Many key components are inherent in a successful functional progression program. Since the program above all else has to be designed for a specific person, following one preset guideline or functional progression cannot be recommended. Therefore, it is important in this chapter to briefly review some of the key components in the rehabilitation process and the process of using and applying functional exercise progressions, and then introduce in the following chapters a detailed series of functional progressions, with supportive evidence and background information in anatomy and biomechanics, to empower the reader to develop his or her own progression for successful applications.
The continued monitoring of the signs and symptoms of the patient during the functional progression is of critical importance for the success of any progression. This forms the basis for the rate and frequency of the progression of the program. Some of the key signs and symptoms are introduced in chapter 1 but are so important that they warrant repeating. For example, the presence of intra-articular swelling is one factor of critical importance in virtually all rehabilitation and functional progressions. Although it may be somewhat joint specific, intra-articular swelling can be palpated and measured or clinically observed in several key joints throughout the body. Swelling about the knee and ankle, for example, is easily monitored and in lower extremity progressions can be an extremely valuable marker for clinical progression. In other joints such as the glenohumeral and coxofemoral joints, swelling is much less noticeable and does not play a major role in the screening process. Progressing exercise and activities in the presence of joint swelling is contraindicated and clearly not recommended.
Other signs and symptoms that often occur with or without swelling are joint pain, significant muscular fatigue or loss of control, and decreased joint motion. The presence of any of these in isolation or combination slows down the functional progression. Using visual analog scales (VAS) or simply asking the person to rate his level of pain, fatigue, or improvement using a scale of 0 to 10 can help put an objective slant on otherwise subjective perceptions of the person’s function and feelings during the progression.
The concept of continuous progression is apparent to most, but it is often not adhered to in many suboptimal programs. It is difficult and often encumbering to initially design the functional progression program. Continuing to adjust and progress the program, however, is required to successfully progress the person to optimize gains in strength, motion, and function. Frequent and periodic reevaluations of function as well as consistent monitoring of performance are required to allow continuous progression of the program once initiated. Each of the subsequent chapters on the upper and lower extremities and the trunk will outline specific progressions, complete with information about the methods commonly used and recommended for progressing the program. These form the basic elemental aspects of a functional progression program and can include increases in volume, frequency, duration, and of course exercise intensity.
This key concept highlights the need to balance specific training with the required basic progressions to ensure that optimal baseline strength, coordination, and other important factors remain present throughout the progression. To best illustrate this concept, here is a specific example. When a throwing athlete returns to pitching after rotator cuff tendinitis, baseball-specific progressions are used, including throwing drills that progressively increase the intensity and distance of the throwing motion as well as progress from throwing on flat ground to off the mound. Although this sounds like a very sound progression for a baseball pitcher (and from a throwing perspective, it is), failure to address rotator cuff and scapular strengthening—which for all intents and purposes may appear to be too basic—will likely result in inadequate emphasis on those important muscle groups and lead to muscular imbalance and suboptimal recovery. Additionally, ignoring core stability training and hip strengthening progressions during this return program would also be remiss because these programs (rotator cuff and scapular program, core stability, and hip strengthening) form the basis on which the functionally specific program can progress.
This example highlights the importance of combining sport- or activity-specific programs with more-basic programs to ensure strength development and muscular balance. Other examples include the continued emphasis on quadriceps strength development in the patient while cutting and running drills are concomitantly being progressed to ensure that this important muscle group is continuing to develop during the sport-specific progression. The basic progressions supplied in this book for key muscle groups, and concepts such as core stability, scapular stabilization, and rotator cuff strength, cannot be forgotten or deemphasized once the other sport-specific functional progressions are initiated.