What’s the difference between facilitation and stabilization?
This is a very common question related to rehab, physical therapy, and many of the exercises that we utilize here in the clinic to comprehensively treat our patients. Facilitation is basically turning on a switch in the brain to reactivate the muscle. Stabilization is exercising the muscle once it is activated in order to make it stronger.
After evaluating a patient’s issue and determining that it is due to weakness in a specific area, we will focus on facilitation. Basically, we are training the brain to relearn how to fire the muscle properly.
When I tell a patient that our focus will initially be on facilitation, I am often presented with a deer in headlights look, as if they are wondering what exactly that means. The best way to explain it is that our brain forgets how to fire the muscles over time as we stop using them. We have talked about the gluteal muscles in past posts. Let’s look at an example of a patient with weakness in the large muscle in the buttock.
In this instance, I explained to the patient that his issue was gluteal weakness—he thanked me and said that he was off to the gym to work with his personal trainer. This is exactly what you do not want to do. If a certain muscle is not being activated properly during exercise, you will compensate by recruiting other surrounding muscles (such as the hamstring). Instead, we need to get the brain re-accustomed to firing the muscle properly. Sometimes, this will only take a few minutes to correct. Other times, it may take three to four visits.
While the condition may have occurred over a long period of time, the nature of treatment in the form of motor learning drills and exercises allow for immediate progress to take place. one of the most basic exercises that we perform in the clinic is actually called ‘deer in headlights’ because of the look on the patient’s face. The exercise involves lying the patient on their back and having them activate their right/left gluteal muscles independently of each other.
We also use bands and other equipment to isolate the muscle during these exercises. Once the brain becomes re-accustomed to firing the muscle, progress is relatively quick.
After the muscle is firing properly, we can develop more difficult exercise progressions to stabilize the muscle. These are the types of exercises that involve going to the gym and working with a trainer to improve strength and stability. The common drills performed will consist of squats, lunges, etc. The exercise progression facilitates increased strength—once patients master the easier exercises, they will move on to increasingly challenging variations.
For example, the exercise can begin flat on the ground, then in the quad position, followed by kneeling, and then ultimately standing upright. Instead of starting the exercise standing on the feet, which is most challenging, patients should begin on their bellies. Once the patient is able to demonstrate proficiency, we can work our way up with slow but steady progress.
Additionally, the patient is given some exercises to do on their own. I am a large proponent of self-management and being accountable for your own care. Many of the patients that we see are very athletic and highly active. They want to know how they can take proactive steps toward recovery.
Many other offices miss out on those options because they are so focused on treating the patient in the clinic. While in-clinic treatment is beneficial, we think that proper attention should also be paid to patient education.
To learn more about how we can use muscle facilitation and stabilization to provide you with relief, contact us today or give us a call at (918) 743-3737.