Movement Regressions and Physical Therapy Exercise

Knowing how and when to make a movement easier or more challenging is a crucial skill for physical therapists. Your client’s recovery is based upon your ability to help them succeed via appropriate exercise recommendations. Give someone too much, too soon and they will feel frustrated with their lack of progress. Give them too little and their gains will be minimal.  For this article, let’s talk about the ways to use skill regressions in your physical therapy home exercise program handouts.

First of all, what is a movement regression?

A movement regression is an easier variation of a desired skill. Think of it as an alternative that helps someone progress toward the movement goal.

As an extreme example, consider someone who wants to be able to perform a one arm chin-up. To get to that point, there are a variety movement benchmarks that he or she needs to unlock before doing it. They must be able to do a regular, two-arm chin-up. They need to be able to hang by one arm, at both the top and the bottom of the chin-up. They also need to be able to control a smooth eccentric motion, back to bottom starting position.

Without being able to perform these regressions, there is little chance that someone could perform a one-arm chin-up unassisted. The regressions are fundamental to the movement. Jumping up to try a one-arm chin-up without mastery of the regressions, would be putting the cart before the horse. It could also be dangerous and cause harm to the athlete.

So, why is it important to include movement regressions in your physical therapy home programs? Let’s take a look at a few reasons.

Reflect on a day in your busy schedule. Think of all the times that someone has struggled with a new movement that you introduced to their plan-of-care. Perhaps they lacked the flexibility to obtain the start or end position. Maybe they lacked the strength to control the movement effectively. Maybe they lacked the motor planning to perform the movement with grace.

In each of these cases, it is natural to wonder how you might modify the movement to help someone have success. Of course, you are going to address any strength or mobility deficits that are causing the limitation. You should also be thinking holistically in terms of what other movements might mimic the overall skill that you are going after. These alternatives are the movement regressions that will help your client the most.

Consider how elderly clients can often struggle to rise to standing from a low chair. What they would like to achieve is an unassisted sit-to-stand. The movement regressions that you might use to help someone in this situation include:

• Elevated sit-to-stand (using pillows or some other height elevation in the chair)

• Double arm, and then single arm assist (pushing off armrests)

• Controlled eccentric chair squats (going from standing to sitting)

These regressions are common-sense, and don’t take that much effort to brainstorm. They are also quite effective. After a few weeks of training these drills, a hands-free sit-to-stand is often not that far off.

What if someone presents to your clinic with the goal of being able to balance on one foot? In terms of movement regressions, you might increase the challenge of regular two-foot stance by having them stand on an airex pad or pillow. In terms of a home exercise program, you could have them work on tandem stance at the kitchen counter. If they are ready for it, you could also have them try balancing on one foot, with the tiptoe of the opposite foot on the ground behind them. That regression is called toenail balance, and is great exercise.

For other movement regressions, think of what other physical therapy tools might be useful:

• You can use a resistance band to provide some assist through the movement. (Useful for pull-ups.)

• You can provide a stop to the depth of the motion with a physio ball or plyo box. (Useful for squats.)

• You can decrease the lever-arm by shortening a limb with joint flexion. (Useful for hip or shoulder flexion.)

• You can provide a counter-balance to the movement by having someone hold a weight away from their body. (Useful for squats, including pistol squats.)

As a movement-based professional, it is your responsibility to understanding what exercise solutions might be best for an individual. What is the right dosage? What is the right intensity? And what, if necessary, is a useful variation to the desired movement skill?

Now, instantly remembering hundreds of exercise variations in your mind isn’t always going to be feasible. There are so many combinations of resistance techniques and movement patterns, that it would take some serious bandwidth to have every single regression memorized.

That is where a high-quality physical therapy exercise software program can be beneficial. A well-designed software platform should minimize the brainstorming needed to create a home exercise program handout. When you search for a desired movement, the software should automatically return the exercise with relevant regressions and progressions. It should anticipate ways in which you might need to modify an exercise for your client.

If you are looking for a squat variation for someone who is struggling with the movement, your HEP software should suggest box squats, counter-balance squats, and other assisted-squats. You should not have to dig too deep to find what you are looking for. The faster you can find a regression that will help your clients, the more time you get to spend with them. It’s all about minimizing your effort, so that you can do what you are best at!

The  current version of the BPM Rx exercise prescription software was built with movement regressions in mind. Significant effort was spent in cataloging and tagging the exercises to match them with your search criteria. You can even add the word “regression” to your search, to help further refine what you want.

Don’t be shy. Take the software for a spin. There is a free 14-day trial to see if you like it.

Here’s to making the world a better place through improved human movement!