In this article I am going to explain how this one equation guides my approach to rehabilitation and also give you a few secrets into how we get Gold Coasters pain free in record time.

There are actually two reasons why I am going to share this. One is that recently a good friend and colleague of mine, Paul Nash popped into my Burleigh Heads training facility and asked me how I would approach the rehab of the forearm or thumb. After treating him with a bit of Active Release Techniques (which Paul does also), I did not quite get round to delving into the finer points of what I would use for his rehab. As a bit of background, Paul is the head of remedial massage for the Brisbane Broncos & Queensland Reds and also has his own practice in Brisbane. So his forearms and thumbs get a fair bit of work especially dealing with the bigger rugby league and union lads. The other reason is that I gave a small seminar about back pain and poor posture in my Burleigh practice on the Gold Coast last weekend and we got such good feedback I thought I would throw some of the information to all my readers. 

Now when you think of with rehabilitation, you always have to take into account this one law.

It is called the Law of Repetitive Motion is a great way to start thinking of how chronic injuries occur. I first learnt of it from Eric Cressey and Mike Robertson and furthered my understanding of it when I completed the Australian Active Release Techniques courses. The law gives us a number of proven options to start rehabbing those nagging painful injuries. This is the law:

Now for some definitions. ‘I’ is the insult or injury to the tissue. Although technically any time we complete any activity, we will have some insult to the tissue. However it is only after the insult crosses a certain threshold point that it starts to cause pain and becomes a chronic injury or pain. Before I give you the breakdown of what the other factors are, just remember we want to make the left side of the equation as small as possible. Meanwhile we also want to make the factors on the right side of the equation as great as possible to lower ‘I’.

‘N’ is the number of repetitions the tissues have to put up with. For example this may be sitting at a computer typing. Here you are completing the same movement over and over again with the fingers, which is akin to doing thousands of repetitions. Also by sitting in the same position with poor posture means there is a constant activation/length of muscles that is also comparable to a high amount of repetitions. In Paul’s case, it is constantly working his magic on NRL and Super 14 players that will make ‘N’ so high. Now simply by reducing ‘N’ or the amount of repetitions, you will improve ‘I’. So rest will work. But this is nothing groundbreaking right? However, if you can also redistribute the load by changing the repetition technique, this will also reduce ‘N’. 

Have a look at the following two dumbbell bench press videos and you will see what I mean. The first video shows us how trainees typically perform a dumbbell press in a typical Gold Coast gym and the second shows us how we perform them in the Burleigh Heads CCPC training facility.

 

Now this simple technique adjustment has just redistributed most of the load and will reduce ‘N’ (and therefore ‘I’) in most trainees with shoulder pain. This highlights the importance of getting a qualified personal trainer or exercise physiologist to check up on your technique.

‘F’ stands for the percentage of maximum force you are applying during the repetitions. Basically the weaker your tissue or muscle is, the greater ‘F’ will be and the more likely the tissue will get injured and re-injured. This is why resistance training is so important in achieving a complete rehabilitation. Simply by making the tissues stronger, you will reduce ‘F’ and therefore have less insult or injury. Now this works even if the injured tissue is not the cause of the problem. Take for example rehabbing chronic hamstring tears. Now a regular cause of this problem could be a lack of gluteal function and/or restricted psoas and hip flexor muscles. So in most hamstring rehab cases, you would focus some of your time to addressing those issues along with soft tissue, dynamic flexibility and mobility work. However if you just complete hamstring training by working them as knee flexors (e.g. a hamstring curl) and hip extensors (e.g. back extensions, Romanian deadlifts) you will increase strength and reduce ‘F’. This in turn will improve the incidence of hamstring tears. 

With Paul’s forearm and thumb issues, I have thrown a couple of training exercises below that will improve his symptoms. Why? They all improve the strength in the affected structures and if their strength goes up, then the percentage of strength (‘F’) he needs to complete the same tasks as before goes down.

 

The third factor in the equation ‘A’ is the amplitude of the repetitions. This is the range of motion each repetition goes through. If ‘A’ is small, then insult or injury in turn will be high. 

Take carpal tunnel syndrome for instance. As most of us know, constant typing can cause this syndrome. Now hopefully you have been following where we have been heading with this. With typing there is a very high ‘N’ and a very low ‘A’ – basically the fingers move through a tiny range of motion over and over again throughout the day. This is exactly the opposite of what we want with the law of repetitive motion. Now if we were to increase the range the fingers moved through while they typed, the incidence or severity of carpal tunnel syndrome would be diminished. There would not be as many words typed each day but this small adjustment would help them be able to keep workin. This is a alot better than having surgery and spending 6 months in rehab don’t you think? 

You also need to consider ‘A’ with exercise technique. Which of the following squat demonstrations has more or less amplitude?

 

Based on our law, the full squatter (Gold Coast athlete Melissa Howard) is less likely to be injured simply because the range of motion is greater than the parallel or half squat. Why? Remember we want the right side of the equation (including ‘A’) to be as high as possible. So if the amplitude if movement is greater then insult will be less. Don’t believe me from years of being brain washed by an inept fitness and personal training industry? Full squatting is actually confirmed in the good research literature on squat technique to be far safer (and much more beneficial) than parallel squats.  

Lastly ‘R’ is the relaxation time or rest between those repetitions. This is one of the reasons why resting works. Case in point - if you have back pain, a doctor will tell you to simply rest for a week. And this has been proven to work (it will bring the symptoms back under threshold) although it almost definitely does not fix the underlying issue. Another factor you need to remember is that although rest is crucial for a banged up joint or muscle, sometimes it is a lot more advantageous to again redistribute the load (as we mentioned with ‘N’). The big advantage of this is that hypoxia due to lack of circulation in the injured tissue is not prolonged. Hypoxia or the lack of oxygen in the tissues is one of the primary reasons for adhesions or scar tissue developing after an injury. In fact maybe the biggest benefit of Active Release Techniques is simply the increase in circulation and increased oxygen levels in the tissues from the treatments.

Although this is can be a simplistic view, I hope the law of repetitive motion helps you understand how we should approach chronic injuries a bit better. If you want to know more about our Burleigh Heads based rehabilitation services, have a look here.