Functional Exercise Prescription

Supporting rehabilitation in movement and sport

Eyal Lederman

• Publisher: Handspring Publishing
• Year: 2022
• ISBN:
  9781912085491
• Topic: Medicine
• Subtopic: Alternative & Complementary Medicine

In Functional Exercise Prescription Eyal Lederman presents a revolutionary new approach for exercise prescription that uses the individual's own movement repertoire. The book demonstrates how daily activities (the life gym) can be amplified to provide the necessary movement challenges to support movement rehabilitation in many musculoskeletal and pain conditions. Hence, all activities can become remedial without the need to prescribe unfamiliar exercise; in other words, 'how to exercise without exercise' or 'how to rehabilitate without exercise'.

People recover from most musculoskeletal and pain conditions through three key processes: repair, adaptation, and alleviation of symptoms. The author explains how to identify the individual's recovery process and how to select the appropriate daily or sporting activities, and, how they can be modified to support recovery.

Functional Exercise Prescription is a dramatic departure from the traditional strength and conditioning models that have been used for rehabilitation. The book explores the limitation of these models and explains how they can be replaced by functional daily activities ('functioncise'). It provides the practitioner with practical tools to construct a tailor-made plan for each individual to help expedite and optimize their recovery. Most rehabilitation can be constructed from a small familiar set of daily or sports activities.

All human physical activity is exercise. Life is your gym.

1

About the book

There are two main themes running through the book: a functional management that individualizes the rehabilitation, and a process approach which makes it condition- and recovery-specific.

In a functional approach, all human movement is considered to be an exercise. The remedial exercises are constructed from the individual’s own movement repertoire. The rehabilitation of a person following knee surgery will be constructed from their daily activities, such as standing, walking, climbing stairs, and so on. If, within their movement repertoire, they play soccer, this activity will be added to the management at some point. In this approach the patient is managed using activities that they are familiar with and which represent the ultimate goals of their rehabilitation: that is, stand, walk, play soccer. In essence, all human activities can become remedial by varying their intensity and duration. It seems that, in most conditions, maintaining daily physical activities provides the main drive for recovery. If these health-promoting activities are so effective, why not focus on amplifying them? Throughout the book these forms of exercise will be termed functional exercise or functional challenges.

A process approach is a remedial management that focuses on the processes underpinning recovery in musculoskeletal and pain conditions. Recovery in most of these conditions is associated with three dominant processes: repair, adaptation, and alleviation of symptoms. These recovery processes can be supported and optimized by a management that targets specific elements within the individual’s environment. Exercise prescription plays an important role within the physical aspect of these environments. Each recovery process requires a specific exercise management to support it. For example, the exercise prescribed for post-surgery rehabilitation (repair) will be very different from that for post-immobilization rehabilitation (adaptation). Some of the management elements are shared between the three recovery processes. Why and how they differ, and what is the shared management, is discussed throughout the book.

So, why is a new approach needed? Functional and process models represent a patient-centered approach where the exercises are derived from the individual’s own movement repertoire and are specific to their recovery process. Exercises that are outside an individual’s movement experience are termed extra-functional exercise/challenges/activities; sometimes, they will be referred to as auxiliary exercise. They are more likely to reflect the practitioner’s discipline and style of practice. It is not unusual for the extra-functional exercise to be “method”-based and hijacked by fads or trends, rather than being informed by science and explored from a rational basis. Hence, currently, movement rehabilitation is dominated by exercise derived from strength and conditioning methods, Pilates, yoga, and core stability training. These approaches often promote strict exercise protocols that lack individualization or specificity to the recovery processes. These wholesale exercises are unlikely to address the person’s uniqueness and their particular needs during recovery, and may therefore impede the return to functionality.

All exercises are better than no exercise. There are no “bad exercises”; there are only exercises that do not serve the goals of rehabilitation. This book is about shifting the emphasis from traditional extra-functional management towards a functional management: an approach which is more likely to support the individual’s recovery needs and goals. However, there are occasions when the individual is unable to engage in functional movement. This may be due to surgical considerations (such as tendon repair), health status (autoimmunity, cancer), deficits in movement control (stroke), or environmental conditions which limit the extent of functional participation (weather conditions). Under such circumstances, extra-functional exercises play an important role in the rehabilitation program.

The book is divided into parts that reflect the functional and process approach themes. The first part (Chapters 2–3) explores functional and process approaches; the second part (Chapters 4–5) explores recovery by repair; part three (Chapters 6–9) addresses recovery by adaptation; and part four (Chapters 10–12) focuses on recovery by alleviation of symptoms. Part 5 pulls it all together: the shared management is examined in Chapter 13, while a summary, and information on how to construct functional and process approaches for common musculoskeletal and pain conditions, are provided in Chapter 14. This is supported by photographs demonstrating how the remedial exercise can be integrated into daily activities – “the life gym.”

In this part of the book you will explore the basic principles of how to construct an exercise management program from the individual’s own movement repertoire and how to match the management to their condition: how management can be personalized and made condition-specific.

▪The principles of a functional approach (personalization of exercise)

▪The principles of a process approach (how to match the exercise to the individual’s recovery process)

Part 1

Principles of management

CHAPTER 2A functional approach: individualizing the management

CHAPTER 3A process approach: constructing a condition-specific management program

2

A functional approach: individualizing the management

Perhaps the place to start the exploration of a functional management is to identify the goal of this rehabilitation approach. A person’s functional capacity or “functionality” is seen as the ability to perform daily activities effectively, efficiently and comfortably. This capacity can be affected by various musculoskeletal and pain conditions. The aim of a functional rehabilitation is to enable the individual to regain their pre-injury capacity by using their own movement repertoire.

Imagine a session in which two patients are prescribed exercise for a similar knee injury. One patient is a keen tennis player and another a strength and conditioning enthusiast. How do we construct a functional exercise management? What would be similar and what would be different between the two presentations? How do we individualize the management? Can individualizing the exercise improve outcome? To start this exploration, we first need to look at what an exercise is.

WHAT IS AN EXERCISE?

Which of these activities would be considered an exercise: climbing a flight of stairs, walking home with shopping bags, pushing a baby carriage up a hill, repeated bending to clear clutter off the floor, cleaning the house, laying bricks, or gardening? Or would these set of activities be considered exercise: lifting weights in the gym, walking or running on a treadmill, or stretching in a yoga class?

Most people are likely to consider the first set of daily activities as undesirable daily chores. An activity would often be considered an exercise when it reaches some level of exertion and is performed in block repetitions. We also associate exercise with particular gear or sportswear, or a dedicated space and time, such as a gym. In this mindset, exercise and sports activities are believed to confer health and fitness benefits which are not provided by daily, non-recreational activities.

From a rational point of view, all human activities provide some form of physiological, physical, and psychological challenge. What we consider to be an exercise and therefore different from daily activity is more about a mindset and context, rather than a true physiological or physical difference. From the “body’s point of view,” lifting a basket of washing could provide similar physical challenges to lifting a dumbbell in the gym. What forms an exercise may also depend on how incapacitated a person is. A seemingly unchallenging daily task, such as rolling out of bed, can be an exhausting exercise if the patient is very old or has been bed-ridden for several weeks. Similarly, getting in and out of a chair or walking would be a demanding challenge to a person who is recovering from lower limb surgery.

So, is there a physical activity which is not an exercise? Yes: resting or quiet sitting is considered a low metabolic activity that places minimal physical demands on the body;¹ hence, it is an activity that is unlikely to contribute to movement rehabilitation (although it is important to our well-being). However, a slow walk, which is also low on metabolic demands, could be an essential physical challenge in post-stroke or post-surgery rehabilitation. From a musculoskeletal rehabilitation perspective, it seems that all physical activities can be used to maintain, recover, or enhance performance, as well as providing wider health benefits. These considerations form the basis for broad definitions of exercise and remedial exercise:

Exercise is the behavior a person adopts in order to maintain or enhance their physical performance or health.

Remedial exercise is the behavior a person adopts in order to recover their physical performance or health.

These definitions encompass the notion that all human activity,...