Whiplash Trauma and "New School" Isometrics

When I was in chiropractic college more than 25 years ago, I was taught to use isometric exercises for whiplash trauma recovery. The technique was pretty simple: Place one hand on the back of your head and push the hand and the head against each other. Keep the neck in a neutral position and don't let the head move backward. Build up to tension in 2 seconds, hold the tension for 6 seconds and gradually relax over 2 seconds, and then repeat for 10 reps. The exercise was also performed in flexion, rotation and lateral bending.

This form of exercise involves the static contraction of a muscle without any visible movement in the angle of the joint; the length of the muscle does not change. We'll call that technique "old school" because the old German model (Hettinger and Muller) of 6-second actions was used in the original experiments and was adequate for strength gains, but was insufficient to cause hypertrophy in muscles. If you were looking to get big, this was not the technique.

In a rehabilitation practice, it is not our job to train muscles for the sole purpose of making them bigger. The contemporary approach is to help train clients to improve movement patterns. Patients notice benefits to strength and power of "movements" - this is called "functionality." Functional training is any training that improves the ability to perform a target activity.

Enter "new school" isometrics or maximal intensity isometric training (1-5 reps with 90 percent to 100 percent of your max), using sets lasting 20-120 seconds. This will stimulate strength, endurance and hypertrophy. This technique can be used in the early stages of rehab and then combined with repetitive-effort isotonics (6-12 reps with 70 percent to 90 percent of your maximum).

As an example, consider a patient who was involved in a rear-end motor vehicle accident. We'll say this patient is a 50-year-old female who sustained an injury to her neck, her right wrist is splinted due to carpal sprain, and she is deconditioned. In this case, there are numerous advantages of starting with isometrics in her rehab, along with a few disadvantages:

Isometrics: Advantages and Disadvantages

Advantages

• An injured or immobilized extremity can be tensed while in a cast or in a splint after the immediate pain has subsided.
• Ideal for people with no exercise experience.
• Can be used early in a rehab program.
• Great way to teach proper biomechanics.
• Helps prevent muscle and strength losses.
• Achieves maximum muscular contraction and increases strength faster than any other form of training.
• Builds strength in isolated areas or muscle groups without moving the joints (It may increase muscle size and develop more efficient muscle contractions).
• Works muscles with more intensity in a shorter period of time.
• Prepares the musculoskeletal system for more advanced activities.
• Increases neurological strength, recruits more muscle fibers for each movement.
• Good for enforcing movement patterns (especially in youth).
• Isometric workouts can be fast and can be done anywhere.
• Safer than conventional training (doesn't involve movement).
• Dramatically improves conventional training; improves lifts by as much as 14 percent to 40 percent.

Disadvantages

• Potential of reducing muscular endurance. (Progress patients to isometrics to avoid this.)
• Potentially reduces speed of muscle response, which will slow you down.
• Generally boring to perform.
• Increases blood pressure, which could lead to ruptured blood vessels or irregular heartbeat.
• Strength gains achieved occur only within 20 degrees of the angle; there is approximately a 10-degree overflow on each side of the muscle fibers being used.

This "everything old is new again" program still encourages active participation of the patient during recovery, provides patient education on proper posture and body mechanics, highlights proper nutrition, and teaches corrective exercise therapy the patient can do at home on her own.

Isometrics and Resistance Testing

Isometrics can easily become part of the exam process itself. You can test what you want to test and the tests are reproducible. The test and the exercise can involve the length of time the patient can hold a pose. As strength increases, time under tension will improve and this becomes an objective finding. For example, resistance in isometric exercises typically involves contractions of the muscle using the following (the neural patterns used in #2 below may have a bigger impact on concentric strength and #3 below on eccentric strength and muscle mass):

1. The body's own muscle (e.g., pressing the palms together in front of the body at varying heights).
2. Fixed structural items (e.g., pushing against a door frame). You can push or pull against an immovable resistance (e.g., pushing against the pins in a rack). Thus, there is no actual external movement while you are attempting to move the resistance.
3. The use of free weights, kettlebells, weight machines or elastic tubing (e.g., holding a weight in a fixed position). Hold a kettlebell weight in your hand with the weight at your side. Your objective is to prevent it from going down and avoid shifting your posture. Once again, there's no external movement; however, your intent is no longer to move the load, but to prevent its movement.
4. Pressure-type equipment that has a digital readout of maximal force (grip strength).

"Static hold" isometric exercises can also be included in patients' isometric routines. For example, during a set of rows, I have some clients hold their shoulder blades together when the handles are closest to their chest to "squeeze" the interscapular muscle in an effort to further strain the muscle. Depending on the goal of the exercise, the exertion can be maximal or submaximal.

A Treatment Plan Based on "New School" Isometric

Let's create a treatment plan for our 50-year-old patient involved in a rear-end motor-vehicle accident using "new school" isometrics. Here are some beginning exercises I use for cervical spine rehab patients who are deconditioned:

Stability Ball Bridge

• Head and upper back on a stability ball.
• Torso in a "table top" pose.
• Contract the gluts to create a bridge.
• The glutes should be the primary muscles recruited (also some abs and quads).
• No low back discomfort and no hamstring cramps.
• As the patient progresses, they can keep their head off the ball.
• Build up to holding each "squeeze" from 10 seconds to 30 seconds. Perform five reps.

Supine Gut Contractions

• Supine position, legs extended.
• Contract the glutes to create a bridge.
• The buttocks should be the primary muscles recruited.
• No low back discomfort and no hamstring cramps.
• Maintain the cervical spine in various angles of slight flexion and extension.
• Build up to holding each "squeeze" from 10 seconds to 60 seconds. Perform five reps.

Sustained Wall Sit

• Back/shoulders/head flat against wall.
• Hip/knee/ankle flexed to 30 degrees. Progress to 60 degrees and then 90 degrees.
• Progress to one-leg wall sit.
• Maintain this position and add wall angels.
• Build up to holding the wall sit pose with the thighs parallel to the floor for 2 minutes. Perform one rep.

Sustained Plank (Isolates pecs and core)

• Use two 25-pound kettlebells or stands that are about 18" off the ground. (Push-up bars work great.)
• Slightly wider than shoulder-width apart.
• Hands below the nipple line.
• Keep back flat and cervical spine in neutral.
• Keep body/torso in alignment.
• Build up to holding the plank for 1 minute. Perform two reps.

Upper-Body Arm Hang (Advanced)

• Pull up on the bar and keep eyes horizontal to bar.
• Hand/wrist in neutral position.
• Elbows at 90 degrees.
• No movement in body.

Anterior Abdominal Wall

• Supine, knees bent; strap legs in while leaning on bolster.
• Must keep the ear/shoulder/hip in alignment.
• Remove support.
• Time begins when position can be maintained.
• Make sure the lower back does not hyperextend and the cervical spine stays in neutral.

Other testing and exercise examples include: sustained side bridge (right and left)), sustain V sit (test) and sustained back extensor (test). Patients enjoy it when I instruct them to hold a weight at a certain position in the range of motion and time them for form; for example, holding a "heavy" kettlebell statically in the "rack" position (thumb pointing to the clavicle with the elbow into the body) for a certain amount of time. They then progress to walking around with the kettlebell in the rack position while maintaining good posture. The next progression is holding the kettlebell overhead and walking around. This builds core strength.

Other exercises include pushing or pulling against an immovable external resistance (e.g., heavy-band pulls/pushes). I try to get patients to hold the pose for 10 seconds and then 20 seconds, eventually getting to 60-plus seconds. Example exercises using bands or kettlebells include the following:

Overhead Reaching

• Use a band with handles.
• Stand in a staggered leg stance.
• Grasp the handles at shoulder height with elbows bent.
• Brace your abdominals as you push the band (tubing) upward, extending the elbows.The arms are angled in front of the ears.
• Maintain proper cervical posture (do not allow forward head).

Overhead Pressing

• Double-leg stance.
• Grasp the handles at shoulder height with elbows bend.
• Brace your abs as you push the tubing upward, extending the elbows.
• Arms are hiding the ears (the movement is straight upward).
• Maintain good cervical alignment.

Diagonal Lifting

• Wide stance.
• Grasp the handle with both hands.
• Begin at the left knee level and rotate your trunk to the right.
• Continue to look at the handles as you lift your trunk and rotate upward and to the right.
• Stretch the tubing across your body.
• Keep the elbows straight.
• Keep your eyes and head turned upward.

Diagonal Chopping

• Wide stance.
• Grasp the handle above your shoulder by extending and rotating your trunk.
• Continue to look at the handles as you pull the tubing downwards.
• Rotate and bend your trunk.
• Stretch the tubing across your body.