Written by integrativetherapeutics on . Posted in The Body Mechanic, by Todd A. Forman, PT

Central to Japanese martial arts is the concept of Mushin or “no mind”. It is a deceptively difficult concept to grasp. When one has trained to the point where the techniques require no thought, when the patterns of motion are completely ingrained in your being, when one respond without effort, as naturally as taking one’s next breath, one has achieved mushin.

There is a bit of a paradox here: to achieve such a level of skill requires a lifetime of intentional, focused, dedicated training and practice. The goal of all of these focused efforts is to be able to perform without conscious effort. There are close parallels to this paradox in rehabilitation.

One of the many points of debate in physical therapy (PTs agree about as much as economists…) is whether corrective exercise should be isolated and precise, using a single muscle in a single plane, or “functional”, mimicking how the body actually performs in real life.

The main argument for isolation style exercise (like a biceps curl, for example) is that they force the client to use a muscle or practice a motion that they are avoiding using. Well designed isolation-style exercise make it quite difficult to “cheat” and compensate using a different muscle. Because they are so focused, they can precisely load to part in question to make it stronger and speed healing. All pretty good arguments. The problem with isolation exercises is that they are often quite artificial. We rarely use extremely isolated patterns of motion in everyday life or in athletic activities. As the results of strength training are notoriously specific to the pattern trained, there is a valid question about how much “real world” carry over there is with isolation-style exercise.

“Functional” style exercise, though, mimics the patterns the client needs to excel at to meet his or her goals . A “walking lunge” is a good example of a functional exercise. Functional exercises provide excellent carry-over to real world performance, because they closely mimic real world patterns. The problem is that these exercises are often complex, and, even under excellent expert supervision, clients can find ways to “cheat” the exercise. (This usually happens unconsciously- simply the body’s natural drive to perform a difficult task while expending the least amount of energy).

So, which is best? I believe both are critical. Clients end up in physical therapy because they have developed some movement dysfunction- a way of moving that is inconsistent with normal physiological operation. Dysfunctions are (usually) unconscious, and present when the client tries to function. Isolation exercises are critical to breaking down this dysfunctional pattern and “forcing” dysfunctional muscles to turn on. The instant that occurs, “functional” exercises are critical to integrate the problem muscle back into normal operation with its partners. When that occurs, the body begins to operate normally, without thought. Mushin.

A whole lot of work to get to a point where things are easy. Sounds like the definition of PT.

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