Written by Brendon Tod
When considering how we are going to progress our clients from their current physical capacity to a physical capacity that matches their goals, most exercise and rehabilitation professionals think about how to progress musculoskeletal range of movement, stability and strength using the basic principles of muscle physiology and adaptation.
Example of a Progressive Rehabilitative Exercise Framework based on Muscle Physiology:
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Phase 1: Range of Movement |
Phase 2: Local Stability / Postural Reconditioning |
Phase 3: Dynamic Stability |
Phase 4: Movement Patterns / Functionally Specific Exercise |
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Key Goals:
Restore joint range of movement
Restore length / tension of tight musculature |
Key Goals:
Improve activation / endurance of local stability and postural musculature |
Key Goals:
Integrate stability and postural musculature into musculoskeletal sling mechanisms
Improve dynamic strength across kinetic chain |
Key Goals:
Improve strength of movement pattern
Improve strength / endurance of movements specific to sport or occupation |
Applying a holistic approach to exercise prescription however, dictates that we must consider the physiological components of a range of different physiological systems. We need to ask ourselves how is this programme affecting my client’s autonomic nervous system, their hormonal axis or the cognitive and neuromuscular dynamics of the clients motor control system?
Progressing exercise holistically requires us to consider a client’s overall physiological landscape which is made up of a range of aspects including nutritional habits, physiological stress loads, sleep patterns, motor control ability, implicit resilience and their motivation for exercise. From here we can tailor different methods of exercise to ensure that we are prescribing a truly individualised programme. Holistic exercise prescription will include exercise modalities that target these (and more) physiological parameters.
For example, research shows, that after about 2 weeks of pain, the area of the motor cortex representing the site of pain starts to shrink in size. This will affect a client’s proprioception and neuromuscular control of that area. It is therefore essential that when prescribing exercise to someone in pain, we progressively apply exercises and effective exercise cueing to enhance a client’s motor control and bodily awareness. In this case we should start with Motor Sensory Mapping Exercise, progress to proprioceptive exercise and then on to exercise that promotes movement in flow.
Using another example, a client who is under high stress will be presenting with an exaggerated sympathetic nervous system response to any stressor including exercise. This in turn will influence every physiologic function in your client’s body, including adaptation to exercise. In this case, fitting Autonomic Nervous System Balancing exercises into a client’s progressive exercise plan is essential if we are going to elicit the desired physiological adaptation.
Example of a Holistic Exercise Progression Framework
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Muscle Physiology |
Phase 1: Range of Movement |
Phase 2: Local Stability / Postural Reconditioning |
Phase 3: Dynamic Stability |
Phase 4: Movement Patterns / Functionally Specific Exercise |
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Key Goals:
Restore joint range of movement
Restore length / tension of tight musculature |
Key Goal:
Improve activation / endurance / function of local stability and postural musculature |
Key Goals:
Integrate stability and postural musculature into musculoskeletal sling mechanisms
Improve dynamic strength across kinetic chain |
Key Goals:
Improve strength of movement patterns
Improve strength / endurance of movements specific to sport or occupation |
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Autonomic Nervous System Physiology |
Phase 1 ANS Balancing: Relaxation Response |
Phase 2 ANS Balancing: Relaxation Response Under Load |
Phase 3 ANS Balancing: ANS Manipulation |
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Key Goal:
Enhance ability to elicit a Parasympathetic Nervous System shift and Relaxation Response with movement |
Key Goal:
Enhance ability to elicit relaxation response with functional movement under load |
Key Goal:
Enhance ability to elicit a parasympathetic or sympathetic response depending on situational needs |
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Motor Control Physiology |
Phase 1: Motor Sensory Mapping |
Phase 2: Proprioception |
Phase 3: Postural and Movement Patterning Awareness |
Phase 4: Movement in Flow |
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Key Goal:
Improve central nervous system awareness and neuromuscular control / reduce motor sensory amnesia |
Key Goal:
Improve awareness of relationship between ground reaction forces, base of support and center of gravity resulting in improved balance |
Key Goal:
Improve implicit postural and movement efficiency |
Key Goal:
Effectively utilise ground reaction forces and kinetic chain to transfer force through the body increasing movement power and efficiency |
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Hormonal Axis Physiology |
Phase 1 Physiological Landscape |
Phase 2 Physiological Landscape |
Phase 3 Physiological Landscape |
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Key Goal:
Change nutritional habits to optimise recovery and push body into anabolic state
Improve sleep patterns and stress management ability to optimise recovery and push body into anabolic state |
Key Goal:
Combine exercise, nutrition, sleep and stress management factors to build resilience |
Key Goal:
Integrate Phase 2 factors and coaching / cognitive behavioural / confidence building techniques to allow for high performance under high stress loads |
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Ask yourself how much you consider these holistic factors when planning your client’s exercise programmes. The Early Phase Holistic Exercise Prescription Workshop will explore the practical applications of these techniques, including assessing your client and applying appropriate holistic exercise principles and techniques to their programme.
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