Sensory Practice #4: Graded Movement
Our final stop on moving beyond healing to a place where we realize that we are already healthy and whole, is beginning to add graded movement.
Adding movement judiciously after a sensitization event (such as a trauma, illness or recent injury) is the most important step in educating your sensory system and the tissues in your physical body (muscles, ligaments, tendons) about what to expect and how it will be used in the future. It is a crucial phase in our healing process.
If you are dealing with a medical condition, please know that this is not a DIY project and requires care and guidance by a medical provider.
If you are healthy and well and looking to gently expose yourself to more movement, start by asking yourself what it is you want more of (from a functional stand point- function relates to movement).
Maybe you want to be able to walk more? Or hike farther? Maybe you want to lift your bags more easily when traveling?
The sky is the limit with the questioning, but allow yourself only one answer (it can be really tempting to want 10 things, but that’s just being a bit greedy!)
Graded movement is something that makes our Practical Strength program unique- it is why I separate foundations from progressions classes and why I do not have drop ins to our classes.
Grading movement accurately is a unique skill of occupational and physical therapists and it is something that personal trainers and many folks teaching movement, might not have insight into.
I have personally dropped in on yoga classes that requested I do 50 surya namaskaras or bootcamp classes that asked me to do 50 burpees or 150 jumping lunges (after not having done any), and I can tell you from first hand account- that kind of excessive output when you haven't trained for it is always a bad idea.
The body needs to be ramped up into activity. Your muscle needs time to grow. Bone and ligament need time to adaptively stiffen into the direction of use so that you can perform safely.
Graded movement relies on movement gently progressing in muscular demand, proprioception and neuromuscular complexity.
A simple and effective way that I like to introduce graded movement in our classes is through the following progression:
1) Non weight bearing (exercises done on the ground) isometric activities (without actively moving a body part through range)
2) Non weight bearing active motion (eventually resistance can be added)
3) 2 limb weight bearing isometric activity
4) 2 limb weight bearing active range of motion
5) 1 limb weight bearing isometric activity
6) 1 limb weight bearing active motion
7) Plyometrics/ added resistance via weights
This progression allows folks to gently move through stages of healing and strength in a logical, step wise fashion. When I started employing these techniques in the clinic, I noticed that clients had far fewer flare ups and were able to move up in strength.
Remember that strength takes about 6 weeks to develop in a best case scenario! Give yourself time to transition through these phases.
Let’s use this model of graded movement to examine a common goal of returning to run. I have just progressed myself back through these activities as I resume jogging following my ankle fracture October 1, 2021.
Let’s also presuppose for our example that you do not have a medical condition that would limit your running.
Take stock of how much you are currently doing- and be honest.
Maybe you notice you are walking for 10 minutes, every other day.
Next, check in with your strength. Running is a plyometric activity- so your strength foundation should support a #7 activity level. Are you able to do 20 single leg body weight squats (#6 on the above list) with great form? Are you able to do 20 single leg heel lifts (#6 on the above list)? Are you able to do 3 sets of 30 double and single leg hops (a beginning #7 activity)?
If the answers to the above is yes, please proceed with the following. If the answers to any of the questions are no, you are not yet ready to resume jogging. Please refer to the numbers above to find your appropriate activity level, and meet yourself there while you work on building up walking.
Let’s say you’ve given yourself the green light. First, start by ramping up slowly. Maybe add 5 minutes to your walk. Then Try to walk 4-5 times per week instead of three.
As you ramp up activity, check in with your body- how is your recovery? How are you sleeping?
A good rule of thumb, is to ramp up activity no more than 20% even when you are responding very well.
Gently progress from walking to jogging. Maybe at first you jog 1 minute every 5 minutes, in your 20 minute walk.
There are wonderful return to run programs you can find online. My favorite and the one I use most often, can be found here.
Assess your progress and take care of yourself as you continue. If you encounter pain, swelling, your cues that your tissues may not have been ready for the level of activity- hold back a little.
The goal here is to keep calm, carry on, and not do anything too quickly. You are supporting the evolution of your tissues and the return of healthy sensitization in your sensory system- to make it gradually more robust and resilient. If you do too much too soon, you will end up with inflammation, sensitization and you will need to give yourself more time to recover. Even when you encounter these boundaries, it does not mean that overdoing it has re-injured tissue. It simply means you have encountered your limit.
For more information on healthful, graded and safe movement, check out our Practical Strength Foundations classes, starting back up in the new year.
Until then, may you move beyond even healing to an understanding that you are already healthy and whole.
Happy New Year!