Chapter 23: Advanced Functional Training

Introduction

Functional training involves developing and progressing exercise programs that improve a patient's muscle performance in order for the individual to regain his or her pre-injury level of function. For those individuals whose goal it is to return to high-level work, leisure, recreational, or athletic activities, rehabilitation must progress to meet the anticipated demands. The process requires that multiple steps be taken that utilize the individual's readiness to progress. For the therapist, it requires a continued process of decision-making that involves:

• A thorough knowledge of the anatomy, biomechanics, and function of the human body.

• An understanding of tissue healing, the effect of time on healing, and the response of tissues to imposed stresses.

• An understanding of neuromuscular responses to various forms of exercise.

• The ability to examine and evaluate the structural and functional impairments that restrict activity and full functional participation within the context of personal and societal expectations.

• Knowledge of diagnoses, surgical and therapeutic exercise interventions, special precautions, and each patient's potential for achieving the projected outcomes.

Rehabilitation begins as early as possible with specific muscle activation and training techniques designed to develop a balance in strength and timing of contractions between synergists and antagonists. Proximal stability is critical for coordinated functioning of the extremities, and therefore, exercises to develop stability and balance are incorporated early into the program as well.

As muscle strength, endurance, and control of the involved region improve (and other goals are met, such as increasing joint mobility and muscle flexibility), greater emphasis is placed on strengthening muscle groups in functional patterns, using both weight-bearing and nonweight-bearing exercises. Care is taken to ensure that stronger muscles do not dominate the pattern in preference to weaker, impaired muscles. As function improves, exercises become more activity specific.

Functional motor skills are composed of an array of movements carried out in various positions, at varying speeds, and for varying repetitions or durations of time. The cornerstone of a functionally relevant therapeutic exercise program is the inclusion of task-specific movements that are superimposed on sufficient stability, balance, and muscle strength, endurance, and power to meet the necessary, expected, and desired functional demands in a patient's life.

It is the purpose of this chapter to describe a variety of advanced exercises for functional training that involve the total body and may be appropriate for the final phase of rehabilitation. The chapter is divided into two sections. The first section focuses on advanced exercises for stability and balance and the second on advanced exercises for strength and power. The choice of exercises to be implemented and progressed is based on the desired outcome for the patient, so the motor skills needed for that outcome are the ones emphasized in the program.