Over the years dozens of failed PT patients have found help and hope at Inertia Health Center. The difference in outcomes comes from our process being refined, specific, and thoughtfully different. Here are the biggest reasons why we’ve had success:
More is not always better.
Progression of intensity of load, which exercise to choose, which starting position, how long to hold each rep cannot be hasty. What we have found is patients are often pushed through harder and harder exercises even though they struggled to execute the very first one. Progress for the sake of keeping up with a flow chart is prioritized rather than ensuring the patient can load the muscle properly prior to moving on to something harder.
Persistent & chronic pain signals must be dealt with prior to strengthening.
Given the right circumstances, the pain signals coming from the injured area can become the dominant sensory input to the nervous system. If this becomes your reality, it becomes incredibly difficult to get traction on strengthening because normal sensory events (ex: basic joint stretching) get overridden and coded as pain. A number of our failed PT patients required sensory/pain receptor-focused treatment to get them over the hump.
Rehab should follow an ideal loading pattern. We are unwaveringly picky.
Next time you are at the gym, watch everyone doing push ups and compare. Are they all utilizing the exact same movement pattern? Not a chance. Even small differences in rotation at the shoulder, shoulder blade positioning, head positioning changes the load and force distribution. We are unwavering in our pickiness to make sure patients are loading the right muscle in the optimal pattern. There is no compromise and no shortcut.
Ligaments & tendons need isometrics first.
It is well known and documented that ligaments and tendons deposit new collagen fibers with long isometric holds. Most incomplete tears in the rotator cuff, for example, need extensive isometric loading prior to beginning other types of loading. Pain will persist and collagen fiber reinforcement will be lacking if isometrics are skipped.
Joint injuries need capsular, labral, & articular cartilage decompression first.
Your nervous system will quickly adapt to avoid pain. If one of the damaged tissues is inside of a joint, the joint needs to be appropriately unloaded and rested until compression no longer produces inhibition of the surrounding muscles. Patients cannot move forward productively until this step is satisfied.
Closed chain vs Open chain exercises
Movement repatterning requires closed chain exercises rather than open chain exercises.
For those that don’t know the difference, here’s an example:
- A dumbbell curl is an open chain biceps exercise.
- An underhand pull up is a closed chain biceps exercise.
Both load the same muscle, but the fixed point and movement point are different.
When we load open chain exercises, we build muscle in the movement pattern we already have. BUT, when we load closed chain exercises, we build muscle AND we have the potential to build a new movement pattern. This is especially crucial for people recovering from non-tramatically induced injuries– in other words, this is necessary for people who created their own injuries.