We have previously gone over many methods and indications for utilizing repeated motions, especially pain and mobility. Something that can be overlooked however is the effect it can have on muscle strength. I recently had a patient who I was treating for "hip OA." As is typical, the patient actually responded well to repeated lumbar extensions, improving her hip mobility, strength and pain. It wasn't until a couple weeks later the patient reported she experiences "drop foot" after walking approximately half a mile and it had been going on for years. I instructed the patient to perform her repeated extensions before her walk. The following appointment she reported no drop foot at all.
There are a couple things that I want to review here. First, while it is important to do your repeated motions HEP hourly (or more!), it is essential to perform them prior to any "fitness" training. The activities challenge our bodies more than normal, so our deficits can become more pronounced typically. I used to experience my sciatic neural tension only when running, but it could be prevented with sideglides. If we don't try and reset our bodies prior to exercise, we may actually be reinforcing the dysfunction. Second, never dismiss our potential effectiveness in treating chronic injuries. You will encounter patients that have been experiencing a pain, or in this case a weakness, for decades that become fast responders to repeated motions. Finally, a weak muscle may not be secondary to local atrophy. Pay attention to muscles that don't seem to improve in strength. Muscles may test weak only because of spinal inhibition. Whenever you evaluate a patient with an extremity deficit or pain, check for spinal mobility restrictions as a sign for potential contribution.
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