Exercise therapy approaches are based on improving the body's tolerance to mechanical wear and tear that occurs on a daily basis, with the overall aim of reducing the pain you experience from your various daily activities. Exercise therapy is often an important part of preventing recurrence of pain. Most of us would be familiar with some very common approaches such as simple stretching or strengthening exercises. However for many people with chronic problems these useful and straight forward approaches can sometimes be either too aggressive or too difficult to perform without aggravating your pain. In such cases some more precise exercise aimed at the correct level of difficulty for your weak muscles are not only more appropriate but far more successful. This will allow you to develop strength where it is specifically needed so that you can get better faster (a general all-over strengthening approach doesn’t correct imbalances at all). Some of these approaches are outlined below.
Either through injury or via habitual patterns of muscle use (or disuse), a pattern may begin to form in the body whereby some muscles become tighter and stronger, whilst others become weaker. This situation is known as "muscle imbalance", and may lead to chronic mechanical (musculoskeletal) pain. Pain and eventually joint degeneration is thought to occur as the muscles act in an unbalanced manner around the joints, leading to poor alignment and uneven movement. This situation is somewhat analogous to faulty wheel alignment on your car, which is known to cause uneven wear on the tyres and suspension that prematurely wears them out. Exercise therapy approaches to correct this problem rely firstly on eliminating any sources of muscle irritation or inhibition, for example by ensuring that injuries or ongoing pains are eliminated. Exercise then aims to do 3 major things, to stretch tight muscles, to strengthen and increase the activation of weak muscles, and lastly but most importantly to "reprogram" the brain to ensure that the muscles are acting in a balanced and appropriate manner about the joints when you are going about your daily activities. If this last part of the approach is neglected or forgotten, or the weak muscles are not strengthened back to full normal strength, the imbalance typically recurs over time and the pains slowly return, typically in about 3-12 months.
This approach originally developed as an off-shoot from the muscle imbalance approach, when it was realised that many of the muscles which commonly become weak are deep, small muscles whose primary job is to hold or stabilise the body (especially the spine, hips and shoulders, ie the "core" of the body) upright against gravity. These muscles include the deep back muscles, the abdominals, psoas (a hip flexor on the front of the spine), gluteals (buttock muscles) and some of the shoulder and deeper neck muscles. Interestingly, these muscles are normally activated whenever you move and are typically activated by reflex rather than by conscious effort, meaning that you can't always improve some of these muscles doing the regular gym-based approach to strengthening, particularly if you have a long-standing problem. More specific approaches are needed in such cases. One well known approach, for example, is Pilates and other variations of floor exercises. However there are many other ways to develop these muscles, including Vojta Reflex Therapy & Sensorimotor Stimulation as described below.
A European approach in which specific reflex points have been identified that are thought to preferentially stimulate the deep stabilisng muscles of the trunk, hips and shoulders. In cases where the muscles are particularly difficult to activate due to extreme and long standing weakness, this approach can help to get the muscles active again. This is usually then followed up with daily home exercises to reinforce the initial work.
The "core stabilising" muscles of the body (see above) are usually activated by reflex, and are under the control of several subconscious or reflexive parts of the nervous system including the vestibular, cerebellar and proprioceptive systems. The basis of the sensorimotor stimulation approach is that by increasing the "drive" or activity of the vestibular, cerebellar and proprioceptive systems (which all contribute to balance and upright posture control), it is possible to preferentially increase the activity of the deep core stabilisers. This is done by challenging your balance using unstable surfaces such as balance boards, Janda balance sandals or Swiss Balls. When your exercise program incorporates unstable surfaces it is thought to increase the efficiency of your muscle improvement by up to 4 times when compared to exercise on a stable surface. We have found this approach to be of benefit for people with chronic pain that is associated with poor muscle control. When you have fully recovered it is also a very useful way of maintaining muscle control and preventing recurrence of your symptoms, and can form a valuable part of a weights program.
The muscles and organs of the body are covered by fascia, a substantial connective tissue structure (see myofascial technique). These "myofascial" (= muscle + fascia) structures interconnect, and in some cases form a "sling" which runs across a section of the body. The muscles in this sling are usually activated together when performing a movement, for example in the abdominal region the external oblique muscle on one side of the body always acts with the internal oblique muscle on the opposite side when twisting your trunk. When a weakness is detected in one of the slings, exercises directed at activating all of the muscles simultaneously can be effective in overcoming the problem. This is the essence of the locomotor slings approach to exercise therapy, and is often incorporated towards the end of rehabilitation (eg for return to sports or more physical duties).