What It Is
Functional rehabilitation is a way of assessing and correcting musculoskeletal imbalances and faulty movement patterns. Movement screens are used to discover imbalances or inadequate movement, and exercises are given based on each patient’s individual needs. Additionally, limiting activities are evaluated, with exercises being tailored to enhance the performance of necessary activities of daily living.
The primary objective of functional rehabilitation is to educate patients on how to move their bodies more effectively and efficiently in order to maintain better posture and alignment. A good sense of body awareness, posture, balance and coordination are continuously stressed and encouraged.
How It’s Different
This approach differs from traditional physical therapy in that less emphasis is placed on finding and treating specific injured tissues. Finding an exact diagnosis can be difficult due to the close proximity of possible pain generators, this being especially true for spinal pain. Also, false negatives are very common with orthopedic testing and even imaging. Instead, movements and positions that exacerbate pain are identified and addressed. Finally, there is little to no emphasis placed on strengthening individual muscle movements, i.e machine weights. Correcting overall posture, stability and movement often has better long term success than focusing on an isolated sources of pain or individual muscles.
Building a Foundation for Functional Rehabilitation
Before functional screens are administered and interpreted, painful movements or postures must be identified and addressed. A common example would be pain that is brought on from sitting or rising from a chair. In this scenario, McKenzie extension maneuvers might be recommended as well as advice about proper sitting posture. Then, the patient would be taught how to activate their core properly and to move through their hips, minimizing lumbar spine flexion.
Next, passive motions are evaluated and restrictions are removed. Excessive tightness in one area or one side of the body will create an imbalance that can result in misalignments of the pelvis or spine. Also, restrictions can interfere with nervous system proprioceptive feedback, making it difficult to do the exercises correctly. Some common causes of restrictions include; myofascia, nerve tension, and joint restrictions. These are commonly treated using myofascial release, stretching, neurodynamic techniques and spinal manipulation.
Once painful movements or postures are addressed, and restrictions are removed, functional assessments can begin. The goal is to discover how a person naturally moves their body. We all have ingrained programs from an early age that determine how we move to perform tasks. If a developed pattern is one that creates an unbalanced distribution of loads, it can become strenuous on certain tissues, e.g. too much rounding of the spine with bending creates disc pain. After observing movement patterns, weakest link areas can be discovered and treatment can begin.
Stages of Progression
With prescribing exercises, the first focus is on enhancing coordinated movements and balance. This entails making sure the patient has a good sense of body awareness and an acceptable amount of motor control while performing basic tasks. Many verbal and tactile cues are used to help the patient to become more in-tune with certain areas of their body. This is to help them establish, or re-establish a better sense of connectedness to weakened areas of their body.
Next, there is a large focus on core stability. It is recognized that the ‘core’ is the center of gravity and foundation for all movements. The muscles around the pelvis, in particular the transverse abdominals, are supposed to activate before any limb movements, i.e. taking a step or reaching for an object. If this isn’t happening, the core needs to be stabilized before progressing to strengthening exercises. Especially important is maintaining adequate balance between the trunk flexors and extensors (rectus abdominis and spinal erectors).
Finally, endurance and strengthening exercises are added using whole body movements, requiring multiple muscle groups to work in unison. The goal is to make sure that the core stays stable, acting as a platform from which other muscles can generate movement. The prescribed exercises are meant to strengthen discovered weaknesses and are tailored for the patient’s specific daily requirements.