Patients with acute and chronic joint conditions respond favorably to inexpensive elastic tubing rehabilitation
Rehabilitation of all types of joint problems—acute injuries, sports-related, and degenerative conditions—is at a crossroads. Economic pressure from managed care is combining to place more emphasis on cost-effective solutions. The high-tech and high-cost approaches are constantly being questioned with more focus on home-based programs. However, handing out exercise sheets has not been found to be very useful, especially when accompanied by minimal instructions. These developments have resulted in a search for easy, safe, and effective methods of exercise training for joint problems.
Casing the Joint
The healing process and types of rehabilitation needed are similar for joints in different anatomic areas of the body. Current literature shows the advantage of early, progressive rehabilitation exercise for many types of joint conditions.1-3 These benefits include restoration of range of motion (ROM), decreased pain and swelling, decreased neural inhibition, quicker return of muscle function, and improved performance in sports and all daily activities. Early rehabilitation programs may reduce the number of joint reinjuries.4 - 6
Newer concepts in joint rehabilitation emphasize functional activities and retraining of normal loading and movement patterns. It is especially important to regain full neurological coordination of the surrounding muscles and connective tissues, which are the true source of joint stability.
The proprioceptive input from receptors in the muscles, connective tissues, and joint capsules is different between the supine and prone positions. This is why it is so important to bring joint rehab exercises closer to real-life positions, and it also explains why patients make rapid progress when taught to exercise in a functional position.
Do exercises done on the floor, on a weight bench, or constrained by a machine train muscles and joints to function better during daily or sports activities? The neurological patterns developed on the floor or in a pool provide some improved joint function during upright demands. However, learning new skills and movement habits in a machine does not generally translate to better functioning during independent, usual activities or improved sports performance. Additionally, for most, it is difficult and expensive to get patients into a facility with machines or a pool to exercise.
Totally Tubular
Figure 1. Posterior translation exercise (pelvis).The frequent use of exercise tubing is an important component of regaining coordination. Elastic tubing allows patients to exercise in a weight-bearing, functional position that has been shown to be safe and effective.7 Another benefit is its simplicity of use. In addition to being focused and practical, upright exercising trains and strengthens joints to perform daily activities. Patients are receptive to exercises that clearly prepare them for function during normal activities. A good example is the use of the posterior translation pelvic exercise (Figure 1). Using double elastic tubing allows a patient to perform a pelvic slide exercise with resistance while standing. This maneuver helps to correct for an anterior translation postural distortion.
The usual methods of shoulder joint rehabilitation have focused on the use of resistance exercises to progressively strengthen the rotator cuff and all the muscles that move the shoulder joints. Traditionally, expensive machinery that isolated the muscles and controlled the speed of movement was thought to be necessary. Recently, elastic tubing has been found to be a safe and an effective method of providing progressive resistance exercises.8
Figure 2. Extension exercise (shoulder).An easy and often-used program starts with a consistent isotonic exercise routine using a single band of elastic tubing (Figure 2). This is initially performed within a limited, pain-free ROM, building to full range as pain subsides. Eventually, the entire series of shoulder exercises should be performed. This inexpensive rehabilitation program should be practiced initially under supervision to ensure proper performance. Once good exercise mechanics and control are demonstrated, a self-directed program of home exercises is appropriate.
Tubing also permits exercises to be performed in diagonal and multiplanar motions, which are especially useful in advanced shoulder rehab for athletes.9
Resistance is Futile
Elastic tubing provides a unique form of isotonic exercise. The actual amount of resistance varies significantly with the amount of stretch applied to the tubing.10 Have the patient begin exercising with some slack in the tubing, thereby ensuring relatively low resistance. As the patient improves, the exercise is performed with less slack, increasing the resistance gradually and safely. Eventually, the exercise progresses to starting with some pre-stretch to stimulate and activate a widespread neurological response to the movement. In this way, most patients are able to advance through their entire joint rehabilitation program with just one exercise tubing design rather than having to purchase several different levels, which is cost-effective.
Exercise tubing needs to be accompanied by a strap device and/or handles, along with an illustrated, descriptive exercise booklet. It should also be packaged with a system for temporary but dependable attachment to a door or wall (such as straps or clips). It can be easily carried on business and vacation trips. In comparison to other forms of resistance exercise, such as weights with pulleys and machines, the cost is minimal.
Exercise tubing has been used extensively in home-based exercise programs for older adults.11 An additional benefit is being able to customize sports equipment with elastic tubing to provide sport-specific joint rehabilitation. A closely monitored home exercise program using exercise tubing allows the doctor of chiropractic to provide cost-efficient, effective, and specific rehabilitative care.
About the Author
Kim D. Christensen, DC, CCSP, DACRB, founded the SportsMedicine & Rehab Clinics of Washington. He is a postgraduate faculty member of numerous chiropractic colleges and the president of the American Chiropractic Association (ACA) Rehab Council. Christensen can be reached at Chiropractic Rehabilitation Consulting, 18604 NW 64th Ave, Ridgefield, WA 98642 or via email: kimdchristensen@hotmail.com.
References
1. Lill H, Korner J, Rose T, et al. Fracture-dislocations of the elbow joint—strategy for treatment and results. Arch Orthop Trauma Surg. 2001;121(1-2):31–37.
2. Carpenter DM, Nelson BW. Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exer. 1999;31(1):18–24.
3. Wolfe MW, Uhl TL, Mattacola CG, McCluskey LC. Management of ankle sprains. Am Fam Physician. 2001;63(1):93–104.
4. Barkler EH, Magnusson SP, Becher K, et al. The effect of supervised rehabilitation on ankle joint function and the risk of recurrence after acute ankle distortion. Ugeskr Laeger. 2001;163(23):3223–3226.
5. Holme E, Magnusson SP, Becher K, et al. The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain. Scand J Med Sci Sports. 1999;9(2):104–109.
6. Cleeman E, Flatow EL. Shoulder dislocations in the young patient. Orthop Clin North Am. 2000;31(2):217-229.
7. Glasoe WM, Allen MK, Awtry BF, Yack HJ. Weight-bearing immobilization and early exercise treatment following a grade II lateral ankle sprain. J Orthop Sports Phys Ther. 1999;29(7):394–399.
8. Roy S, Irvin R. Sports Medicine: Prevention, Evaluation, Management, and Rehabilitation. Englewood Cliffs, NJ: Prentice-Hall; 1983:195.
9. Kibler WB, McMullen J, Uhl T. Shoulder rehabilitation strategies, guidelines, and practice. Ortho Clin North Am. 2001;32:527–538.
10. Hughes CJ, Hurd K, Jones A, Sprigle S. Resistance properties of Thera-Band tubing during shoulder abduction exercise. J Orthop Sports Phys Ther. 1999;29:413–420.
11. Mikesky AE, Topp R, Wigglesworth JK, et al. Efficacy of a home-based training program for older adults using elastic tubing. Eur J Appl Physiol Occup Physiol. 1994;69(4):316–320.
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