Strategies for Using Gravity in Rehab

Gravity being a constant, is nice to work with, mainly as a driver of motion.  The most obvious is a squat. Here gravity drives the motion as you descend into the squat, loading the system, driving the bones that create the joint motion and load the muscles.

Since gravity is constant it's a skill to manipulate ots effects. To increase the effect gravity on the body, you can add load to the body. Another way in which gravity can be used is by understanding the body's orientation to gravity.  If you are standing, the way the body deals with gravity is very different to the way it will deal with it being prone in a press-up position.  The main reasons for doing this is to load different muscles/movements or to change the difficulty level of an exercise.  For example, to load a press-up pattern in a case when floor press-ups are too intense you can change the orientation to gravity by raising the hands. You can do this all the way up to a wall press-up where the forces are minimal.

Strategies for Using Ground Reaction Force(GRF) in Rehab

Ground reaction force can be used to regulate the intensity of the exercises. GRF is a great way to adjust the intensity of the amount of force exerted on the tissues as per the demands of different body systems.

If something is very acute or if low stress is required on the systems you can position the patient (in stride stance for example) and then they will simply rock back and forth to create the small reaction that is required.  For example, right foot forward and rocking the right knee back and forth creates a small front foot load.

For more progress the patient will have to deal with more GRF.  A simple progression might be from the above rocking to 3D lunges in a small range (a few inches) from this right foot forward stance.  Then maybe lunges from neutral stance. Then step to balance, tweaking the range height and speed to alter the GRF and therefore the intensity of the exercise.

You can finish off with jumps and hops, after which the patients can resume their normal activities.

Strategies for Using Mass and Momentum in Rehab

Creating authentic motion in the body is very important and using the mass and momentum of one body segment to drive motion in another is the best way to achieve that.  

The most common drivers that can be used are either hand drivers or leg drivers.  These are really easy to use as the patients get it really quickly and can tweak the intensity easily by adjusting the angle, height, range, speed, etc of the driver.  The advantage of using drivers is that you can empower the patients by getting them in control of the intensity and also you can keep them on the threshold of their ability, which is the best way to maintain progression.

Subconscious drivers are also very useful in many situations and are preferred by many physiotherapists. 

If you want to create a reaction in the thoracic spine for example, and you want right rotation, a nice easy way to do this is to ask the patient to drive the left hand into right rotation at shoulder height.  This means the patient isn’t thinking about their thoracic, but is getting lots of right rotation.

You can use any segment to create the motion, also use the knee, shoulders and head fairly regularly.  It is this freedom of creativity that really allows you to help each individual patient in a way that suits them.