Exercise and stretching programs

Exercise and stretching form an integral part of most rehabilitation programs. Exercise helps to increase energy and range of motion, strengthen the muscles, bring blood to the extremities and improve cardiovascular health. Stretching is essential not only for muscle, but for the soft tissue as well. Stretching helps to elongate muscles, increase range of motion, provide flexibility, promote healing and prevent future injury. In the rehabilitation of many sports injuries such as plantar fascitis, shin splints, iliotibial band syndrome to name a few, stretching is recommended.

Exercise can be grouped into four categories:

1. Aerobic exercise
   This is exercise that increases the body's use of oxygen. It is usually of moderate intensity and should last between 20-60 minutes. It should raise the individual's heart rate to 60%-80% of its maximum. Examples of aerobic exercise are running, jogging, swimming.
2. Anaerobic exercise
   This includes strength training with weights. This form of exercise relies on intermittent bursts of energy.
3. Therapeutic exercise
   This is done under the guidance of a physiotherapist or health care professional to improve the rate of healing in muscles, joints and tendons. This may take the form of passive range of motion (where the physiotherapist moves the part) active ROM (the individual moves the part on his own) active assisted ROM (the physiotherapist assists the individual in moving the part) and resistive exercise where the patient performs muscle contraction against resistance.
4. Stretching exercises.
   Stretching exercises improve flexibility and help prevent injury. Examples are yoga, tai-chi and basic stretching exercises.

Other benefits of exercise are:

• It produces a feeling of well being by releasing the neurotransmitters, serotonin and dopamine, which contribute to feelings of euphoria and peace. These neurotransmitters also help increase brain function while performing mental tasks. Many doctors prescribe exercise in place of antidepressants for patients who suffer from depression.
• Exercise can reverse the effects of aging by slowing the deterioration of muscle, brain and nerve functions. Exercise has been proven effective in slowing the rate of dementia and Alzheimer's disease.
• Weight loss. Combining an exercise program with proper nutrition is essential to losing weight and keeping it off.

Stretching

Here are the main types of stretching exercises:

Passive stretch
This is done by the physiotherapist or a device such as a continuous passive machine that can be preset to provide continuous passive motion throughout the joint. Passive stretch increases range-of-motion (ROM) when stretching is not contra-indicated.

Active stretch
This serves the same purpose as passive stretch, but is done by the individual.

Proprioceptive Neuromuscular Facilitation stretch
Popularly called PNF stretching, this type uses movement patterns and posture to initiate voluntary movement, speed of response and strength in weak muscles. It is a combination of passive stretching and holding and is believed to be more effective than passive stretch. There are many variations of PNF.

Static stretch
This type of stretch is done while the body is at rest. The muscles are made to lengthen to the point of discomfort, then the position is held for a few seconds. This is said to reduce tension and relax the muscles.

Dynamic stretching
Dynamic stretching uses momentum to propel the muscles into an elongated state. Used by athletes and dancers to develop speed, power and coordination.

Resistance stretching
The muscle contracts (shortens) and elongates at the same time. Provides flexibility. May be combined with strength training.

To gain benefits from stretching:

• Do not overstretch or stretch to the point of pain.
• Stretching when muscles are warm, after exercise, has been proven to be more beneficial than pre-exercise stretching.
• A low-resistance, sustained stretch is preferred to high-resistance stretch with quick, bouncing movements.
• Use of some form of heat before stretching may enhance stretching.

As beneficial as exercise is, it does carry some risks. These are:

• Beginning exercise after long periods of inactivity can be harmful. Serious injuries to joints, muscles and tendons may result. The key is to first consult your physiotherapist or doctor and let them get you started on a level that is right for you.
• Improper exercise techniques may also cause serious injury. Stretching while muscles are cold can cause injury.
• People who suffer from cardiac problems and other illnesses may be at risk for certain types of exercise.

Exercise and stretching hold many benefits for individuals in rehabilitation, as well as individuals who are only interested in improving overall health and well-being. Physiotherapy can help by providing the tools for individuals to reap the greatest benefits from this activity. We will be happy to discuss these in detail with you.