Life’s richest moments and ultimate successes often present themselves through collaborative efforts. We can accomplish far greater achievements through our interdependent efforts, as opposed to independent undertakings.
Meet Benvolio, a 45 year old who loves to bike, play tennis, cross country ski and jog. Two years ago, he fell while playing tennis, and injured his left shoulder. He now suffers from occasional sciatica, and a stiff shoulder that really limits his hitting in tennis. He still gets out for a match now and then, and exercises at home, but the pain has never resolved.
Benvolio is frustrated with the intermittent pain and stiffness that prevent him from enjoying his favorite activities. At the same time, he still wants to move and sweat.
Our mission is to develop a corrective strategy that prepares the biomechanical, neurological and physiological elements for a re-conditioning program that builds movement confidence and complements his corrective exercise strategies.
Corrective Exercise Program
Let’s dive right in to the recommendations from Function First’s Anthony Carey and Kevin Murray – utilizing the principles, strategies and insights of the Pain-Free Movement Specialist educational platform.
Here’s what our Pain-Free Movement Specialist (Anthony Carey) had to say:
“Exercises are never symptom driven. That is outside the scope of a fitness professional. We respect and acknowledge the symptoms, avoiding exercises and movements that provoke or create apprehension (which feeds back into the client’s motor system). We are overlaying pain science on a biomechanical template.
When you look at the objectives in the corrective program, you’ll see that they have a biomechanical, physiological and neurological purpose. In a nutshell, we look to remove mechanical stress and promote an environment for new motor learning and control. This opens a window for tissue recovery, disrupts the neuro representation in the brain, and promotes movement confidence.”
Our first objective with our chosen exercises is to:
- down-regulate the SNS.
- encourage post-isometric relaxation (specific to the hip compartment).
- promote re-alignment and increased stabilization of the SI joint, independent of the lumbar erectors and paraspinals.
To that end, we’ll use the Abductor Presses and Sway Back Ankle Squeezes. We can expect these exercise outcomes:
- post-isometric relaxation to facilitate re-alignment of sacroiliac joint
involves limited joint motion.
- increases hip joint centration.
- decreases reflexive guarding of lateral hip compartment while simultaneously down-regulating the sympathetic nervous system.
- facilitates low-level hip flexor and shoulder joint stabilization coupled with passive extension of lumbar and thoracic spine.
- promotes passive downward rotation and adduction of scapula coupled with improved arthrokinematics (roll & glide) of glenohumeral joint
Our next objective is to increase complexity blending novel & existing motor strategies.
We provide a new movement strategy and associate it with an existing central motor program already stored in Benvolio’s movement database. The focus here is increasing coupled joint mobility and tissue extensibility through the hip and shoulder complex.
We’ve selected the 4-Point Rotation here for the following outcomes:
- decreases reflexive guarding of lateral hip compartment while simultaneously up-regulating a novel motor strategy.
- increase connective tissue adherence through the promotion of tissue extensibility.
- re-educates effective 3D loading through low-level stabilization of hip and glenohumeral joints.
- facilitates an increase in sacroiliac stabilization requirements while simultaneously increasing SI joint mobilization demands.
- low-level erector/paraspinal and abdominal co-contraction for spinal stabilization purposes.
Finally, we want to get Ben upright – parallel to the forces of gravitational pull that begin moving him from the cognitive and associated phases of motor learning, towards the autonomic phase.
Additionally, shifting into the autonomic phase of sensory-motor integration should require no need for cognitive processing. This ultimately replicates an environment he encounters during sport, and is also a requirement of daily life.
The Frontal Plane Samurai and Lunges with Crossover Reach exercises will facilitate this objective with these outcomes:
- increase proprioceptive feedforward/feedback response and cutaneous receptor stimulation.
- increase eccentric loading of multiple myofascial slings and lines while progressing ground reaction force and increasing mass and momentum with a by-product of distributing and mitigating forces globally.
- increase somato-sensory demand by influencing vestibular and visual sub-cortical responses.
- improve reciprocal motion of ankle, pelvis, trunk/thoracic and shoulder complex.
- promote sensory-motor integration and pre-frontal cortex activation through replicating the ipsi-lateral and contra-lateral 3D motion and loading – similar to that of tennis, cross-country skiing and jogging.
Institute of Motion’s Programming Officer Derrick Price walks us through the re-conditioning program that will build Ben’s confidence in movement and complement his corrective exercise strategies.
This program’s main goal is to identify movements that Benvolio feels confident with, and avoid triggering a pain response. We also want a workout that taps into his desire to get his sweat on and kindles a belief that he can move pain-free again.
Metabolically, we’ve chosen a Peripheral Heart Action circuit. Alternating between upper body and lower body dominate exercises creates a systemic aerobic response.
Mechanically, we avoided exercises that might worsen his symptoms – deep hip flexion, squats, isolated shoulder work or moving at 100% intensity. Both loaded exercises for the shoulders are designed to dissipate force through the shoulder vs isolate force to the shoulder tissues. The lower body exercises were selected to give him that feeling of being an athlete again.
We use all four quadrants to create a variable force response. We begin with unloaded exercises to build confidence before progressing to loaded movements in the second half of the circuit.
IoM Pro subscribers can take a look at Metabolic Conditioning Lesson 12 to see what this movement looks like when we progress the handprint, footprint, and overall complexity.
Question: What are your thoughts on Benvolio’s programming? Care to chime in… You can leave a comment by clicking here.