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By Asha De Freitas-Moseley
“Squeeze this ball between your knees while you squat.” “Catch the ball while balancing on one leg.” “Keeping your elbows extended, pull this elastic tubing down to your outer thigh.” All, very simple instructions. “We need to reduce the inflammation.” “I need to tape you.” Sometimes the simplicity of the exercises and techniques employed by athletic therapists and physiotherapists in rehabilitation can deceive people into under-estimating their significance. Squeeze this ball between your knees while you squat: The squat utilises over 200 muscles in a single movement. Primarily targeting the quadriceps muscle, it secondarily targets the antagonist hamstring muscle, then the lower back and core, glut muscles and lots more, but in rehab therapists look at several other things going in the body, besides the strengthening of muscles. For instance, the pelvic positioning and control during the movement. In this particular instance, when a therapist adds the ball squeeze between the knees while squatting, they may be targeting the groin muscles to influence proper knee positioning throughout the execution of the movement.
Catch the ball while balancing on one leg: Everyday, we all employ balance mechanics - during the swing phase of the gait cycle ie walking. Once again, pelvic function and positioning is important for the sake of stability, mobility and balance. Consider that penguins to do not have a pelvic girdle. Then consider the way that penguins walk! This is directly related to the absence of the pelvic girdle. Pelvic strength and stability contributes significantly to the way humans walk, but this is only one of many deficiencies a therapist could be evaluating simultaneously with balance and focus through this simple exercise. Keeping your elbows extended, pull this elastic tubing down to your outer thigh: The heart of the shoulder is actually the scapula. If the scapula does not track properly, everything else goes off-track, just like the steering rack on a car. You will still be able to drive the car but it will be out of alignment which will eventually affect the bearings, the tires and a host of other things, by extension. Similarly, when the therapist has positioned a person with a shoulder injury, into an upright posture, it’s not just because our teachers always told us we should stand straight. It is because in this position, the scapulae are positioned back and down, held against the rib cage, where it best anchors the shoulder joint. Once this posture becomes habit and the chest remains more open versus closed as is customary for people who sit in front of computers a lot or swimmers whose bodies have adapted to their sport, the shoulder can gradually be trained to safely and powerfully execute actions that involve overloading the muscles and joint, such as with lifting or throwing.
In a baseball player, the arm angular velocities generated through the arm can range in excess of 7,000 to 8,000 deg/sec and rotational torque of more than 70 N∑m, shear forces ranging from 300 to 400 N and compressive forces of more than 1000 N. Shoulder decelerators can approach -500,000 deg/sec? (J Andrews, et al, The Athlete’s Shoulder, 2009.) Keeping this in mind, creating a strong foundation for shoulder movements which starts with ensuring that these basic exercises are executed properly may be better appreciated. We need to reduce the inflammation: Yes, everyone knows that when pain or discomfort is felt, ice is recommended. Recognise however, that the healing process of the body incorporates three very basic phases; the acute inflammatory phase, the repair phase and the remodeling phase. While I am a firm believer in cold therapy in the early days of injury, as the body goes through the different phases of healing, cold may not always be indicated. However, as a general rule, when there is swelling, there is inflammation accompanied by pain. Therefore, if you reduce the inflammation the swelling and pain will also reduce and the ability to move the joint or muscle will increase.
I need to tape you: Although taping usually incurs additional cost to the therapy session because it is a consumable item, it plays a significant part in the rehabilitation programme. Most everyone is familiar with the kinesio taping technique as well as the ankle taping technique which uses a white, relatively inelastic tape. Both tapes are coated on one side with hypoallergenic adhesive for the purpose of anchoring however these two types of tape act on completely opposite principles. Unlike the zinc oxide, the kinesio tape is not meant to be an immobiliser. Rather it is meant to stimulate and reeducate the body using the skin receptors of the body which send message to the brain that in turn trigger various responses in the body. These are not the only types of tape out there. Others include Powerflex, Sher-light and Coban to name a few, each one with different properties to facilitate various outcomes.
First, identifying the desired outcome will indicate to the therapist, the most suitable tape and technique for the job. A strong understanding of human anatomy and joint mechanics is necessary for successful application or the effects could be negative. Things like compromised circulation and abnormal torque on the joint(s) can worsen the athlete’s already compromised condition. So, although the rehab protocol may sometimes appear simple and perhaps mundane, there is a method to it, the fragility of which becomes evident only when things do not quite go completely according to plan and regression occurs for reasons such as illness, an accidental slip, or the surprise of another underlying disorder. I hope that the local sports fraternity will eventually embrace the significance of rehabilitation and invest in the proper care and attention their injured athletes require in order to perform at their best.
NOTE: Asha De Freitas-Moseley is a certified athletic trainer with a Masters in Sports & Fitness Administration. She has worked with several of our top athletes and continues to seek out ways to promote the industry of sports as a science in T&T. She works as a private contractor out of Altus Health Services Ltd. and at Total Rehabilitation Centre.