were increasing; however, there was little progress toward achieving his goal of being able to pray without the use of a chair.
After several discussions about his progress in therapy and how it related to his daily activities, I decided to add a functional flexibility exercise to his weekly routine. His goal was to sit on the floor with bent knees, so that’s exactly what we did. We warmed up the muscles around his knees with some light exercise as you should always do before attempting to stretch a muscle. Then, starting out with several pillows behind his knees to keep the knee joint from fully flexing, he sat with knees bent each day for a short time, usually until the pain was too great to continue. After a few weeks we removed one of the pillows and performed the same exercise, now with more joint flexion and a lower level of pain. These two factors are key measures in physical therapy and with all therapy and training, measuring your progress is vital to ensure you are advancing towards your goal.
After another few weeks the pillow was removed and he was able to sit with bent knees long enough to perform his prayers. There was still discomfort, but the goal was achieved and with continued effort the pain has continued to diminish and his bent-knee seated position has become easier to achieve and withstand. One of the most important aspects of all types of exercise and therapy is that they are personalized to the goals of the individual. A generalized physical therapy routine is without a doubt helpful in increasing muscle strength and endurance, but tailoring the therapy to your specific goals will always yield optimal results.
The muscles of the pelvic floor play an important role during childbirth. These muscles must relax and expand to allow the baby to more easily move through the birth canal. The body will release hormones during pregnancy which cause a loosening of both the muscles and the ligaments of the pelvic floor, allowing the baby to be delivered without major injury to the mother. Exercising these muscles before and during pregnancy will strengthen and increase their elasticity. This can produce a two-fold benefit. Increased elasticity will allow the muscles to stretch more easily during delivery, and stronger muscles will lead to a quicker recovery after childbirth. Strengthening the pelvic muscles may also alleviate the possibility of postpartum urinary incontinence, an issue experienced by many women.
The deep squat with a pelvic floor squeeze is a functional exercise that can be done before and during pregnancy. To perform this exercise, stand with your feet in a wide position and your knees and toes pointed outward. Squat down as far as you can comfortably go and hold that position at the bottom. If needed hold onto a wall or an immobile object for balance. At the bottom of the squat, squeeze your pelvic floor muscles and hold. This is a difficult task best described as squeezing as if you were attempting to stop the flow of urine. Hold the squeeze for ten seconds if you are able to, then return to the standing position and repeat five to seven times. This exercise can be done three to four days a week and is a lovely addition to your health and wellness routine.
Many of our activities of daily life are performed with little or no thought until they become difficult or painful. When that happens, simple daily tasks can easily turn into a long list of unattractive and unwelcomed chores. If this sounds familiar to you, then you may be a candidate for adding some functional training into your weekly schedule. Tailor the program to your needs, measure your progress, and adjust the program as needed to propel yourself to your goal. You owe it to yourself to remove the stressful events in your life and eliminate your major malfunctions. As always, consult with your physician before taking on any new fitness or wellness activities.
Ali Othman has been an NSCA certified personal trainer for the past 13 years with specialization in weight loss, functional training, muscular hypertrophy, and human nutrition. He also works in the Technical Department at IFANCA and manages IFANCA business activities in South Korea.