True strength gain, by definition, takes 6 weeks. True strength gain is marked by a higher manual muscle test grade, physiological hypertrophy, and more power. What physical therapist has 6 weeks or more just to reach strength goals? None! We have to reach functional goals quickly – to be reimbursed by the insurance companies and to satisfy patients.
Strengthening exercises can become compensatory movement facilitation, because you can’t strengthen a muscle that isn’t activated. The compensatory muscles are happy to kick in and perform the task, but perhaps with pain or decreased range of motion. A muscle that is “shut off” needs to be neurologically activated before it can become physiologically stronger.
Activation is neuromuscular therapy. Physical therapists are not personal trainers, we are neuromuscular experts. Let’s separate ourselves from the other fitness professionals by utilizing our entire education when we treat patients.
A familiar example of muscle activation is a patient who presents with unilateral quadriceps weakness, often with marked atrophy, after an ACL reconstruction. If he goes through typical quad exercises and doesn’t see results, the muscle may be neurologically deactivated. PTs have reactivated neural connection of the quad with biofeedback and e-stim , with suspension exercises on equipment like Redcord, with instability exercise on a balance cushion, and with specific inhibitory and activating exercises with Postural Restoration. The PTs know the muscle is reactivated when it performs better immediately upon retesting. Now you can go strengthen that quad!
A less familiar phenomenon is the practically instant activation of muscles. I often get such results using the Neurac Methodology. I am able to activate the serratus anterior through shoulder protraction with their hands in ropes and often with trunk assistance with bungees. When I am able to challenge them extensively without pain– they perform pain free shoulder ROM – after presenting with chronic or acute shoulder pain and decreased AROM – from injuries such as a frozen shoulder or a proximal humeral fracture.
I wish for all therapists to achieve these results – and activation of the correct muscle is essential. You do not have to use Neurac on Redcord equipment, nor is Postural Restoration is key, but you do have to know what muscles to challenge, to dare to challenge your patients, and to do it with pain free exercises. Neurac with Redcord and Postural Restoration have documented neuromuscular activation.
Click here to read more about author Kristina Marcussen