Every person struggling with pain or an injury must progress through the six-step Capitol Rehab Sequence.
The six-step rehab sequence will efficiently move you from injury to wellness. Understanding the relationship between the six steps not only helps you understand why you may not be improving as you had thought you would once you got over an injury, but it will also lay out the dynamic relationship that must exist between your medical doctor, your chiropractor, your physical therapist, your massage therapist, and your personal trainer.
The six-step Capitol Rehab Sequence is how we handle all our patients to ensure that rehab is not just about getting back into action after an injury, but about restoring the body's natural, healthy movements and making sure that your body can function at its best performance on a regular basis. Understanding this sequence will all but eliminate the frustration and questions people have about injuries, recovery, and where they are in the wellness process.
First, however, to perform the sequence correctly, we start at Step 0. The Capitol Rehab Sequence assumes that "red lights" have been ruled out. Red lights are things like fractures, infections, tumors, and dislocations. This is where a proper exam, sometimes including specialized tests, are utilized to rule out very serious injuries and illnesses that can not be fixed by a rehab plan. This step is not listed in the rehab sequence because it isn't a treatment, but rather the prudent initial step of making a correct diagnosis.
STEP ONE — REDUCE INFLAMMATION: The use of medications, anti-inflammatories, ice and heat, electrical stimulation and other physical therapy modalities are used in this step. It is critical to first control and manage inflammation before proceeding further.
STEP TWO — INCREASE JOINT MOBILIZATION: This step is where chiropractic care is king! When we speak of mobilizing or moving fixated and stuck joints, I explain it this way: Imagine you had a dislocated shoulder, what would be the very first thing you would want your doctor to do? Of course, it would be to set the shoulder joint back in place. Similarly, when we find joints of the spine and elsewhere that have become disrupted, we need to correct joint movement. Doing so alleviates some of the muscle spasm as well as turns on some of the weak muscles that may have become inactive as a result of the dysfunctional joint. Mobilizing joints with a chiropractic adjustment has been shown to drastically stimulate the central nervous system. Doing so starts the process of turning on weakened muscles and relaxing spastic and overactive muscles.
STEP THREE — REDUCE TIGHT OR OVERACTIVE MUSCLES: This step is why I am such a big advocate for having a good sports massage therapist. Overactive and tight muscles often present as scar tissue. Scar tissue is more sensitive, more likely to reinjure or re-tear, and less durable than normal tissue. So a scar tissue in a muscle can't be stretched, it needs to physically be broken up. Useful modalities include Active Release Technique, Dry Needling, Cupping, and Graston. Now that we have reduced inflammation and improved joint function, addressing these overactive and irritated soft tissue areas is the next step in the process.
STEP FOUR — IMPROVE MOTOR CONTROL: We call this "brain training." Some chiropractors and medical doctors do work in the area of introducing rehabilitative movements, but this space is really owned by the physical therapists. Functional Rehab can't exist without re-training the body to do what injury may have caused the body to forget. Think about a person who injures his lower back, and then notices a loss of core strength and flexibility afterwards. Improving motor control is re-teaching the brain to coordinate the body's movements. This type of exercise often looks and feels different than what you would typically do in a gym workout. Brain training requires repetition — thousands of repetitions. The research shows it takes between 3,000-5,000 repetitions before your brain has learned how to perform a movement automatically. Motor control happens once your brain has learned how to automate that movement.
STEP FIVE — INCREASE SPEED OF CONTRACTION: Think of the person who "twists" her ankle and notices a loss of balance as a result. Speed of contraction is how quickly your body responds to a change in environment. We can think of it as proprioception or balance training. A good physical therapist will incorporate proprioceptive training into the rehab process. Balance training, unlike strength training, DOES NOT require gradual improvement over time, balance training is much more like "turning on a light switch." When your body remembers how to balance, the improvement will TURN ON, and it will stick with you.
STEP SIX — MASS MOVEMENTS: Mass Movements would be what people associate with exercise. Going to the gym, yoga, pilates, Kettlebell classes are forms of Mass Movement training. Mass Movements is the last step of the six-step Capitol Rehab Sequence. It is significant because resuming exercise is often incorporated way too soon for people trying to recover from injury. Capitol Rehab's Mass Movement program is directed by our physical therapists and is perfect for the person who wants more direction and confidence in developing a safe and effective exercise program.
Follow the steps above and you will see a smooth path towards recovery.