functional training

[Alessandro Mainente]

some days ago i've followe a seminar (wich was the result of an extensive research and study) in my university about the need to use the functional training for the rehabilitation process also in person who suffer of obesity or need to be stronger for future strength elements

the seminar covered only one case of the application of funtional training. btw i had the opportunity to ask to the guy who did the relation about the instruments that were used in this study, he was talking about trx, medica ball and of course gymnatics rings and something more (bar, proprioception tables etc)

he wasn't specific about the exercises but he talked about plank and L-sit progression for some people.

The seminar was offered also in papers so i have copied the biggest and relevant part of the study here, i hope you can enjoy it!

INTRODUCTION

In many popular and professional publications, the

term functional training, 3D training or spatial exercise

is often encountered. Functional training from a clinicalanatomical

perspective and its application in clinical

practice is dependent on a sound knowledge of clinical

anatomy. Functional training highlights a need for furthering

anatomical knowledge in the postgraduate education

of physicians from various fields of clinical practice, e.g.

in sports medicine and physiotherapy.

Functional training is a suitable alternative to power

exercise and stems from rehabilitation and physiotherapy

routines. It is modelled on the basis of the patient’s functional

impairment and muscle function test results. The

aim of 3D training is not only to improve physical fitness

and muscular coordination, it is also recommended for

all age groups in healthy as well as indisposed individuals.

Many of its exercises are based on common everyday

activities which require coordination and fluid movement

to a greater or lesser extent, such as walking, running,

lifting an object, etc. During such daily activities we call

into action many muscle groups, with increased demands

on neuromotor coordination and maintenance of body

posture.

We have been using 3D training in our Pediatric Clinic

for the therapy of obese children. We believe it has wider

application in various clinical fields. However, search of

the traditional medical data bases reveals a dearth of information.

This review aims to provide elementary information

on the principles, roles, methods and applicability

of 3D training.

METHODS

Database search using the lemmatization method

and data bases: Web of Knowledge, Web of Science,

UpToDate, PubMed and Google Scholar for the years

2005-2011. Given the dearth of information in traditional

medical databases, these were available options.

We examined studies that focused on the possibilities

of using functional 3D training in clinical practice based

on implementing the anatomical findings. As this is a

fairly new method, so far not used as standard in general

clinical practice, we were only able to carry out analysis

of a limited number of studies. Our experiences are presented

in a case report which correlates with available

references.

RESULTS

Functional training

Functional training is a synergetic involvement of

several muscle groups simuůtaneously enabling training

that is more productive. The most commonly used tools

for 3D training are: free pulleys, single-handed weights, a

medicine ball, a large ball, exercise bands, imbalance pads,

bags with sand or water, GRAVITY program in rehabilitation

on Power Tower system and the very effective army

navy system TRX- Training Resistance Exercise..

A prerequisite for this training is quality of perceived

movement rather than isolated muscle function. During

activities of daily living, the body does not move in isolated

patterns. It moves as an integrated unit, be it functional

or dysfunctional It strives to create such individual

structure of exercises that help carry out common daily

activities with greater efficiency and lower risk of injury.

At the same time, the training leads to greater muscular

balance and strengthening of the spine stabilization

system; it has positive impact on articular stability and

significantly contributes to preventing musculoskeletal

injuries. Functional training restores and enhances the

way the body performs everyday physical activities and

memorizes such muscular functions.

All these muscles create only a single subsystem of

the deep stabilization system, known as active. The passive

element is formed by the vertebrae, ligaments and

intervertebral discs. The stability of the spine is impacted

by the neural element via the afferent supply from receptors,

and subsequent control of the active element.

Imbalance of one of their elements can cause a) immediate

compensation – function normalisation, b) long-term

adaptation process of one or several subsystems – with

function normalisation, but with a change in the stabilization

system, c) disabling of one or several elements

of some system – with total imbalance, which leads to

e.g. the painful syndrome of low back pain (LBP) – in

these patients we find variations in stabilization of muscle

function in comparison with the development model of

stabilization. In patients with LBP, greater damage in

the thoracic area of Musculus erector spinae (MES) in

comparison to the lumbar area of MES was proven with

an EMG examination. Targeted interference of the deep

stabilization system in chronic vertebrogenic difficulties

is therefore the main therapeutic procedure and enables

targeted focus on the damaged area. One caveat is that

opinions on the character of these exercises differ.

The therapeutic methods can be used not only as part

of physiotherapy, for the therapy of already developed

muscular and neuromuscular imbalance, but also as prevention

in reconditioning and training of athletes, especially

in sports with significantly asymmetric degree of

load in the lumbar spine area. This fact was confirmed by

the Renkawitz’s study, on tennis players and proved the

development of neuromuscular imbalance at the L2 and

L4 level in connection with asymmetric load, exhibited

by altered electric activity of MES measured by means of

EMG examination.

The National Academy of Sports Medicine (NASM),

which was founded in 1987 in Chicago, specifies functional

training as a modern method of exercise involving

coordinated precision movement in the stages of acceleration,

deceleration and stabilization of the postural muscle

groups in all three axes of the Cartesian coordinate system13.

Schofftal (2010) found a significantly greater muscle

activity examined with electromyographic (EMG) of the

internal obliques (IOs), during a prone V-up on TRX compared

to various abdominal isometric exercises.

Since physical training can be an important method

for preventing falls e.g. in patients with neurodegenerative

disease, and given the positive effects of exercise on

healthy articular cartilage it can be protective against the

onset of osteoarthrosis.

Functional training performed on unstable surfaces

might best be utilized during after injury rehabilitation or

during in-season training to maintain core endurance levels

and reduce the incidence of injuries. Fitzgerald, Axe,

and Snyder-Mackler found that performance of wobble

board exercises improved rehabilitation outcomes in subjects

with anterior cruciate ligament (ACL) rupture.

During the exercise, we usually work with the weight

of our own body, many muscle groups are connected in

one fluid exercise movement and we check the correct

posture of body’s centre of gravity (COG), flexibility and

coordination of muscle groups, and especially the posture

and operation of body’s deep stabilization system, i.e. postural

muscles during training.

The main quantitative physical forces affecting the

human body are of three types: gravity, the strength of

muscles and the “third factor”, which is known as the

force of physiological impact and deformation forces. The

effect of these forces on a specific body element is concentrated

on a single point, the body’s centre of gravity.

The position of such centre of gravity is what absolutely

determines the stability of a body and enables us to

study the course of movement and conditions of body

posture. Change in the body posture or manifestations

of instability are, according to the law of action and reaction,

balanced by tonic correction of muscles, whereby

upon incorrect involvement of compensation muscles or

upon muscle function impairment, we must renew correct

stability of the body through exercise and thereby

retroactively effect the body’s centre of gravity.

The body’s centre of gravity has no permanent place

as it oscillates according to the movement of its parts.

The centre of gravity in basic anatomical position of rest

is in the median line at L3-L4 in women and L2-L3 in

men, 4.5-5.5 cm ventrally from facies anterior corporis

vertebrae.

If the body’s centre of gravity is the foundation of

body’s stability, such stability is then increased by posture,

muscle strength and increased mass of the body erectors.

One of the most significant ones, activated to the maximum

extent during functional training, is musculus erector

spinae (MES).

MES is the most extensive and voluminous of the deep

stabilization system muscles, the main function of which

is erecting the torso. It belongs to postural muscles that

control and impact active movements of the spine, apart

from anteflexion due to the antagonist activity of the abdominal

muscles.

As for its function, MES is responsible for maintaining

stability of the spine and as bilateral action, for erecting

the spine and backward bending of the head. As unilateral

action, it helps in bending of the spine and rotation to the

side of an acting muscle. It participates practically in all

fundamental and critical movements required for movement

of an individual.

Deep dorsal muscles belong to a group of indigenous

muscles and they can be divided according to the layers

in a dorsal-ventral direction into.

MES is in intense and constant interaction with all

layers of the dorsal muscles and impacts the function and

efficiency of the abdominal muscles and participates in

them. The system of work and stabilisation of abdominal

muscles was demonstrated by Kapanji on a model of two

circles with equal diameter and on the principle of a rotating

hyperboloid, the surface of which is sunken like

a hyperbolic curve. Maikala also describes significant

relations between movements of the spine and vascular

supply to intervertebral discs and muscles of the spine,

including MES . The intervertebral disc (IVD)

has important mechanical functions such as spine load

distribution and maintenance of flexibility. IVD degeneration

represents a major pathological process in low back

pain.

Correct function of MES plays a significant role in

proper function of the entire deep stabilization system

of the spine. It participates in spine stabilization during

static load while seated or standing and also during dynamic

load when the extremities are in motion; it allows

transfer of forces and load from the area of upper and

lower extremities, the pelvis and the upper torso.

The muscle stabilization system in the lumbar spine

area comprises the major stabilizers latissimus dorsi m.,

gluteus maximus m., erector spinae m., biceps femoris m.,

exteral and internal oblique abdominal m, rectus abdominis

m., which secure direct segmental stability together

with the pelvic floor muscles and the diaphragm.

These muscles are demonstrated in figures

which are sequences of the one 3D exercise. Figures show

anatomical muscle teamwork during phases of the movement.

CORE training

The term “CORE”, i.e. the centre, in specialised terminology

means muscles of the trunk in the area of the thoracic

and cervical spine, in the lumbar area, area of pelvis

and hips – the so called LPHC complex (lumbar-pelvichip

complex). Any fast and sudden changes in the direction

and position of the body are perceived as a change

in balance. These approximately 26 muscles stabilize and

provide control over all movements. In special athletic

training the primary target is strengthening the “centre

of the body”. In this area, all movements are initiated

and the body’s centre of gravity – COG – is located here.

Such athletic training leads to strengthening of the deep

muscle system, i.e. muscles that are not often involved in

common exercise. Core training also helps in preventing

injuries during athletic as well as everyday movement,

backaches, and it improves body posture.

Core training is used by professional fitness trainers

to render speed and strength abilities, which are reflected

in repeated accelerations, more effective. A firm trunk

should definitely not be omitted, as it plays a great role

in preventing injuries and it is also beneficial in one’s

personal life. These exercises are focused on static muscle

strengthening and compensations of muscle imbalances,

mainly in the area of trunk, where the entire body is stabilized

and remains in a balanced position for a period

of 15 s/30 s/45 s/60 s.

As a result, the deep stabilization muscles are strengthened.

In this way we also focus on strengthening phasic

muscles, which have the tendency to slacken and we

stretch postural muscles that tend to shorten.

Training Resistance Exercise (TRX) and Gymnastics Rings

The TRX system and the gymnastic rings are a unique suspension systems, which

uses movement in all three planes for exercising with the

possibility of adjusting the level of difficulty and the incorporation

of additional balancing tools. Suspension

training is characterized by one or more hands or feet

supported by a single anchor point while the opposite end

of the body is in contact with the ground. It uses your own

body-weight as resistance and takes advantage of stability

to load and unload exercises. Resistance exercises performed

in unstable body positions have been hypothesized

to increase the muscular strength and muscular endurance

of the core musculature, which may translate to more

powerful and efficient movement patterns and less risk.

The entire system has great use, apart from in cardio

and strength fitness training, mainly in smooth physiotherapy

for muscle imbalance, disorders of knee stability,

chronic “low back pain” conditions, strengthening the

deep stabilization system of the body, strengthening the

pelvic floor muscles and so on.

The results of the three-month suspension training

study of Yang on the diving athletes’ shows, that balancing

and core stability capacity were greatly improved, particularly

in the non-stable state, which means the coordination

of their internal muscle and the coordination between

muscles were greatly improved. At the same time, by

testing the front and back vertical Jump, it is noted that

the athletes’ explosive force of lower limbs significantly

improved. All the improvement in these abilities may

have a direct impact on improving their special technical

capabilities. The study showed that physical training

based mainly on the suspension method is a new way of

strength training and it is especially important for the

skill-led events such as diving .

CASE HISTORY

A boy (L.B., 16 years of age) was examined at our

paediatric obesitology outpatient department.

Subjectively: the patient complained of poor physical

fitness, shortness of breath even during moderate exercise

(longer walks over a straight terrain, walking up the stairs,

etc.). He jad excessive perspiration frequent pains in both

knee joints when idle (VAS3-4) and following physical

activity (VAS 7).

Objective findings: obesitas magna, fine pink stretch

marks on the abdomen and arms. Remaining somatic

findings were physiological.

Anthropometric parameters: Height 185 cm, weight:

104 kg, BMI: 30.4, waist 99 cm, hips 114 cm, Waist/hip

ratio: 0.86, arm circumference: 33 cm, thigh circumference

66cm, chest circumference at max. inspiration: 110

cm, chest circumference at max expiration: 105cm, (difference

between chest circumference inspiration/expiration:

5cm), chest circumference at middle position: 108 cm.

Locomotor apparatus examination: Relaxed posture

when standing, head protuberant forward, shortened

scalene muscles, shortened elevator scapulae muscle

more significantly l.dx, shoulders position in internal

rotation- shortened pectoral muscles, asymmetric position

of shoulder blades, shoulder blade elevation l.dx,

hypotonia of rhomboid muscles bilateral, hypotonia of

ambdominal muscles, hyperlordosis of the L spine (7cm)

with shortened iliopsoas muscle bilateral (Thomayer 15

cm), asymmetric position of the pelvis, shortened external

hip rotator muscles – obturator mucsle, gemelli muscles

bilateral and piriformis muscle bilateral. Shortened flexors

of lower limb bilateral (55 degrees). Hypotonic gluteal

muscles and significantly valgus in knees.

Due to joint pains of the lower limbs and the presence

of functional disorders in the locomotor apparatus, we

prepared an individual 8 week long training programme

for the boy, including 45 min of functional training twice

a week, with a combination of exercises, performed on

TRX, rings and Gravity, and walking twice a week with gradually

extended time of up to 45 min.

Once the training programme was completed, there

was a significant objective improvement in physical fitness.

The boy managed walking at a moderate pace for

45 min without feeling short of breath. He perspired less.

He manages his common daily activities without any significant

fatigue.

Anthropometric parameters:

Height: 186 cm, weight: 97 kg, BMI: 28, waist 89 cm,

hips 111 cm, Waist/hip ratio: 0.8, arm circumference: 34

cm, thigh circumference 65 cm, chest circumference at

max. inspiration: 109 cm, chest circumference at max.

expiration: 98 cm, (difference between chest circumferences

inspiration/expiration: 11cm), chest circumference

at middle position 101cm.

Locomotor apparatus examination: Following training

completion, the overall posture improved significantly,

especially the slumping of the shoulder blade l.dx (stretching

of the levator scapulae muscle), stretching of pectoral

muscles, symmetrical position of shoulders, strengthening

of the interscapular muscles. The most significant

effect was achieved according to Janda’s muscle test by

strengthening the deep stabilization system (erector spinae

miscle). Lumbar lordosis was at borderline of physiological

standard (4 cm). Stretching of the knee flexors

(75 degrees). Strengthening of the abdominal wall.

CONCLUSIONS

Functional 3D training is an effective method for

strengthening the postural muscles of the human body

increasing articular stability, strengthening the ligaments

and increasing the stability of muscle groups-especially

of the back muscles during training for improving the

lung capacity. The method of functional training is also

of considerable significance in activating the pelvic floor

muscles and the pelvic-trochanteric muscles for gynegymnastics

and incontinence prevention in the falls in the case

of patients with neurodegenerative diseases and in the

therapy of obesity in children and adults.

ABBREVIATIONS

3D, Three dimensional; COG, centre of gravity; m.,

muscle; mm., muscles; L, lumbal; MES, erector spinae

muscle; NASM, The National Academy of Sports

Medicine; TRX, Training Resistance Exercise.