Whiplash Trauma and "New School" Isometrics
By Jeffrey Tucker, DC, DACRB
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
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):
"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
Supine Gut Contractions
Sustained Wall Sit
Sustained Plank (Isolates pecs and core)
Upper-Body Arm Hang (Advanced)
Anterior Abdominal Wall
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:
Dr. Jeffrey Tucker is a rehabilitation specialist, lecturer and healer best known for his holistic approach in supporting the body's inherent healing mechanisms and integrating the art and science of chiropractic, exercise, nutrition and attitudinal health. He practices in West Los Angeles and lectures for the National Academy of Sports Medicine and the American Chiropractic Rehabilitation Board. For more information, please visit www.drjeffreytucker.com.